인지기능 저하와 체내 중금속 10종 간 연관성 분석 = Association between Cognitive Decline and Ten Heavy Metals

다국어 초록 (Multilingual Abstract)

Background: Due to the rapid aging of the South Korean population, neurological diseases such as dementia are increasing. Many studies have reported that the incidence of dementia is associated with environmental factors along with age.
Objectives: This study analyzed the association between cognitive function and ten heavy metals in the body: arsenic, aluminum, chromium, manganese, cobalt, nickel, iron, copper, zinc, and lead.
Methods: From 2018 to 2019, a total of 120 participants who suffered from cognitive impairment were recruited for this study. Blood and urine samples were collected and analyzed for heavy metal concentrations using an inductively coupled plasma mass spectrometer. Demographic information was obtained through face-to-face questionnaires completed by a trained investigator. Cognitive function was evaluated with the Korean version of the Mini-Mental State Examination and the Korean version of the Boston Name Waiting Test. The associations between cognitive function scores and heavy metal concentrations were analyzed using multiple logistic regression analysis.
Results: The average age of the 120 participants was 72.7 years, and 69.2% were female. The mean of the MMSE-K and K-BNT scores were 22.9 and 37.9, respectively. The geometric mean of aluminum (Al) was 8.42 µg/L. MMSE-K was associated with iron (Fe), but the significance was removed in the logistic regression based on 24 points. K-BNT was significantly associated with aluminum and the odds ratio for K-BNT above 38 decreased by 45% as the aluminum concentration increased.
Conclusions: The association between aluminum and the K-BNT score indicated that aluminum is associated with language-related cognitive decline. Based on this result, further study will be conducted by considering co-exposure effects of heavy metals including aluminum.

참고문헌 (Reference)

1 신미혜 ; 이승길 ; 김경희 ; 최재욱, "치매환자 여부와 혈중 납, 카드뮴, 수은 및 망간 농도와의 상관성" 한국환경보건학회 46 (46): 267-275, 2020

2 김재민 ; 신일선 ; 윤진상 ; 이형영, "치매 선별을 위한 MMSE-K와 K-MMSE의 진단 타당도 비교" 대한신경정신의학회 42 (42): 124-130, 2003

3 곽지영 ; 국승희, "언어장애가 있는 외상성 뇌손상 환자의 이름대기 능력" 한국임상심리학회 21 (21): 75-91, 2002

4 차영 ; 이준엽 ; 김진성 ; 이종범 ; 구본훈, "알쯔하이머형 치매에서 한국판 보스톤 이름대기검사와 지연회상검사 조합의 진단적 유용성" 대한생물치료정신의학회 17 (17): 30-37, 2011

5 Shin RW, "luminum modifies the properties of Alzheimer’s disease PHF tau proteins in vivo and in vitro" 14 (14): 7221-7233, 1994

6 United Nations, "World Population Prospects: The 2022 Revision"

7 Kim S, "Using urinary biomarkers to elucidate dose-related patterns of human benzene metabolism" 27 (27): 772-781, 2006

8 Alzheimer A, "Uber einen eigenartigen schweren Er Krankungsprozeβder Hirnrinde" 25 : 1129-1136, 1906

9 ATSDR, "Toxicological Profile for Zinc"

10 ATSDR, "Toxicological Profile for Nickel"

11 ATSDR, "Toxicological Profile for Manganese"

12 ATSDR, "Toxicological Profile for Lead"

13 ATSDR, "Toxicological Profile for Chromium"

14 ATSDR, "Toxicological Profile for Arsenic"

15 ATSDR, "Toxicological Profile for Aluminum"

16 Selvi Öztorun H, "The impact of treatment for iron deficiency and iron deficiency anemia on nutritional status, physical performance, and cognitive function in geriatric patients" 9 (9): 493-500, 2018

17 Cheng BJ, "The association between essential trace element mixture and cognitive function in Chinese community-dwelling older adults" 231 : 113182-, 2022

18 Ji-Yeon Lee ; Kyung-Su Park ; Jae-Hoon Kim ; 최달웅 ; Dong-Woo Lee ; Jun-Hyun Park ; Hye-Jung Yoon ; 표희수 ; 권호장, "The Association of Heavy Metal of Blood and Serum in the Alzheimer’s Diseases" 한국독성학회 28 (28): 93-98, 2012

