Neuropsychological function in manganese alloy plant workers

  • Rita Bast-PettersenEmail author
  • Dag G. Ellingsen
  • Siri M. Hetland
  • Yngvar Thomassen
Original Article



The objective was to investigate potential nervous system effects of manganese (Mn) exposure in workers employed in manganese-alloy-producing plants.


One hundred male Mn alloy plant workers were compared with 100 age-matched referents. The subjects were examined with a comprehensive neuropsychological test battery. Exposure was assessed by measurement of Mn concentrations in the workroom air, blood and urine.


The geometric mean (GM) concentration of inhalable Mn in workroom air was 301 μg/m3. The GM concentration of Mn in whole blood (181 nmol/l vs 160 nmol/l) (P=0.002) and urine (0.9 nmol/mmol creatinine vs 0.4 nmol/mmol creatinine) (P<0.001) was higher among the exposed subjects than among the referents. The Mn-exposed subjects had increased postural tremor while conducting a visually guided tremor test (static steadiness test) compared with the referents (mean number of contacts 94 vs 59 (P= 0.001); duration of contacts (in seconds) 5.1 vs 3.5 (P=0.003)). The tremor had larger frequency dispersion, indicating that the tremor included a wider variety of frequencies, among the exposed subjects than among the referents, assessed by the “TREMOR” test system. Smoking habits (self-reported) influenced the tremor parameters significantly, the Mn-exposed smokers having more tremor than the non-smoking Mn-exposed subjects. No differences between the groups were found in tests for cognitive functions, reaction time or in symptom reporting.


The Mn-exposed subjects had increased hand tremor compared with their referents. The tremor was related to exposure parameters. Smoking habits (self-reported) influenced the tremor parameters.


Tremor Manganese exposure Smoking Neuropsychological Neurobehavioural 



We thank the occupational health services of the plants for their kind assistance, and we are especially indebted to occupational health nurses Audhild Bellesen, Ida Djuv, Gunhild Ekrem, Jorun Jordal and Anne Storhaug for their skilful help when carrying out the study. The study was carried out with financial support from the Working Environment Fund of the Confederation of Norwegian Business and Industry, the Elkem ASA, Norway, the Tinfos Jernverk AS, Norway, and the ERAMET ASA, Norway.


