title: The interaction of education and cumulative lead exposure on the Mini-Mental State Examination.
abstract: The effect of lead exposure on neurobehavioral performance is modified by age. Whether educational achievement can serve as an effect modifier on the lead-cognitive performance relationship is examined. The Mini-Mental State Examination (MMSE) and the reading section of the Wide Range Achievement Test-Revised (WRAT-R), a measure of educational achievement, were administered to 256 lead smelter workers. The workers had a mean (standard deviation) age of 41 (7.9) years, education of 10 (2.8) years, employment duration of 17 (8.1) years, current blood lead of 28 (8.8) micrograms/dL, and working lifetime integrated blood lead index (IBL) of 725 (434) micrograms-yr/dL. The median (range) MMSE score was 29 (19 to 30). Multiple linear regression assessed the contribution of age, WRAT-R, education, alcohol intake, cigarette use, IBL, and IBL x WRAT-R on MMSE performance. A significant IBL x WRAT-R interaction examined by stratification found a significant dose-effect relationship between IBL and MMSE, but only in the 78 workers with a WRAT-R reading grade level below 6 years. Workers with higher educational achievement compensated for the effect of lead on cognitive performance.
authors.affiliation: Center for Occupational and Environmental Neurology, 3901 Greenspring Avenue, Suite 101, Baltimore, MD 21211, USA. coen@msn.com
authors.forename: Margit L
authors.initials: ML
authors.lastname: Bleecker
authors.forename: Karen N
authors.initials: KN
authors.lastname: Lindgren
authors.forename: D Patrick
authors.initials: DP
authors.lastname: Ford
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Tiburzi
mesh_terms: D000328:Adult; D000395:Air Pollutants, Occupational / Q000009:adverse effects; D004305:Dose-Response Relationship, Drug; D004522:Educational Status; D005260:Female; D006801:Humans; D007854:Lead / Q000009:adverse effects / Q000097:blood; D020265:Lead Poisoning, Nervous System, Adult / Q000175:diagnosis* / Q000209:etiology; D008297:Male; D008396:Maryland; D008609:Mental Status Schedule / Q000706:statistics & numerical data*; D008875:Middle Aged; D009784:Occupational Diseases / Q000175:diagnosis* / Q000209:etiology; D011594:Psychometrics; D015203:Reproducibility of Results
chemical_list: D000395:Air Pollutants, Occupational; D007854:Lead