Drinking water arsenic, urinary arsenic biomarkers, and cognitive impairment in the REGARDS study

There are several pathways by which inorganic arsenic (iAs) exposure can affect cognition among adults. Few epidemiologic studies evaluate iAs in water and inter-individual differences in urinary arsenic toxicokinetics. We aimed to estimate the association between individual-level urinary arsenic biomarkers, county-level iAs in drinking water, and cognitive impairment in a cohort of Black and White Americans.

We evaluated the association between county-level iAs in water and urinary iAs metabolites with incident cognitive impairment in REasons for Geographic and Racial Differences in Stroke (REGARDS). Participants were linked to county-level concentrations of arsenic in public water (n = 15,516) and county-level probabilities of private well arsenic exceeding 10 μg/L (n = 20,448). In addition, urinary concentrations of iAs, monomethylarsonic acid (MMA) and dimethylarsinic acid (DMA) were measured in a subset of participants (n = 1,013). Cognitive impairment was determined by the Six Item Screener (SIS) and the Enhanced Cognitive Battery (ECB). We used multivariable logistic regression to estimate odds ratios.

Approximately 9 % of participants in REGARDS developed incident cognitive impairment on the SIS over 10 years of follow-up. County-level public water iAs concentrations and private well iAs probabilities were not associated with increased odds of cognitive impairment. Higher concentrations of MMA (OR: 1.74 [95 % CI: 1.22, 2.49]) and iAs (OR: 1.58 [95 % CI: 1.12, 2.22]) in urine were associated with greater odds of cognitive impairment on the SIS. Results for the ECB were similar.

iAs exposure may be associated with cognitive impairment. Our findings highlight the importance of considering multiple measures of iAs exposure.