Pattern of blood lead levels over working lifetime and neuropsychological performance.

The authors examined the impact on neuropsychological performance of past high lead exposure, followed by lower proximate lead exposure, in 2 groups of smelter workers selected on the basis of their patterns of blood lead levels (BLLs) over time. Prior to 1980 (past exposure), both groups had more than 90% of their BLLs > or = 40 microg/dl. During and subsequent to 1980 (proximate exposure), those subjects with more than 90% of their BLLs remaining at > or = 40 microg/dl were assigned to the high-high (H-H) pattern group (n = 40); whereas those with 90% of levels below 40 microg/dl were assigned to the high-low (H-L) pattern group (n = 40). Means (and standard deviations) for pre-1980 time-integrated blood lead (IBL) levels were similar for the H-H pattern [633.2 (202.2) microg/yr-dl] and the H-L pattern [556.5 (144.8) microg/yr x dl]; however, IBLs from 1980 on were significantly different [H-H pattern = 646.9 (58.70) microg/yr x dl and H-L pattern = 408.8 (46.37) microg/yr x dl; p < 0.0001]. Age, education, and years of employment were similar for both groups. Examination of 5 neuropsychological measures revealed that verbal memory was significantly better in the H-L pattern group than in the H-H group. Multivariate examination of the data showed that pattern of exposure contributed significantly to verbal memory performance, after adjustment for the covariates, current BLL, and IBL. A partial correlation analysis between verbal memory and IBL for past high exposure showed an association with H-H pattern, but none with H-L pattern. Pattern of BLLs over a working lifetime contributed unique variance to verbal memory. Absence of an association between past high lead exposure and verbal memory in the H-L pattern group suggests that reversibility of function may occur when proximate BLL is maintained below 40 microg/dl.