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. 2025 Jun 28:39:100624.
doi: 10.1016/j.lansea.2025.100624. eCollection 2025 Aug.

The cognitive toll of household air pollution: cross-sectional associations between polluting cooking fuel use, cognitive functions and brain MRI in a rural aging population from Karnataka, India

Sumedha Mitra  1 , Manogna Sagiraju  1 , Hitesh Pradhan  1 , David Yao  2 , Jayant M Pinto  3 , Jonas S Sundarakumar  1 ; CBR-SANSCOG Study Team
Affiliations

The cognitive toll of household air pollution: cross-sectional associations between polluting cooking fuel use, cognitive functions and brain MRI in a rural aging population from Karnataka, India

Sumedha Mitra et al. Lancet Reg Health Southeast Asia. .

Abstract

Background: Household air pollution (HAP) from polluting cooking fuels, a rampant issue in rural India, is suspected to be a significant modifiable risk factor for cognitive impairment; however, evidence supported by neuroimaging in this population, is lacking.

Methods: Baseline cross-sectional data (n = 4145) of participants aged ≥45 years from the ongoing Centre for Brain Research-Srinivaspura Aging, Neuro Senescence, and COGnition (CBR-SANSCOG) study in a rural South Indian aging population, was utilised. HAP exposure was proxied via polluting cooking fuel or technology use (only clean vs. at least one polluting vs. only polluting cooking technology use). Global and domain-specific cognitive functioning was assessed using computerised culturally adapted test batteries. A subset (n = 994) underwent brain MRI (3T) to estimate regional brain volumes and white matter hyperintensities (WMHs) burden. Fully adjusted linear regression models were used to test the associations between HAP exposure, cognition, and brain MRI parameters.

Findings: Only polluting cooking technology users had significantly lower scores in global cognition (βstd. = -0.28 [-0.44, -0.11], padj [FDR corrected p-value] = 0.002), visuospatial ability (βstd. = -0.28 [-0.48, -0.08], padj. = 0.013), and executive functions (βstd. = -0.25 [-0.44, -0.07], padj. = 0.019), whereas at least one polluting cooking technology users had lower scores in global cognition only (βstd. = -0.10 [-0.15, -0.04], padj. <0.001), compared to the clean cooking technology users. Upon sex-stratification, only female polluting cooking technology users had lower global cognitive scores (βstd. = -0.11 [-0.20, -0.03], padj. = 0.018) and lower hippocampus volumes (βstd. = -0.18 [-0.35, -0.01], p = 0.030).

Interpretation: Polluting cooking technology users may be at a higher risk for cognitive impairment. Rural females, who tend to be more exposed than males, could have greater vulnerability to HAP's adverse effects on the brain. Policies promoting clean cooking fuel/technology adoption are imperative.

Funding: CBR-SANSCOG study is funded by the Centre for Brain Research, India.

Keywords: Cognition; Cooking fuel; Household air pollution; India; MRI.

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Conflict of interest statement

Sumedha Mitra, Manogna Sagiraju, Hitesh Pradhan, and David Yao declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Jayant M. Pinto has received payments for advisory roles from Regeneron, Sanofi, and Optinose, focused on nasal polyps, and has served on the Board of the Hyde Park Institute, a non-profit focused on character in education. These engagements are unrelated to the submitted work. He has received a grant from the National Institute on Aging (AG067497), paid to his institution. He declares no personal competing financial interests. Jonas S. Sundarakumar reports funding support from the Centre for Brain Research (CBR) for the present work from the CBR-SANSCOG (Srinivaspura Aging, NeuroSenescence, and COGnition) study, in which he is the Principal Investigator (PI). Additionally, he has received institutional grants from SoftwareAG (India) Pvt. Ltd. as PI for the SoftwareAG Autonomic Nervous System Lab (SANSLab), from the Pratiksha Trust as Co-PI for the Extra-Mural Support for Transformational Aging Brain Research (EMSTAR) grant, and from the Tata Trusts as Co-PI for the Tata Longitudinal Study of Aging (TLSA)-Phase II project. He declares no personal competing financial interests.

Figures

Supplementary Figure S1
Supplementary Figure S1
Flow diagram depicting selection of participants included in this study.
Supplementary Figure S2
Supplementary Figure S2
VBM results showing (uncorrected p-value) Puncorr < 0.001 significant clusters.
See this image and copyright information in PMC

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