19 Cummings JL, "Subcortical Dementia" Oxford University Press 251-259, 1990

20 Statistics Korea, "Population Projections for Korea: 2020~2070"

21 Parlato V, "Patterns of verbal memory impairment in dementia. Alzheimer disease versus multinfarctual dementia" 10 (10): 343-351, 1988

22 Lee HJ, "Pathogenic mechanisms of heavy metal induced-Alzheimer’s disease" 10 (10): 1-10, 2018

23 CDC, "National Health and Nutrition Examination Survey:NHANES 2015-2016 Laboratory Data"

24 Kim H, "Naming deficits in patients with dementia of the Alzheimer type : error analysis of Korean version-Boston naming test" 15 (15): 1012-1021, 1997

25 Park JH, "Modification of the mini-mental state examination for use in the elderly in a non-western society. Part 1. Development of Korean version of mini-mental state examination" 5 (5): 381-387, 1990

26 Oteiza PI, "Metals in neurodegeneration:involvement of oxidants and oxidant-sensitive transcription factors" 25 (25): 103-115, 2004

27 Afridi HI, "Levels of arsenic, cadmium, lead, manganese and zinc in biological samples of paralysed steel mill workers with related to controls" 144 (144): 164-182, 2011

28 Kwon YC, "Korean version of mini-mental state examination(MMSE-K)" 28 (28): 123-135, 1989

29 Bakulski KM, "Heavy metals exposure and Alzheimer’s disease and related dementias" 76 (76): 1215-1242, 2020

30 World Health Organization, "Health Risks of Heavy Metals from Long-range Transboundary Air Pollution"

31 Killin LO, "Environmental risk factors for dementia : a systematic review" 16 (16): 175-, 2016

32 Miodovnik A, "Environmental neurotoxicants and developing brain" 78 (78): 58-77, 2011

33 Iqbal G, "Elevated heavy metals levels in cognitively impaired patients from Pakistan" 60 : 100-109, 2018

34 Arvanitakis Z, "Diagnosis and management of dementia: review" 322 (322): 1589-1599, 2019

35 Camerer C, "Deficits in word retrieval in Alzheimer’s Disease" Heinrich-Heine-Universität Düsseldorf 2017

36 Sachdev PS, "Classifying neurocognitive disorders : the DSM-5 approach" 10 (10): 634-642, 2014

37 Jin R, "Associations of renal function with urinary excretion of metals: evidence from NHANES 2003-2012" 121 (121): 1355-1362, 2018

38 Ahmad Rather M, "Asiatic acid attenuated aluminum chloride-induced tau pathology, oxidative stress and apoptosis via AKT/GSK-3β signaling pathway in Wistar rats" 35 (35): 955-968, 2019

39 Bulka CM, "Arsenic and obesity : a comparison of urine dilution adjustment methods" 125 (125): 087020-, 2017

40 Exley C, "An interaction of betaamyloid with aluminium in vitro" 324 (324): 293-295, 1993

41 Bassil N, "Alzheimer’s dementia : a brief review" 60 (60): 192-199, 2012

42 Sakamoto T, "Aluminum inhibits proteolytic degradation of amyloid beta peptide by cathepsin D: a potential link between aluminum accumulation and neuritic plaque deposition" 580 (580): 6543-6549, 2006

43 Hao W, "Aluminum impairs cognitive function by activating DDX3X-NLRP3-mediated pyroptosis signaling pathway" 157 : 112591-, 2021

44 Rondeau V, "Aluminum and silica in drinking water and the risk of Alzheimer’s disease or cognitive decline : findings from 15-year follow-up of the PAQUID cohort" 169 (169): 489-496, 2009

45 Mold M, "Aluminum and amyloid-β in familial Alzheimer’s disease" 73 (73): 1627-1635, 2020

46 Tomljenovic L, "Aluminum and Alzheimer’s disease : after a century of controversy, is there a plausible link?" 23 (23): 567-598, 2011

47 Jomova K, "Advances in metal-induced oxidative stress and human disease" 283 (283): 65-87, 2011

48 World Health Organization, "Action is Needed on Chemicals of Major Public Health Concern" World Health Organization 2010

49 Alzheimer’s Association, "2020 Alzheimer’s disease facts and figures" 16 (16): 391-460, 2020

50 Yoon CS, "2005 Work environment measurement institution quality control education collection" KOSHA 2005