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The role of per‐ and polyfluoroalkyl substances in cognitive impairment and dementia
Hannah E. Gardener, Bonnie E. Levin, Kurunthachalam Kannan, Tatjana Rundek. Alzheimer s & Dementia, 2025-05-01
Topic: Risk, prevention and care in population studies
Per- and polyfluoroalkyl substances (PFAS) are ubiquitous persistent organic pollutants. The neurotoxic and cardiometabolic effects of PFAS are well documented, leading to the hypothesis that exposure increases dementia risk. However, empirical data on PFAS in relation to cognitive impairment and dementia are weak, limited, and inconsistent. This report reviews the literature on PFAS and cognitive impairment and provides a rationale and overview of the PFAS VascCog Longitudinal Study, a new study using the population-based Northern Manhattan Study cohort, to prospectively examine serum concentrations of 13 PFAS in relation to lipids, carotid atherosclerosis, cognitive impairment, and dementia. We hypothesize that PFAS deleteriously impact cognition through a pathway involving hyperlipidemia and atherosclerosis. Rigorous examination of PFAS exposure in relation to dementia is needed to inform public health policies on PFAS-containing products, support regulations to reduce community exposure, and provide new avenues to protect cognitive health and impact dementia at the individual and community levels. HIGHLIGHTS: PFAS exposure increases cardiometabolic risk factors and neurotoxicity. Data on PFAS in relation to cognitive health is limited, weak, and controversial. We hypothesize that PFAS exposure increases dementia risk. We hypothesize a mechanistic pathway involving hyperlipidemia and atherosclerosis. Rigorous study of PFAS exposure and dementia risk can inform public health policy.
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
APA 7th
Gardener, H. E., Levin, B. E., Kannan, K., & Rundek, T. (2025). The role of per‐ and polyfluoroalkyl substances in cognitive impairment and dementia. Alzheimer s & Dementia. https://doi.org/10.1002/alz.70226
Vancouver
Gardener HE, Levin BE, Kannan K, Rundek T. The role of per‐ and polyfluoroalkyl substances in cognitive impairment and dementia. Alzheimer s & Dementia. 2025. doi:10.1002/alz.70226. PMID: 40346447.
BibTeX
@article{gardener2025-40346447,
author = {Gardener, Hannah E. and Levin, Bonnie E. and Kannan, Kurunthachalam and Rundek, Tatjana},
title = {{The role of per‐ and polyfluoroalkyl substances in cognitive impairment and dementia}},
journal = {Alzheimer s \& Dementia},
year = {2025},
doi = {10.1002/alz.70226},
pmid = {40346447},
url = {https://doi.org/10.1002/alz.70226}
}
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Key findings
- HIGHLIGHTS: PFAS exposure increases cardiometabolic risk factors and neurotoxicity.
- Data on PFAS in relation to cognitive health is limited, weak, and controversial.
- We hypothesize that PFAS exposure increases dementia risk.
- We hypothesize a mechanistic pathway involving hyperlipidemia and atherosclerosis.
- Rigorous study of PFAS exposure and dementia risk can inform public health policy.
Why it matters
This report reviews the limited and inconsistent data on PFAS exposure and cognitive impairment and describes a planned longitudinal study to examine the relationship. It presents a hypothesis that PFAS may increase dementia risk through hyperlipidemia and atherosclerosis, but no results on treating, curing or preventing dementia are reported.
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Study details
- Study designlongitudinal study
- Evidence strengthModerate
How this study scored 50/100
Published in a peer-reviewed journal, and it is a longitudinal study following the same people over time. Scored zero for sample size, effect reported, studied in people and randomized / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Alzheimer s & Dementia) |
| Journal's citation record | 2 / 4 | Alzheimer s & Dementia: journal h-index 228 (OpenAlex, 2026-10-29) |
| 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 | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 4 / 5 | 2025 — within 3 year(s) of the newest study here |
| Sample size | 0 / 4 | Participant count not stated — scores zero (not stated in the record — scored 0) |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 0 / 3 | Not stated whether this was studied in people — scores zero (not stated in the record — scored 0) |
| Randomized / blinded | 0 / 2 | No randomization or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 2 / 7 | Cited 14 times (OpenAlex, 2026-10-10) |
| Citations per year | 2 / 5 | 4.7 citations a year over 3 year(s) since 2025 |
| Impact for its field and year | 3 / 6 | Cited 4.2× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 0 / 6 | No other study in this library cites it |
| Still being cited | 1 / 4 | Cited 14 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 3 / 4 | Last-listed author Tatjana Rundek: h-index 91 (OpenAlex, whole career) |
| Institution's track record | 1 / 3 | University of Miami: institution h-index 998 (OpenAlex) |
| Multicenter collaboration | 1 / 3 | OpenAlex lists 3 institution(s) in 1 country |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 40346447) |
| Free to read | 2 / 2 | Free to read |
| Total | 50 / 100 | — |
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