The firestorm within: A narrative review of extreme heat and wildfire smoke effects on brain health.

Climate change is generating increased heatwaves and wildfires across much of the world. With these escalating environmental changes comes greater impacts on human health leading to increased numbers of people suffering from heat- and wildfire smoke-associated respiratory and cardiovascular impairment. One area of health impact of climate change that has received far less attention is the effects of extreme heat and wildfire smoke exposure on human brain health. As elevated temperatures, and wildfire-associated smoke, are increasingly experienced simultaneously over summer periods, understanding this combined impact is critical to management of human health especially in the elderly, and people with dementia, and other neurological disorders. Both extreme heat and wildfire smoke air pollution (especially particulate matter, PM) induce neuroinflammatory and cerebrovascular effects, oxidative stress, and cognitive impairment, however the combined effect of these impacts are not well understood. In this narrative review, a comprehensive examination of extreme heat and wildfire smoke impact on human brain health is presented, with a focus on how these factors contribute to cognitive impairment, and dementia, one of the leading health issues today. Also discussed is the potential impact of combined heat and wildfire smoke on brain health, and where future efforts should be applied to help advance knowledge in this rapidly growing and critical field of health research.