Geographical associations between aluminium in drinking water and death rates with dementia (including Alzheimer's disease), Parkinson's disease and amyotrophic lateral sclerosis in Norway.

Comparisons of maps and correlation and regression analysis indicate a geographical association between aluminium (Al) in drinking water and registered death rates with dementia (coded from death certificates as the underlying or a contributory cause of death) in Norway. High levels of Al in drinking water are in most cases related to acid precipitation. In general, correlations between aggregate environmental measurements and mortality are a weak source of evidence for risk factors for disease, however, and interpretations regarding cause-and-effect relationships should therefore be made with great care. The major uncertainty probably relates to the use of registered death rates with dementia as a measure of incidence rates of Alzheimer's disease. The dementia rates are correlated with population density, and it is possible that the association between AI and dementia might be due to differences in diagnosis and reporting of dementia. Thus, the present study can only be regarded as introductory, and further epidemiological studies are needed to help elucidate the role of AI in Alzheimer's disease. The results provide little evidence of an association between AI in drinking water and Parkinson's disease or amyotrophic lateral sclerosis.