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Association Between Indoor Air Pollution and Cognitive Impairment Among Adults in Rural Puducherry, South India Yuvaraj Krishnamoorthy, Gokul Sarveswaran, K

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Association Between Indoor Air Pollution and Cognitive Impairment Among Adults in Rural Puducherry, South India Yuvaraj Krishnamoorthy, Gokul Sarveswaran, K Published online: 2019-09-02 Original Article Association between Indoor Air Pollution and Cognitive Impairment among Adults in Rural Puducherry, South India Yuvaraj Krishnamoorthy, Gokul Sarveswaran, K. Sivaranjini, Manikandanesan Sakthivel, Marie Gilbert Majella, S. Ganesh Kumar Department of Preventive and Background: Recent evidences showed that outdoor air pollution had significant Social Medicine, Jawaharlal influence on cognitive functioning of adults. However, little is known regarding the Institute of Postgraduate Medical Education and association of indoor air pollution with cognitive dysfunction. Hence, the current study was done to assess the association between indoor air pollution and cognitive Research, Puducherry, India Abstract impairment among adults in rural Puducherry. Methodology: A community‑based cross‑sectional study was done among 295 adults residing in rural field practice area of tertiary care institute in Puducherry during February and March 2018. Information regarding sociodemographic profile and household was collected using pretested semi‑structured questionnaire. Mini‑Mental State Examination was done to assess cognitive function. We calculated adjusted prevalence ratios (aPR) to identify the factors associated with cognitive impairment. Results: Among 295 participants, 173 (58.6) were in 30–59 years; 154 (52.2%) were female; and 59 (20.0%) were exposed to indoor air pollution. Prevalence of cognitive impairment in the general population was 11.9% (95% confidence interval [CI]: 8.7–16.1). Prevalence of cognitive impairment among those who were exposed to indoor air pollution was 27.1% (95% CI: 17.4–39.6). Individuals exposed to indoor air pollution (aPR = 2.18, P = 0.003) were found to have two times more chance of having cognitive impairment. Conclusion: About one‑fourth of the participants were exposed to indoor air pollution, out of which more than one‑fourth was found to have cognitive impairment which is twice that of the general population. Hence, prevention of exposure to indoor air pollution needs to be done through increased availability to cleaner fuels for household usage. Keywords: Cognition, dementia, indoor air pollution Introduction burden of impairment and determining risk factors, he World Health Organization (WHO) has especially among low‑ and middle‑income countries [2] T reported that dementia will become an epidemic in like India. Understanding the environmental and the near future because of growing elderly population, social factors responsible for cognitive impairment is especially in developing countries.[1] This demands an important given the increasing elderly population keep early action to identify the persons at risk of dementia on increasing globally. and prevent the disease from occurring or treat the Address for correspondence: Dr. Marie Gilbert Majella, affected persons accordingly. Cognitive impairment is Department of Preventive and Social Medicine, Jawaharlal the transitional phase between normal aging process and Institute of Postgraduate Medical Education and Research, dementia. Hence, screening for cognitive impairment Puducherry, India. E‑mail: [email protected] will help in recognizing the persons at risk of dementia and take corrective measures immediately. However, This is an open access journal, and articles are distributed under the terms of the there is limited evidence available regarding the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical Access this article online terms. Quick Response Code: Website: For reprints contact: [email protected] www.ruralneuropractice.com How to cite this article: Krishnamoorthy Y, Sarveswaran G, Sivaranjini K, DOI: Sakthivel M, Majella MG, Kumar SG. Association between indoor air 10.4103/jnrp.jnrp_123_18 pollution and cognitive impairment among adults in rural Puducherry, South India. J Neurosci Rural Pract 2018;9:529-34. © 2018 Journal of Neurosciences in Rural Practice | Published by Wolters Kluwer - Medknow 529 Krishnamoorthy, et al.: Association of indoor pollution with cognition One of the environmental factors which is less studied institute which caters to a population of around 10000 but found to have significant influence on cognitive in the villages of Ramanathapuram, Thondamanatham, function is exposure to air pollutants. Studies around the Pillaiyarkuppam, and Thuthipet. The study was world have reported that the exposure to high amounts conducted during the months of February and March of air pollution can negatively impact the cognitive 2018. Individuals belonging to age group of 30 years functioning of the adults.