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Cadmium Exposure and Incidence of All-Cause Dementia and Alzheimer’s Disease in US Adults
Walker E, Rodríguez-Carmona Y, Wang X, Mukherjee B, Arboleda-Merino L, Hao W, Dodge H, Albin RL et al.. medRxiv, 2026-01-19
Topic: Air pollution and environmental exposures
Introduction While longitudinal studies aid in understanding and preventing long-latency disorders like dementia, evidence for cadmium’s role in these conditions is still limited. We evaluated associations between cadmium exposure and incident Alzheimer’s disease (AD) and all-cause dementia in US adults. Methods National Health and Nutrition Examination Survey (NHANES) III (1988-1994) and continuous NHANES (1999-2016) data were linked with Medicare claims to identify incident AD and dementia cases through 2018. Urinary and/or blood cadmium were measured during NHANES. We used covariate-adjusted, survey-weighted Cox proportional hazard models to evaluate the associations between cadmium exposure biomarkers and AD/dementia over follow-up. Results In NHANES III (N=6,122), baseline age was 53.9±0.5 years and urinary cadmium was 0.8±0.02 ug/L. Over a follow-up of 20.4±0.3 years, 743 AD and 1,508 all-cause dementia cases occurred. Urinary cadmium was not associated with AD (HR: 1.01, 95% CI: 0.9-1.0) nor all-cause dementia incidence (HR: 1.02, 95% CI: 0.96-1.08). In continuous NHANES (urinary cadmium N=2,833; blood cadmium N=8,038), baseline age was 64.1±0.2 years, urinary cadmium was 0.5±0.03 ug/L, and blood cadmium was 0.6±0.01 ug/L. Over 9.5±0.1 years, 587 AD and 1,260 all-cause dementia cases occurred. Urinary and blood cadmium showed no associations with AD (HR [95% CI]: 1.09 [0.9, 1.4]; 1.06 [0.9, 1.2]) nor all-cause dementia (HR [95% CI]: 1.07 [0.9, 1.3]; 1.06 [0.95, 1.2]). Conclusion No association between cadmium exposure and dementia incidence was observed. Our null findings should be interpreted while considering potential methodological issues and verified by subsequent studies.
Key findings
- Results In NHANES III (N=6,122), baseline age was 53.9±0.5 years and urinary cadmium was 0.8±0.02 ug/L.
- Urinary cadmium was not associated with AD (HR: 1.01, 95% CI: 0.9-1.0) nor all-cause dementia incidence (HR: 1.02, 95% CI: 0.96-1.08).
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Study details
- Study designlongitudinal study
- Participants6,122
- Effect sizeHR: 1.01; HR: 1.02
- Evidence strengthModerate
How this study scored 16/100
Preprint — not yet peer-reviewed. It scored 50 on the same rubric, but non-peer-reviewed sources are capped at 16, so it shows as 16. Scored zero for randomised / blinded because the record does not state it. We have no data on times cited, citations per year, impact for its field and year, cited by studies here, still being cited, senior author's track record, institution's track record and multi-centre collaboration, so those were left out: it earned 31 of the 62 points we could judge it on, which is 50 out of 100.
| Component | Points | Why |
|---|---|---|
| Journal tier | 2 / 10 | Tier 4 — not a peer-reviewed journal (medRxiv) |
| Journal's citation record | 0 / 4 | Not a journal article, so the journal's record does not count |
| Study design | 7 / 12 | A longitudinal study following the same people over time |
| Strength of evidence | 3 / 5 | Rated “moderate” in our summary |
| Peer-review validation | 4 / 10 | Preprint — not yet peer-reviewed. Hosted on a preprint server. |
| How recent | 5 / 5 | 2026 — within 1 year(s) of the newest study here |
| Sample size | 3 / 4 | 6,122 participants |
| Effect reported | 3 / 3 | Effect reported with a statistic (interval, p-value, ratio or similar) |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | — / 7 | No citation count (not found in OpenAlex) — left out of this score |
| Citations per year | — / 5 | No citation count or no year — left out of this score |
| Impact for its field and year | — / 6 | No field-weighted citation impact (OpenAlex has none yet) — left out of this score |
| Cited by studies here | — / 6 | Not yet checked against this library's citation graph — left out of this score |
| Still being cited | — / 4 | No yearly citation counts — left out of this score |
| Senior author's track record | — / 4 | Senior author's record not available — left out of this score |
| Institution's track record | — / 3 | No institution listed in OpenAlex — left out of this score |
| Multi-centre collaboration | — / 3 | Institutions not listed — left out of this score |
| Indexed in PubMed | 1 / 2 | Not in PubMed, but has a DOI |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Points | 31 / 62 | Scored on 12 of 20 parts. We have no data for the rest, so they are left out: 31 of the 62 points we could judge it on is 50 out of 100. |
| Total | 50 / 100 | Capped to 16 because this is not a peer-reviewed article. |
What each of these 20 components measures, and what this score is not →
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Cite this study APA, Vancouver, BibTeX · download .bib or .ris
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APA 7th
Walker, E., Rodríguez-Carmona, Y., Wang, X., Mukherjee, B., Arboleda-Merino, L., Hao, W., et al. (2026). Cadmium Exposure and Incidence of All-Cause Dementia and Alzheimer’s Disease in US Adults. medRxiv. https://doi.org/10.64898/2026.01.16.26344271
Vancouver
Walker E, Rodríguez-Carmona Y, Wang X, Mukherjee B, Arboleda-Merino L, Hao W, et al. Cadmium Exposure and Incidence of All-Cause Dementia and Alzheimer’s Disease in US Adults. medRxiv. 2026. doi:10.64898/2026.01.16.26344271.
BibTeX
@article{walker2026-3d2e2265,
author = {Walker, E. and Rodríguez-Carmona, Y. and Wang, X. and Mukherjee, B. and Arboleda-Merino, L. and Hao, W. and Dodge, H. and Albin, R. L. and others},
title = {{Cadmium Exposure and Incidence of All-Cause Dementia and Alzheimer’s Disease in US Adults}},
journal = {medRxiv},
year = {2026},
doi = {10.64898/2026.01.16.26344271},
url = {https://doi.org/10.64898/2026.01.16.26344271}
}
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