Summary
A multidisciplinary cross-sectional study was performed to examine the chronic neurotoxicity of organic solvents. Participating in the study were 105 persons employed as spray painters and having long-term solvent exposure (10–44 years) and a control group consisting of 58 construction workers, electricians, and plumbers without occupational contact to solvents. Samples were matched for age, preexposure intelligence level, occupation, and socioeconomic status. After controlling for potentially non occupational confounding factors (neuropsychiatric diseases, metabolic disorders, high blood pressure, alcohol intake) 83 spray painters and 42 controls were entered finally into the study. The evaluation included work history, self-rating questionnaire, neurologic investigation, psychiatric analysis using the Present State Examination (PSE), psychological testing, and computerized axial tomography (CAT) of the brain. Physical and neurologic examinations demonstrated no case of overt disorders of the central or peripheral nervous system. An important result of the psychiatric analysis was that the syndromes “special features of depression” and “loss of interest and concentration” occurred significantly more frequently among spray painters than among controls. Further analyses demonstrated an association with chronic exposure over 30 years and repeated acute neurotoxic effects during solvent exposures. Neither psychological nor performance tests demonstrated any statistically significant differences in the performance sets after adjustment according to premorbid intelligence level; this finding supports the presumption of only a low grade of mental dysfunction. Correlation analyses indicated a relationship between subjective health complaints and long-term solvent exposure; however, the effect of age cannot be completely ruled out. Visual evaluation of CAT scans of the brain demonstrated significantly higher values for spray painters on the Cella media index, a measure of the inner liquor system of the brain. None of the other CAT parameters of inner or external brain atrophy showed significant differences. The rate of diffuse cerebral atrophy was not increased in spray painters. No statistical relationship between the solvent exposure index and CAT parameters was found by correlation analysis. In summary, the results do not support the hypothesis of an increased risk of solvent-induced encephalopathy among spray painters. It is not possible to establish a typical picture of central nervous system dysfunction due to chronic solvent exposure. Differences in the frequency of PSE symptoms “special features of depression” and “loss of interest and concentration” could be considered solvent related only if long-term (on average 30-year) exposure in combination with repeated acute neurotic effects had occurred. Cerebral atrophy beyond that of normal aging was not found in long-term exposed spray painters.
This is a preview of subscription content, access via your institution.
References
Arlien-Søberg PH, Hansen L, Ladefoged O, Simonsen L (1992) Report on a Conference on Organic Solvents and the Nervous System. Neurotoxicol Teratol 14:81–82
Baker EL, Letz RE, Eisen EA, Pothier LJ, Plantamura DL, Larson BAM, Wolford R (1988) Neurobehavioral effects of solvents in construction painters. J Occup Med 30:116–123
Baker EL, Letz RE, Fidler AT (1985) A neurobehavioral evaluation system for occupational and environmental epidemiology: rationale, methodology and pilot study results. J Occup Med 27:206–212
Baker EL, Smith TJ, Landrigan PJ (1985) The neurotoxicity of industrial solvents: a review of the literature. Am J Ind Med 8:207–217
Bebbington P, Hurry J, Tennant C, Sturt E, Wing JK (1981) Epidemiology of mental disorders in Camberwell. Psychol Med 11:561–579
