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We investigated prospective associations between lead exposure and incident Alzheimer's disease (AD) and all\u2010cause dementia in nationally\u2010representative US populations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>\n                      Baseline measured blood lead and estimated patella and tibia lead from the National Health and Nutrition Examination Survey (NHANES)\u2010III (1988\u20101994, blood\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a06,217, bone\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a05,865) and continuous NHANES (1999\u20102016, blood n\u00a0=\u00a08,038, bone n\u00a0=\u00a04,824) were linked to Medicare and the National Death Index for incident AD and all\u2010cause dementia, with up to 30 years of follow\u2010up. Survey\u2010weighted Cox regressions estimated hazard ratios (HRs) and 95% confidence intervals (CIs).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>In continuous NHANES, estimated patella lead was associated with AD (HR\u00a0=\u00a02.96, 95% CI:1.37\u20106.39) and all\u2010cause dementia (HR\u00a0=\u00a02.15, 95% CI:1.33\u20103.46), comparing quartile\u20104\u00a0vs. quartile\u20101. We observed weaker associations in NHANES\u2010III. Blood lead showed no association.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>DISCUSSION<\/jats:title>\n                    <jats:p>These findings suggest cumulative lead as a potential dementia risk factor.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Highlights<\/jats:title>\n                    <jats:p>\n                      <jats:list list-type=\"bullet\">\n                        <jats:list-item>\n                          <jats:p>We examined Medicare\u2010linked National Health and Nutrition Examination Survey (NHANES) on lead exposure and incident Alzheimer's disease (AD) and dementia.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>Lead exposure was assessed by blood lead and algorithm\u2010estimated bone lead levels.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>High estimated patella lead was linked to increased all\u2010cause dementia incidence.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>\n                            Dementia cases drop by 18% if all patella lead levels reduce to the 25\n                            <jats:sup>th<\/jats:sup>\n                            percentile.\n                          <\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>Cumulative lead exposure may raise dementia risk, highlighting its potential impact.<\/jats:p>\n                        <\/jats:list-item>\n                      <\/jats:list>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/alz.71075","type":"journal-article","created":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T12:00:44Z","timestamp":1770897644000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Exposure to lead and incidence of Alzheimer's disease and all\u2010cause dementia in the United States"],"prefix":"10.1002","volume":"22","author":[{"given":"Xin","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Epidemiology School of Public Health University of Michigan  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelly M.","family":"Bakulski","sequence":"additional","affiliation":[{"name":"Department of Epidemiology School of Public Health University of Michigan  Ann Arbor Michigan USA"},{"name":"Michigan Alzheimer Disease Center University of Michigan  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erika","family":"Walker","sequence":"additional","affiliation":[{"name":"Department of Epidemiology School of Public Health University of Michigan  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bhramar","family":"Mukherjee","sequence":"additional","affiliation":[{"name":"Department of Biostatistics Yale School of Public Health Yale University  New Haven Connecticut USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroko","family":"Dodge","sequence":"additional","affiliation":[{"name":"Massachusetts General Hospital Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roger L.","family":"Albin","sequence":"additional","affiliation":[{"name":"Michigan Alzheimer Disease Center University of Michigan  Ann Arbor Michigan USA"},{"name":"Department of Neurology University of Michigan  Ann Arbor Michigan USA"},{"name":"Neurology Service &amp; 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