  1. 1.
    Aschner M (1999) Manganese homeostasis in the CNS. Environ Res 80:105–109CrossRefPubMedGoogle Scholar
  2. 2.
    Aschner M (2000) Manganese: brain transport and emerging research needs. Environ Health Perspect 108:429–432Google Scholar
  3. 3.
    Baker EL, Letz R, Fidler A (1985) A computer-administered neurobehavioral evaluation system for occupational and environmental epidemiology. J Occup Med 27:206–212PubMedGoogle Scholar
  4. 4.
    Beuter A, Mergler D, deGeoffry A, Carrière L, Bélanger S, Varghese L, Spreekumar J, Gauthier S (1994) Diadochokinesimetry: a study of patients with Parkinson’s disease and manganese exposed workers. Neurotoxicology 15:655–664PubMedGoogle Scholar
  5. 5.
    Beuter A, Edwards R, deGeoffry A, Mergler D, Hudnell K (1999) Quantification of neuromotor function for detection of the effects of manganese. Neurotoxicology 20:355–366PubMedGoogle Scholar
  6. 6.
    Chia SE, Foo SC, Gan SL, Jeyaratnam J, Tian CS (1993) Neurobehavioral functions among workers exposed to manganese ore. Scand J Work Environ Health 19:264–270PubMedGoogle Scholar
  7. 7.
    Couper J (1837) On the effects of black oxide of manganese when inhaled into the lungs. Br Ann Med Pharm 1:41–42Google Scholar
  8. 8.
    Crump KS, Rousseau P (1999) Results from eleven years of neurological health surveillance at a manganese oxide and salt producing plant. Neurotoxicology 20:273–286PubMedGoogle Scholar
  9. 9.
    Danish Product Development Ltd (1996) CATSYS 7.0 user’s manual: Snekkersten, DenmarkGoogle Scholar
  10. 10.
    Danish Product Development Ltd (1996) TREMOR 7.0 user’s manual: Snekkersten, DenmarkGoogle Scholar
  11. 11.
    Deschamps FJ, Guillaumot M, Raux S (2001) Neurological effects in workers exposed to manganese. JOEM 43:127–132PubMedGoogle Scholar
  12. 12.
    Despres C, Lamoureux D, Beuter A (2000) Standardization of a neuromotor test battery: the CATSYS system. Neurotoxicology 21:725–736PubMedGoogle Scholar
  13. 13.
    Edwards R, Beuter A (1999). Indexes for identification of abnormal tremor using computer tremor evaluation systems. IIEE Biomed Eng 46:895–898CrossRefGoogle Scholar
  14. 14.
    Ellingsen DG, Bast-Pettersen R, Efskind J, Thomassen Y (2001) Neuropsychological effects of low mercury vapour exposure in chloralkali workers. Neurotoxicology 22:249–258Google Scholar
  15. 15.
    Ellingsen DG, Hetland SM, Thomassen Y (2003) Manganese air exposure assessment and biological monitoring in the manganese alloy producing industry. J Environ Monit 5:84–90CrossRefPubMedGoogle Scholar
  16. 16.
    Ellingsen DG, Haug E, Gaarder PI, Bast-Pettersen R, Thomassen Y (2003) Endocrine and immunologic markers in manganese alloy production workers. Scand J Work Environ Health 29:230–238PubMedGoogle Scholar
  17. 17.
    Engvik H, Hjerkinn O, Seim S. WAIS (1978) Wechslers adult intelligence scale. The Norwegian Psychological Association, OsloGoogle Scholar
  18. 18.
    Findley LJ (1996) Classification of tremors. J Clin Neurophysiol 13:122–132CrossRefPubMedGoogle Scholar
  19. 19.
    Gibbs JP, Crump KS, Houck DP, Warren PA, Mosley WS (1999) Focused medical surveillance: a search for subclinical movement disorders in a cohort of U.S. workers exposed to low levels of manganese dust. Neurotoxicology 20:299–314PubMedGoogle Scholar
  20. 20.
    Golden CJ, Hammeke TA, Purish AD (1980) Manual for the Luria Nebraska neuropsychological battery. Western Psychological Services, Los AngelesGoogle Scholar
  21. 21.
    Gomita Y, Suemaru K, K Furuno, Araki Y (1989) Nicotine-induced tail-tremor and drug effects. Pharmacol Biochem Behav 34:817–821CrossRefPubMedGoogle Scholar
  22. 22.
    Gothoni P (1983) Hypersensitivity to the tremorogenic action of nicotine in rats withdrawn from ethanol. Med Biol 61:344–345PubMedGoogle Scholar
  23. 23.
    Hauge R, Irgens-Jensen O (1987) Alcohol in the Nordic countries (in Norwegian). Tidsskr Nord Alkoholforskn 4 [Suppl]:48–49Google Scholar
  24. 24.
    Helsinki Symptom Questionnaire (1983) Finnish Institute of Occupational Health, HelsinkiGoogle Scholar
  25. 25.
    Hetland S, Ellingsen D, Thomassen Y (1997) Inhalable and “total” aerosol exposure in the manganese alloy industry. Fifteenth International Neurotoxicology Conference; Manganese, abstract. 26–29 October, Little Rock, Arkansas, p 38Google Scholar
  26. 26.
    Hobbesland Å, Kjuus H, Thelle DS (1997) Mortality from cardiovascular diseases and sudden death in ferroalloy plants. Scand J Work Environ Health 23:334–341PubMedGoogle Scholar
  27. 27.
    Hochberg F, Miller G, Valenzuela R, McNelis S, Crump KS, Covington T, Valdivia G, Hochberg B, Trustman JW (1996) Late motor deficits of Chilean manganese miners: a blinded control study. Neurology 47:788–795PubMedGoogle Scholar
  28. 28.
    Hua MS, Huang CC (1991) Chronic occupational exposure to manganese and neurobehavioral function. J Clin Exp Neuropsychol 13:495–507PubMedGoogle Scholar
  29. 29.
    Iregren A (1990) Psychological test performance in foundry workers exposed to low levels of manganese. Neurotoxicol Teratol 12:673–675CrossRefPubMedGoogle Scholar
  30. 30.
    Iregren A (1999) Manganese neurotoxicity in industrial exposures: proof of effects, critical exposure level, and sensitive tests. Neurotoxicology 20:315–324PubMedGoogle Scholar
  31. 31.