Bigler ED, Yeo RA, Turkheimer E (eds) (1989) Neuropsychological function and brain imaging. Plenum,New York
Bolla KI, Schwartz BS, Angew J, Ford PD, Bleecker ML (1990) Subclinical neuropsychiatric effects of chronic low-level solvent exposure in US paint manufacturers. J Occup Med 32:671–677
Bowler RM, Mergler D, Huel G, Harrison R, Cone J (1991) Neuropsychological impairment among former microelectronics workers. Neurotoxicology 12:87–104
Brickenkamp R (1975) Test d2. Aufmerksamkeits-Belastungs-Test, 5th edn. Hogrefe, Göttingen
Busse O, Agnoli AL, Lippman R, Schütz HJ (1981) Klinische Bedeutung der Ventrikelerweiterung und Rindenatrophie im Computer-Tomogramm. Radiologe 21:91–97
Cala LA (1987) Is CT scan a valid indicator of brain atrophy in alcoholism? Acta Med Scand 717:27–32
Cala LA, Jones B, Burns P, Davis RE, Stenhouse N, Mastaglia FL (1983) Results of computerized tomography, psychometric testing and dietary studies in social drinkers, with emphasis or reversibility after abstinence. Med J Aust 2:264–269
Checkoway H, Pearce N, Crawford-Brown DJ (1989) Research methods in occupational epidemiology. Monographs in epidemiology and statistics 13. Oxford University Press, New York
Cherry N, Hutchins H, Pace P, Waldron HA (1985) Neurobehavioural effects of repeated occupational exposure to tolunene and paint solvents. Br J Ind Med 42:291–300
Claus D, Aschoff JC (1982) Evaluation of Infratentorial atrophy by computed tomography. J Neurol Neurosurg Psychiatry 45:979–983
Cranach M von, Cooper JE (1972) Changes in rating behaviour during the learning of a standardized psychiatric interview. Psychol Med 2:373–380
Cranmer JM, Golberg L (ed) (1986) Proceedings of the Workshop on Neurobehavioural Effects of Solvents. Neurotoxicology 7: 1–190
De Leon MJ, Ferris SH, Blau I, George AE, Reisberg B, Kricheff H, Gershon S (1979) Correlations between computerized tomographic changes and behavioural deficits in senile dementia. Lancet 859–860
Diener HC, Müller A, Thron A, Poremba M, Dichgans J, Rapp H (1986) Correlation of clinical signs with CT findings in patients with cerebellar diasease. J Neurol 233:5–12
Eggert D (1983) Eysenck-Persönlichkeits-Inventar (EPI). Hogrefe, Göttingen
Elofsson ST, Gamberale F, Hindmarsh T, Iregren A, Isaksson A, Johnsson I, Knave B, Lydahl E, Mindus P, Persson HE, Philipson B, Stery M, Struwe G, Södermann E, Wennberg A, Wilden L (1980) Exposure to organic solvents. Scand J Work Environ 6:239–273
Eslinger PJ, Damasio H, Graff-Radford N, Dalmasio AR (1984) Examining the relationship between computed tomography and neuropsychological measures in normal and demented elderly. J Neurol Neurosurg Psychiatry 47:1319–13254
Filder AT, Baker EL, Letz RE (1987a) Estimation of long-term exposure to mixed solvents from questionnaire data: a tool for epidemiological investigations. Br J Ind Med 44:133–141
Fidler AT, Baker EL, Letz RE (1987b) Neurobehavioural effects of occupational exposure to organic solvents among construction painters. Br J Ind Med 44:292–308
Fornazzari L, Wilkinson DA, Kapur BM, Carlen PL (1983) Cerebellar, cortical and functional impairment in toluene abusers. Acta Neurol Scand 67:319–329
Gamberale F, Hultengren M (1974) Exposure to Styrene. II. Psychological functions. Scand J Work Environ Health 11:86–93
Gilioli R, Cassitto MG, Camerino D, Colombi A, Zocchetti C (1990) Epidemiological study of neurobehavioural effects of long-term low-level exposure to organic solvents. 23rd International Congress on Occupational Health, 22–28 September, Montreal
Gosling RH (1955) The association of dementia with radiologically demonstrated cerebral atrophy. J Neurol Neurosurg Psychiatry 18:129–133
Gossel TA, Bricker JD (1990) Principles of clinical toxicology, 2nd edn. Raven, New York
