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David M. White, PhD; W. T. Longstreth, Jr, MD; Linda Rosenstock, MD; Keith H. J. Claypoole, PhD; Carl A. Brodkin, MD; Brenda D. Townes, PhD

Arch Intern Med. 1992;152(7):1443-1448.

Abstract
Background.—
This article expands on an earlier series of three patients with a neurologic syndrome, who had all worked in an aluminum smelting plant.

Methods.—
Twenty-five symptomatic workers from the same plant were referred for a standardized evaluation, including completion of a health questionnaire, neurologic examination, and neuropsychologic evaluation. An exposure index was calculated for each worker based on level and duration of exposure in the potroom, where exposures were the greatest. This index was correlated with symptoms, signs, and neuropsychologic test scores.

Results.—
Twenty-two (88%) of the patients reported frequent loss of balance, and 21 (84%) reported memory loss. Neurologic examination revealed signs of incoordination in 21 (84%) of the patients. Neuropsychologic test results showed preservation in certain spheres of functioning, such as verbal IQ, with substantial impairment in others, particularly memory functioning. On memory tests, 70% to 75% showed mild or greater impairment. The majority (17 of 19 tested, or 89%) showed depression on the Minnesota Multiphasic Personality Inventory. The exposure index was significantly correlated with signs and symptoms of incoordination.

Conclusions.—
This study and others in humans and animals support the existence of a syndrome characterized by incoordination, poor memory, impairment in abstract reasoning, and depression. Aluminum exposure in the potroom seems the most likely cause.

(Arch Intern Med. 1992;152:1443-1448)

Author Affiliations
From the Departments of Rehabilitation Medicine (Dr White), Divisions of Neurology (Dr Longstreth) and Occupational Medicine Program (Drs Rosenstock and Brodkin), Psychiatry and Behavioral Sciences (Drs Claypoole and Townes), Epidemiology (Dr Long-streth), and Environmental Health (Drs Rosenstock and Brodkin), University of Washington Medical Center, Seattle.

Footnotes
Accepted for publication November 16, 1991.

Reprint requests to the Department of Rehabilitation Medicine, RJ-30, University of Washington Medical Center, Seattle, WA 98195 (Dr White).

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