    Kawamoto MM, Hanley KW (1997) Health hazard evaluation report. HETA-90–0214–2523, Ralston Purina Company, Eveready Battery Company, Marietta, OhioGoogle Scholar
  32. 32.
    Kleinbaum DG, Kupper LL, Morgenstern H (1982) Epidemiologic research, principles and quantitative methods. Van Nostrand Reinhold, New YorkGoogle Scholar
  33. 33.
    Letz R, Gerr F (2000) Reliability of some tremor measurement outcome variables in field testing situations. Neurotoxicology 21:725–736PubMedGoogle Scholar
  34. 34.
    Lezak MD (1995) Neuropsychological assessment. Oxford University Press, New YorkGoogle Scholar
  35. 35.
    Lucchini R, Selis L, Folli D, Apostoli P, Mutti A, Vanoni O, Iregren A, Alessio L (1995) Neurobehavioral effects of manganese in workers from a ferroalloy plant after temporary cessation of exposure. Scand J Work Environ Health 21:143–149PubMedGoogle Scholar
  36. 36.
    Lucchini R, Bergamaschi E, Smargiassi A, Apostoli P (1997) Motor function, olfactory threshold and hematological indices in manganese exposed ferroalloy workers. Environ Res 73:175–180Google Scholar
  37. 37.
    Lucchini R, Apostoli P, Perrone C, Placidi D, Albini E, Migliorati P, Mergler D, Sassine M-P, Palmi S, Alessio L (1999) Long term exposure to “low levels” of manganese oxides and neurofunctional changes in ferroalloy workers. Neurotoxicology 20:287–298PubMedGoogle Scholar
  38. 38.
    Lundberg I, Högberg M, Michélsen H, Nise G, Hogstedt C (1997) Evaluation of the Q16 questionnaire on neurotoxic symptoms and a review of its use. Occup Environ Med 54:343–350PubMedGoogle Scholar
  39. 39.
    Matthews CG, Kløve H (1964) Instruction manual for the adult neuropsychological test battery. University of Wisconsin Medical School, Madison, Wis, USAGoogle Scholar
  40. 40.
    Mena I, Marin O, Fuenzalida S, Cotzias GC (1967) Chronic manganese poisoning. Neurology 17:128–138PubMedGoogle Scholar
  41. 41.
    Mergler D, Huel G, Bowler R, Iregren A, Bélanger S, Baldwin M, Tardif R, Smargiassi A, Martin L (1994) Nervous system dysfunction among workers with long-term exposure to manganese. Environ Res 64:151–180CrossRefPubMedGoogle Scholar
  42. 42.
    Obeso JA, Rodríguez-Oroz MC, Rodríguez M, Lanciego JL, Artieda J, Gonzalo N, Olanow CW (2000) Pathophysiology of the basal ganglia in Parkinson’s disease. Trends Neurosci 10 [Suppl]:8–19Google Scholar
  43. 43.
    Olanow CW, Good PF, Shinotoh H, Hewitt KA, Vingerhoets F, Snow BJ, Beal MF, Calne DB, Perl DP (1996) Manganese intoxication in the rhesus monkey: a clinical, imaging, pathologic, and biochemical study. Neurology 46:492–498PubMedGoogle Scholar
  44. 44.
    Reitan RM, Wolfson D (1985) The Halstead-Reitan neuropsychological test battery. Theory and clinical implication. Neuropsychology Press, ArizonaGoogle Scholar
  45. 45.
    Rodier J (1955) Manganese poisoning in Moroccan miners. Br J Ind Med 12:21–35PubMedGoogle Scholar
  46. 46.
    Roels H, Lauwerys R, Buchet JP, Bernard A, Barthels A, Oversteyns M, Gaussin J (1982) Comparison of renal function and psychomotor performance in workers exposed to elemental mercury. Int Arch Occup Environ Health 50:77–93PubMedGoogle Scholar
  47. 47.
    Roels H, Lauwerys R, Buchet JP, Genet P, Sarhan MJ, Hanotiau I, de Fays M, Bernard A, Stanescu D (1987) Epidemiological survey among workers exposed to manganese: effects on lung, central nervous system, and some biological indices. Am J Ind Med 11:307–327PubMedGoogle Scholar
  48. 48.
    Roels HA, Ghyselen P, Buchet JP, Ceulemans E, Lauwerys RR (1992) Assessment of permissible exposure level to manganese in workers exposed to manganese dioxide dust. Br J Ind Med 49:25–34PubMedGoogle Scholar
  49. 49.
    Siegl P, Bergert K-D (1982) Eine frühdiagnostische Überwachungsmetode bei Manganexposition. Z Ges Hyg 28:524–526Google Scholar
  50. 50.
    Sjögren B, Iregren A, Frech W, Hagman M, Johansson L, Tesarz M, Wennberg A (1996) Effects on the nervous system among welders exposed to aluminium and manganese. Occup Environ Med 53:32–40Google Scholar
  51. 51.
    Thomassen Y, Ellingsen DG, Hetland S, Sand G (2001) Chemical speciation—sequential extraction of manganese in work room aerosols: analytical methodology and results from a field study in manganese alloy plants. J Environ Monit 3:555–559CrossRefPubMedGoogle Scholar
  52. 52.
    Wellbeloved DB, Craven PM, Waudby JW (1990) Manganese and manganese alloys. In: Elwers B, Hawkins S, Schulz G (eds) Ullman’s encyclopedia of industrial chemistry, 5th edn, vol. A16. Weinheim, p 77Google Scholar
  53. 53.
    Wennberg A, Iregren A, Struwe G, Cizinsky G, Hagman M, Johansson L (1991) Manganese exposure in steel smelters a health hazard to the nervous system. Scand J Work Environ Health 17:255–262PubMedGoogle Scholar
  54. 54.
    Yamada M, Ohno S, Okayasu I, Okeda R, Hatakeyama S, Watanabe H, Ushio K, Tsukagoshi H (1986) Chronic manganese poisoning: a neuropathological study with determination of manganese distribution in the brain. Acta Neuropathol 70:273–282PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • Rita Bast-Pettersen
    • 1
    Email author
  • Dag G. Ellingsen
    • 1
  • Siri M. Hetland
    • 1
  • Yngvar Thomassen
    • 1
  1. 1.National Institute of Occupational HealthOsloNorway

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