[3‑8] Several mechanisms and above were included in the study as it is difficult have been proposed for the possible explanation on to detect the impact of air pollution and cognitive link between air pollution and cognitive dysfunction. dysfunction among younger adults. Neurological mechanisms like inflammation of The sample size was calculated by OpenEpi v 3.01 brain in response to particulate matter exposure and (v 3.01 updated on 2013, USA) using anticipated cardiovascular mechanisms are also proposed. However, proportion of cognitive impairment 25% among adults clear mechanisms have not been established yet.[9‑12] living in households with indoor air pollution; confidence Previous studies on link between the cognitive decline interval (CI) of 95%, and absolute precision of 5%, the and air pollution has reported that exposure to pollutants sample size was calculated to be 289. However, we most commonly affects specific domains such as verbal covered 295 individuals. learning, attention, logical and short‑term memory, and executive functioning. However, severe effects were Primary sampling unit was households. Numbers of reported with long‑term exposure to air pollutants.[3,6,13] households needed from each of the four villages were calculated using proportionate sampling after which; However, most of the studies were focussed on outdoor air systematic random sampling was employed to select the pollutants from traffic or industries such as sulfur‑dioxide, households from the villages. Individual belonging to the nitrogen oxide, and carbon monoxide, particulate matter age group of 30 years and above were the study units. The and its relationship with cognitive impairment. Less study participants were chosen from eligible individuals is known regarding the association between indoor air available in the selected households during the house pollution and cognitive dysfunction. Almost all the visit. KISH technique was applied to select one eligible studies on outdoor air pollution and cognitive dysfunction individual from the households when there were multiple have reported a significant association.[3‑8] Hence, for the eligible persons in the household. Households which were current study, we have hypothesized that there could be locked even after three visits were excluded from the study. an association between indoor air pollution and cognitive dysfunction. The WHO has reported that indoor air Four training doctors posted in RHC were chosen as pollution poses serious health risk for almost 3 billion data collectors. They were sensitized regarding the people who cook and use biomass fuels and coals for objectives of the study, confidentiality of information, household purpose.[14] Globally, indoor air pollution participant’s right, and informed consent, and were contributed to about 4.3 million deaths almost all in also trained to administer the questionnaire to the low‑ and middle‑income countries. In India, it is found individuals. Postgraduate students posted in the same to be the second leading cause of premature mortality.[14] RHC supervised the data collection procedure by According to the National Family Health Survey‑IV, about reviewing all questionnaires at the end of each day to 56.2% of households in India do not have access to clean ensure completion of data collection forms as well as fuel, contributing to indoor air pollution. Hence, more addressed any issue faced by the data collectors. focus needs to be given on indoor air pollution and its The purpose of the study and procedure involved association with cognitive impairment, especially among in the study was explained to the individuals before rural areas, who rely on biomass fuels in their households. administration of the questionnaire. Individuals were Despite the higher burden of indoor air pollution in India, also assured regarding confidentiality of the information very little research has examined the influence of indoor and data collection was started after obtaining informed air pollution on cognitive impairment in India. Hence, to consent. The interview consisted of three sections: assess this impact, the current study was done to find the the first section consisted of sociodemographic association between indoor air pollution and cognitive characteristics; the second section comprised household impairment among the adults residing in the selected details such as type of house, type of fuel used for villages of rural Puducherry, South India. cooking, place of cooking, and type of fuel used for cooking. Use of fuel for cooking was seen by direct Methodology observation; the third section consisted of Mini‑Mental A community‑based cross‑sectional study was carried State Examination (MMSE) to determine the mild out
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