Grasso P, Sharratt M, Davies DM, Irvine D (1984) Neurophysiological and psychological disorders and occupational exposure to organic solvents. Food Chem Toxicol 22:819–852
Gregersen P, Angelso B, Nielsen TE, Norgaard B, Udal C (1984) Neurotoxic effects of organic solvents in exposed workers: an occupational, neuropsychological and neurological investigation. Am J Ind Med 5:201–225
Gregersen P, Klausen H, Elsnab CU (1987) Chronic toxic encephalopathy in solvent-exposed painters in Denmark 1976–1980: clinical cases and social consequences after a 5-years follow-up. Am J Ind Med 11:399–417
Hane M, Axelson O, Blume J, Hogstedt C, Sundell L, Ydreborg B (1977) Psychological function changes among house-painters. Scand J Work Environ Health 3:91–99
Hänninen H (1988) The psychological performance profile in occupational intoxications. Neurotoxicol Teratol 10:485–488
Hänninen H, Eskelinen L, Husman K, Nurminen M (1976) Behavioral effects of long-term exposure to a mixture of organic solvents. Scand J Work Environ Health 4:240–255
Hayes AW (ed) (1989) Principles and methods of toxicology, 2nd edn. Raven, New York
Hernberg S (1980a) Epidemiology in occupational health. Developments in occupational medicine. Year Book Medical Publishers, Chicago
Hernberg S (1980b) Evaluation of epidemiologic studies in assessing the long-term effects of occupational noxious agents. Scand J Work Environ Health 6:163–169
Hogstedt C, Axelson O (1986) Long-term health effects of industrial solvents — a critical review of the epidemiological research. Med Lav 77:11–22
Hormes JT, Filley CM, Rosenberg NL (1986) Neurologic sequelae of chronic solvent vapor abuse. Neurology 36:698–702
Hummer J, Claus D (1989) Neurophysiologische Untersuchungen. In: Triebig G (ed) Die Erlanger Spritzlackierer-Studie. Arbeitsmed Sozialmed Präventivmed [Suppl] 13:38–41
Husman K, Karli P (1980) Symptoms of car painters with long-term exposure to a mixture of organic solvents. Scand J Work Environ Health 6:19–32
Ikeda M, Tsukagoshi H (1990) Encephalopathy due to toluene sniffing. Eur Neurol 30:347–349
Jeske H, Lehrl S, Schäcke G, Lüdersdorf R (1983) Einflüsse von Lösemittelgemischen auf Basisgrößen der zentralen Informationsverarbeitung bei Holzlackierern. grgk/Humankybernetik 24:107–113
Johnson BL, Anger WK, Durao A, Xintaras C (eds) (1990) Advances in neurobehavioral toxicology: applications in environmental and occupational health. Lewis, Chelsea, Michigan
Juntunen J, Hernberg S, Eistola P, Hupli V (1980) Exposure to industrial solvents and brain atrophy. Eur Neurol 19:366–375
Kendell RE, Everett B, Cooper JE, Sartorius N, David ME (1968) The reliability of the “Present State Examination.” Soc Psychiatry 3:123–130
King MD (1982) Neurological sequelae of toluene abuse. Hum Toxicol 1:281–287
Kinzel W (1979) Der Defekttest. Probleme der testoperationalen Begriffsfassung bei der Messung psychischer Spätschäden nach Hirnkontusion. Neurol Psychiatrie (Bucuresti) 5:115–122
Kromhout H, Oostendorp Y, Heederik D, Boleij JSM (1987) Agreement between qualitative exposure estimates and qunatitative exposure measurements. Am J Ind Med 12:551–562
Kurppa K, Husman K (1982) Car painters' exposure to a mixture of organic solvents. Scand J Work Environ Health 8:137–140
Lang C, Erbguth F (1989) Neuroradiologische Untersuchung. Die Erlanger Spritzlackierer-Studie. Arbeitsmed Sozialmed Präventivmed [Suppl] 13:43–45
Lazar RB, Ho SU, Melen O, Daghestani AN (1983) Multifocal central nervous system damage caused by toluene abuse. Neurology 33:1337–1340
Lee SH, Krishna CUG (1987) Computerized tomography and magnetic resonance imaging. McGraw-Hill, New York
Lehrl S, Fischer B (ed) (1985) C.I.-Test zur raschen Objektivierung cerebraler Insuffizienzen. Vless, Ebersberg
Lehrl S, Jeske H, Schäcke G, Lüdersdorf R (1984) Cerebrale Insuffizienz durch Lösemittelgemische am Arbeitsplatz von Holzlackierern — Bericht über die 24. Jahrestagung der Deutschen Gesellschaft für Arbeitsmedizin. Gentner, Stuttgart
