Neurology 2000;55:1144-1150
© 2000 American Academy of Neurology
Articles
Past adult lead exposure is associated with longitudinal decline in cognitive function
B. S. Schwartz, MD, MS,
W. F. Stewart, PhD, MPH,
K. I. Bolla, PhD,
D. Simon, MS,
K. Bandeen-Roche, PhD,
B. Gordon, MD, PhD,
J. M. Links, PhD and
A. C. Todd, PhD
From the Divisions of Occupational and Environmental Health (Drs. Schwartz and Stewart) and Radiation Health Sciences (Dr. Links), Department of Environmental Health Sciences, and the Departments of Epidemiology (Drs. Schwartz, Stewart, and Simon) and Biostatistics (Dr. Bandeen-Roche), Johns Hopkins School of Hygiene and Public Health; Departments of Medicine (Dr. Schwartz) and Neurology (Drs. Bolla and Gordon), Johns Hopkins School of Medicine; Neuropsychology Division, Department of Cognitive Sciences (Dr. Gordon), Johns Hopkins University, Baltimore, MD; and Department of Community and Preventive Medicine (Dr. Todd), Mount Sinai Medical Center, New York, NY.
Address correspondence and reprint requests to Dr. Brian S. Schwartz, Division of Occupational and Environmental Health, Johns Hopkins School of Hygiene and Public Health, Room 7041, 615 North Wolfe Street, Baltimore, MD 21205; e-mail: bschwart{at}jhsph.edu
OBJECTIVE: To determine whether adults with past exposure to neurotoxicants have progressive declines in cognitive function years after exposure has ceased, and whether tibia lead is a predictor of the magnitude of change.
METHODS: A total of 535 former organolead manufacturing workers with a mean age of 55.6 years, a mean duration of 16 years since last occupational lead exposure, and low blood lead levels at the first study visit and 118 controls were evaluated with neurobehavioral tests two to four times over 4 years. "Peak" tibia lead levels, estimated from current levels measured by X-ray fluorescence, were used to predict changes in cognitive function over time.
RESULTS: In former lead workers, peak tibia lead ranged from -2.2 to 98.7 µg Pb/g bone mineral. Compared to controls, former lead workers performed worse over time for three tests of visuo-constructive ability and verbal memory and learning (p < 0.05). In former lead workers, peak tibia lead predicted declines for six tests of verbal memory and learning, visual memory, executive ability, and manual dexterity (p < 0.05 for four tests and < 0.10 for two additional tests). On average, for these six tests, an increase of 15.7 µg/g of peak tibia lead was equivalent in its effects on annual test decline to 5 more years of age at baseline.
CONCLUSIONS: These are the first data to suggest that cognitive function can progressively decline due to past occupational exposures to a neurotoxicant.
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