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Original Contribution
June 1998

Neuropsychological Impairment From Acute Low-Level Exposure to Carbon Monoxide

Author Affiliations

From the Department of Pediatrics, Hadassah University Mt Scopus (Drs Amitai and Wexler), the Department of Behavioral Sciences, Ben-Gurion University (Dr Zlotogorski and Mr Golan-Katzav), and the Department of Anesthesiology, Hadassah University Hospital, Ein Karem (Dr Gross), Jerusalem, Israel.

Arch Neurol. 1998;55(6):845-848. doi:10.1001/archneur.55.6.845

Objective  To investigate the effects of acute low-level exposure to carbon monoxide on higher cognitive functions in healthy humans.

Design  An empirical study of the effects of low-level exposure to carbon monoxide on higher cognitive functions in young healthy volunteers and a matched nonexposed control group.

Setting  A dormitory at the Hebrew University campus in Jerusalem, Israel.

Participants  Forty-five student volunteers who were exposed to carbon monoxide from residential kerosene stoves for 1.5 to 2.5 hours (air carbon monoxide concentrations of 17-100 ppm; mean ± SD, 61 ± 24 ppm) served as the experimental group and 47 nonexposed students served as the control group.

Main Outcome Measures  A battery of neuropsychological tests was administered to each participant including digit span, the revised Wechsler Memory Scale for verbal and figural memory, Trail-Making Test parts A and B, digit symbol, block design, and the Rey Auditory Verbal Learning Test.

Results  Venous blood carboxyhemoglobin (HbCO) levels in participants of the study group ranged from 0.01 to 0.11 (mean ± SD, 0.04 ± 0.03) and correlated with air carbon monoxide concentrations (r=0.39; P=.01). The experimental group scored significantly lower than controls on the following tests: digit span forward (P=.02), short-term (P=.008) and long-term semantic memory (P=.008), digit symbol (P=.004), block design (P=.009), recall of figural memory (P=.02), and Trail-Making part A (P=.04). No significant differences were found between the experimental and control groups in other tests.

Conclusions  The lower scores on neuropsychological tests indicate dysfunctions in memory, new learning ability, attention and concentration, tracking skills, visuomotor skills, abstract thinking, and visuospatial planing and processing. These dysfunctions correspond with previous reports of carbon monoxide neurotoxic effects in patients with moderate carbon monoxide poisoning. Low-level exposure to carbon monoxide results in impairment of higher cognitive functions. Neuropsychological testing appears to be sensitive in the detection of subtle neurologic dysfunctions resulting from carbon monoxide poisoning.