Lehrl S, Blither K, Weidenhammer W, Fischer B (1986a) Diagnose und Therapiekontrolle von organischen Psychosyndromen. Vless, Ebersberg
Lehrl S, Kinzel W, Fischer B, Weidenhammer W (1986b) Psychiatrische und medizinpsychologische Meßverfahren des deutschsprachigen Raumes. Vless, Ebersberg
Lindström K, Wickström G (1983) Psychological function changes among maintenance house painters exposed to low levels of organic solvent mixtures. Acta Psychiatr Scand [Suppl 67] 303:81–91
Linz DH, de Garmo PL, Morton WE, Wiens AN, Coull BM, Maricle RA (1986) Organic solvent-induced encephalopathy in industrial painters. J Occup Med 28:119–125
Lishman WA, Jacobson RR, Acker C (1987) Brain damage in alcoholism: current concepts. Acta Med Scand 717:5–17
Lundberg I, Hakansson M (1985) Normal serum activities of liver enzymes in Swedish paint industry workers with haevy exposure to organic solvents. Br J Ind Med 42:596–600
Luria RE, McHugh PR (1974) Reliability and clinical utility of the “Wing” Present State Examination. Arch Gen Psychiatry 30:866–871
Luxenberg JS, Haxby JV, Creasey H, Sundaram M, Rapoport SI (1987) Rate of ventricular enlargement in dementia of the Alzheimer type correlates with rate of neuropsychological deterioration. Neurology 37:1135–1140
Maizlish NA, Langolf GD, Whitehead LW, Fine LJ, Albers JW, Goldberg J, Smith P (1985) Behavioural evaluation of workers exposed to mixtures of organic solvents. Br J Ind med 42:579–590
Maizlish NA, Fine LJ, Albers JW, Whitehead L, Langolf GD (1987) A neurological evaluation of workers exposed to mixtures of organic solvents. Br J Ind Med 44:14–25
Meese W, Grumme T (1980) Die Beurteilung hirnatrophischer Prozesse mit Hilfe der Computertomographie. Fortschr Neurol Psychiatr 48:494–509
Meldegaard B, Andersen K, Ahlgren P, Danielsen UT, Sorensen H (1984) Peripheral neuropathy, cerebral atrophy, and intellectual impairment in chronic alcoholics. Acta Neurol Scand 70:336–344
Mikkelsen S, Jorgensen M, Browne E, Gyldensted C (1988) Mixed solvent exposure and organic brain damage. A study of painters. Acta Neurol Scand 78 [Suppl 118] 1–143
Moesler TA (1982) Syndromspezifische Selbstbeurteilungsskalen. Konzept, Realisierung und empirische Befunde. Dissertation, University of Erlangen-Nürnberg
Moore JW, Dunk AA, Crawford JR, Deans H, Besson JAO, De Lacey G, Sinclair TS, Mowat NAG, Brunt PW (1989) Neuropsychological deficits and morphological MRI brain scan abnormalities in apparently healthy non-encephalopathic patients with cirrhosis. J Hepatol 9:319–325
Morrow LA, Ryan CM, Hodgson MJ, Robin N (1990) Alternations in cognitive and psychological functioning after organic solvent exposure. J Occup Med 32:444–450
Nagata K, Basugi N, Fukushima T, Tango T, Suzuki I, Kaminuma T, Kurashina S (1987) A quantitative study of physiological cerebral atrophy with aging. Neuroradiology 29:327–332
Orbaek P, Lindgren M, Olivecrona H, Haeger-Aronsen B (1987) Computed tomography and psychometric test performances in patients with solvent induced chronic toxic encephalopathy and healthy controls. Br J Ind Med 44:175–179
Pfeiffer J (1985) Zur Frage atrophisierender Vorgängen im Gehirn chronischer Alkoholiker. Nervenarzt 56:649–657
Reisner T, Zeiler K, Strobl G (1980) Quantitative Erfassung der Seitenventrikelbreite im CT — Vergleichswerte einer Normal-population. Fortschr Neurol Psychiatr 48:168–174
Roberts MA, Caird FI (1976) Computerized tomography and intellectual impairment in the elderly. J Neurol Neurosurg Psychiatry 39:986–989
Sachs L (1978) Angewandte Statistik. Springer, Berlin Heidelberg New York
Rothman KJ (1986) Modern epidemiology. Little, Brown & Co, Boston
Schäcke G, Fuchs A, Lüdersdorf R (1984) Gesundheitliche Gefährdung in der Holz- und Möbelindustrie durch Lösemittel und andere Arbeitsstoffe. Zentralbi Arbeitsmed 34:200–207
