Fall Risk, Sleep Behavior, and Sleep-Related Movement Disorders in Young Urbanites Exposed to Air Pollution

Lilian Calderón-Garcidueñas, Randy Kulesza, Glen P. Greenough, Edgar García-Rojas, Paula Revueltas-Ficachi, Adriana Rico-Villanueva, Jorge Orlando Flores-Vázquez, Rafael Brito-Aguilar, Silvia Ramírez-Sánchez, Nora Vacaseydel-Aceves, Ana Paulina Cortes-Flores, Yusra Mansour, Ricardo Torres-Jardón, Rodolfo Villarreal-Ríos, Emel Koseoglu, Elijah W. Stommel, Partha S. Mukherjee

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


BACKGROUND: Quadruple aberrant hyperphosphorylated tau, amyloid-β, α-synuclein, and TDP-43 pathology had been documented in 202/203 forensic autopsies in Metropolitan Mexico City ≤40-year-olds with high exposures to ultrafine particulate matter and engineered nanoparticles. Cognition deficits, gait, equilibrium abnormalities, and MRI frontal, temporal, caudate, and cerebellar atrophy are documented in young adults.

OBJECTIVE: This study aimed to identify an association between falls, probable Rapid Eye Movement Sleep Behavior Disorder (pRBD), restless leg syndrome (RLS), and insomnia in 2,466 Mexican, college-educated volunteers (32.5±12.4 years).

METHODS: The anonymous, online study applied the pRBD and RLS Single-Questions and self-reported night-time sleep duration, excessive daytime sleepiness, insomnia, and falls.

RESULTS: Fall risk was strongly associated with pRBD and RLS. Subjects who fell at least once in the last year have an OR = 1.8137 [1.5352, 2.1426] of answering yes to pRBD and/or RLS questions, documented in 29% and 24% of volunteers, respectively. Subjects fell mostly outdoors (12:01 pm to 6:00 pm), 43% complained of early wake up hours, and 35% complained of sleep onset insomnia (EOI). EOI individuals have an OR of 2.5971 [2.1408, 3.1506] of answering yes to the RLS question.

CONCLUSION: There is a robust association between falls, pRBD, and RLS, strongly suggesting misfolded proteinopathies involving critical brainstem arousal and motor hubs might play a crucial role. Nanoparticles are likely a significant risk for falls, sleep disorders, insomnia, and neurodegenerative lethal diseases, thus characterizing air particulate pollutants' chemical composition, emission sources, and cumulative exposure concentrations are strongly recommended.

Original languageEnglish
Pages (from-to)847-862
Number of pages16
JournalJournal of Alzheimer's Disease
Issue number2
StatePublished - 2023


  • Air pollution
  • Alzheimer's disease
  • Mexico City young urbanites
  • PM
  • TDP-43 proteinopathies
  • falls
  • nanoparticles
  • possible REM sleep behavior disorder
  • quadruple proteinopathies
  • restless leg syndrome
  • Humans
  • Sleep Initiation and Maintenance Disorders/epidemiology
  • Movement Disorders
  • Sleep Wake Disorders
  • Air Pollution/adverse effects
  • Young Adult
  • Sleep
  • Air Pollutants
  • Adult
  • PM2.5


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