Lead and cognitive function in adults: A questions and answers approach to a review of the evidence for cause, treatment, and prevention

Lead has been extensively used worldwide in gasoline, consumer products, commercial applications, and industrial settings. Its use in gasoline and paint has been particularly hazardous to public health leading to widespread population exposure and substantial lifetime cumulative doses in most Americans over age 40 years. Cumulative lead dose can be estimated by measuring the current concentration of lead in tibia bone by X-ray fluorescence. A growing literature has documented that tibia lead levels are associated with decrements in cognitive function and declines in cognitive function over time. Furthermore, there are several interesting lines of biochemical and epidemiological investigation that have demonstrated potential links of lead to neurodegenerative diseases. These studies support the inference that a proportion of what has been termed 'normal' age-related cognitive decline may, in fact, be due to exposure to neurotoxicants such as lead. Well-designed studies of cumulative lead dose and Alzheimer's disease risk should be conducted to follow-up on these leads. The strong and compelling body of literature on lead and cognitive dysfunction and decline also supports a need for intervention studies to prevent lead-related cognitive decline.