Schepank H, Hilpert H, Hönman H, Janta B, Parekh H, Riedel P, Schiessl N, Stork H, Tress W, Weinhold-Metzner M (1984) Das Mannheimer Kohortenprojekt — die Prävalenz psychogener Erkrankungen in der Stadt. Z Psychosom Med Psychoanal 30:43–61
Schmidt MH (ed) (1990) Fortschritte in der psychiatrischen Epidemiologie. VCH, Weinheim
Seppäläinen AM, Husman K, Martenson C (1978) Neurophysiological effects of long-term exposure to a mixture of organic solvents. Scand J Work Environ Health 4:304–314
Spencer PS, Schaumburg HH (eds) (1980) Experimental and clinical neurotoxicology. Williams & Wilkins, Baltimore
Spencer PS, Schaumburg HH (1985) Organic solvent neurotoxicity. Scand J Work Environ Health 11 [Suppl 1]:53–60
Struwe G, Wennberg A (1983) Psychiatric and neurological symptoms in workers occupationally exposed to organic solvents — results of a differential epidemiological study. Acta Psychiatr Scand 303 [Suppl 67]:68–80
Tavaras J, Wood E (1976) Diagnostic neuroradiology, vol 1. Williams & Wilkins, Baltimore
Thomson AD, Pratt OE, Jeyasingham M, Shaw GK (1988) Alcohol and brain damage. Human Toxicol 7:455–463
Triebig G (1985a) Untersuchungen zur peripheren Neurotoxizität von einigen Arbeitsstoffen. Arbeitsmed Sozialmed Präventivmed (Schriftenreihe) vol 72. Gentner, Stuttgart
Triebig G (1985b) Die „dänische Malerkrankheit.” Fortschr Med 103:933–937
Triebig G, Weltle D, Schaller KH, Valentin H (1985) Chronische Lösemittel-Expositionen und Leberenzyme. Fortschr Med 10:271–275
Triebig G, Claus DI, Csuzda I, Druschky KF, Holler P, Kinzel W, Lehrl S, Reichwein P, Weidenhammer W, Weitbrecht WU, Weltle D, Schaller KH, Valentin H (1988) Cross-spectional epidemiological study on neurotoxicity of solvents in paints and lacquers. Int Arch Occup Environ Health 60:233–241
Triebig G, Schaller KH, Weltle D (1992) Neurotoxicity of solvent mixtures in spray painters. I. Study design, workplace exposures, and questionnaire. Int Arch Occup Environ Health 64:353–359
Valciukas JA, Lilis R, Singer RM, Glickman L, Nicholson WJ (1985) Neurobehavioural changes among shipyard painters exposed to solvents. Arch Environ Health 40:47–52
Vesell ES (1987) Pharmacogenetic perspectives on susceptibility to toxic industrial chemicals. Br J Ind Med 44:505–509
Waldron HA (1985) Solvents and the brain. Br J Ind Med 43:73–74
Weidenhammer W, Fischer B (1987) Manual der c.I.-Skala. Vless, Ebersberg
Weyerer S, Dilling H (1984) Prävalenz und Behandlung psychischer Erkrankungen in der Allgemeinbevölkerung. Nervenarzt 55:30–42
Wing JK, Birley JLT, Cooper JE, Graham P, Isaacs A (1967) Reliability of a procedure for measuring and classifying “present psychiatric state.” Br J Psychiatry 113:499–575
Wing JK, Cooper JE, Sartorius N (1974) Present State Examination (PSE), 9th version. Medical Research Council/Cambridge University Press, Cambridge
Wing JK, Nixon JN, Cranach M von, Strauss A (1979) Further development of PSE and cartego system. Arch Psychiatr Nervenkrankheit 224:151–160
World Health Organization (1985) Chronic effects of organic solvents on the central nervous system and diagnostic criteria. WHO Nordic Council of Ministers Working Group, Copenhagen
World Health Organization (1989) Chronic effects of organic solvents on the central nervous system — development of core protocol for international collaborative study. WHO Nordic Council of Ministers Working Group, Copenhagen
Zerrsen D von (1976) Befindlichkeits-Skala Bfs. Beltz, Weinheim
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Triebig, G., Barocka, A., Erbguth, F. et al. Neurotoxicity of solvent mixtures in spray painters. Int. Arch Occup Environ Heath 64, 361–372 (1992). https://doi.org/10.1007/BF00379547
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00379547