The Association Between Indoor Air Pollutants and Brain Structure Indicators Using eTIV-Adjusted and Unadjusted Models: A Study in Seoul and Incheon

As older adults spend increasing amounts of time indoors, concerns are rising about the neurological effects of indoor air pollution. This study examined associations between indoor air pollutants and structural brain changes in community-dwelling older adults in Seoul and Incheon, South Korea. A purposive sample of 23 individuals aged ≥65 years was recruited. Internet of Things (IoT)-based devices were installed in participants' homes to continuously monitor indoor concentrations of PM₁₀, PM_2.5, and CO₂ for over two months. All participants underwent 3T brain magnetic resonance imaging (MRI), and brain structure metrics were analyzed using multiple linear regression models with and without adjustment for estimated total intracranial volume (eTIV). Hierarchical clustering was also performed based on exposure and neuroanatomical characteristics. Brain MRI indicators included cortical surface area, cortical thickness in six regions, and volumes of seven subcortical structures including the hippocampus and amygdala. Higher CO₂ concentrations were significantly associated with lower hippocampal volumes in both hemispheres (left: -2.83, -0.88, -1.02 mm³; right: -3.29, -0.86, -0.99 mm³; <i>p</i> ≤ 0.05). Elevated PM_2.5 levels were associated with reduced bilateral amygdala volume (-283.24 mm³ left; -292.37 mm³ right) and right hippocampal volume (-544.55 mm³; <i>p</i> ≤ 0.05). Cluster analysis showed that, before eTIV adjustment, Group C exhibited the lowest subcortical volumes. After adjustment, Group A showed the smallest cortical surface area, and Group D had the lowest subcortical volumes. These findings suggest that indoor air pollutants, including PM₁₀, PM_2.5, and CO₂, may be associated with structural brain alterations in older adults, supporting the need for age-specific indoor air quality standards and residential monitoring systems.