Environmental Research · Jan 12, 2026

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

By Angley M, Zhang Y, Nigra AE et al.

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: iAs exposure may be associated with cognitive impairment. Our findings highlight the importance of considering multiple measures of iAs exposure.

doi.org/10.1016/j.envres.2026.123768PubMed 41534586Populations