Chronic occupational exposure and memory impairment

A 44 year old man had worked from 1966 to 1982 as a chemical operator. He wore gloves and coveralls and was intermittently exposed to acetone 1,000 ppm, n-butyl acetone 100 ppm, isopropyl ether 500 ppm, isopropanol 400 ppm and MIBK 100 ppm. He had remained well during this period. From 1982 until 1987 he worked as a supervisor in a poorly ventilated area of a solvent extraction facility. He was exposed daily to concentrations of MIBK in excess of 100 ppm for 8 hours daily. Several times a day he also became soaked in the solvent when he climbed into a large chamber. He had daily headaches which cleared during the weekend. Following each period in the chamber he also experienced sedation and syncope. He also worked regular double shifts in 1985 and 1986.

In early 1986 he experienced increasing anxiety, irritability, poor concentration, forgetfulness and severe olfactory impairment. He lost his job because of poor performance. On evaluation 18 months later he reported moderate improvement in cognitive ability, but still had memory and concentration difficulties. Olfaction had improved and he experienced increased sensitivity to some chemical odours. This eventually resolved. During the following 10 year period he had neuropsychological testing six times. He performed poorly in tests involving strategic self-guided retrieval (e.g., verbal fluency, free recall), but was better with tasks that provided direct retrieval cues (e.g., picture naming, vocabulary). He performed poorly on tasks that depended on temporary storage and rapid information processing. Initial neuroimaging showed only slight cerebral atrophy, which was still present on the final evaluation. After 11 years his cognitive deficits still affected his daily life and he occasionally displayed impulsive behaviour and disinhibition. The neurological effects in this case were thought to be due to MIBK. Another worker who worked as a supervisor also experienced cognitive dysfunction with slowed information processing and impaired attention. Other workers who wore protective breathing apparatus were unaffected. No other causes for his memory impairment were found (Grober and Schaumburg, 2000).

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