摘要Objective The results of limited studies on the relationship between environmental pollution and dementia have been contradictory.We analyzed the combined effects of PM2.5 and smoking on the prevalence of dementia and cognitive impairment in an elderly community-dwelling Chinese population.Methods We assessed 24,117 individuals along with the annual average PM2.5 concentrations from 2012 to 2016.Dementia was confirmed in the baseline survey at a qualified clinical facility,and newly suspected dementia was assessed in 2017,after excluding cases of suspected dementia in 2015.National census data were used to weight the sample data to reflect the entire population in China,with multiple logistic regression performed to analyze the combined effects of PM2.5 and smoking frequency on dementia and cognitive impairment.Results Individuals exposed to the highest PM2.5 concentration and smoked daily were at higher risk of dementia than those in the lowest PM2.5 concentration group(OR,1.603;95％CI[1.626-1.635].P＜0.0001)and in the nonsmoking group(OR,1.248;95％CI[1.244-1.252];P＜0.0001).Moderate PM2.5 exposure and occasional smoking together increased the short-term risk of cognitive impairment.High-level PM2.5 exposure and smoking were associated with an increased risk of dementia,so more efforts are needed to reduce this risk through environmental protection and antismoking campaigns.Conclusion High-level PM2.5 exposure and smoking were associated with an increased risk of dementia.Lowering the ambient PM2.5,and smoking cessation are recommended to promote health.