Blood manganese and cognitive and motor skills at age 6-7 in Canadian cohort GESTE

Abstract Background: Increasing evidence suggests that high exposure to manganese (Mn) may impair brain development. In Canada, Mn exposure comes from several environmental sources and the most common is drinking water. Our objective was to examine the relationship between blood Mn and psychomotor skills in school-aged children from the Eastern Townships, Qc, Canada. In addition, we examined the association of Mn with Attention-Deficit Hyperactivity Disorder (ADHD) diagnosis in our study group.Methods: Children were recruited at birth (through their mother) and followed prospectively. At 6-7 years of age, 210 children provided a blood sample for manganese testing and underwent a battery of neuropsychological tests. This battery assessed several major cognitive domains including general intelligence, attention and others via subtests from the Wechsler Intelligence Scale for Children – IV (WISC-IV), the Developmental NEuroPSYchological Assessment-II (NEPSYII) and the Test of Everyday Attention for Children (TEACH). Parents were asked if their child had ever received a physician diagnosis of ADHD. Blood was analysed by inductively coupled plasma mass spectrometry. Multivariate statistic modelling was used to control for potential confounding factors, including blood lead.Results: Median blood Mn was 9.9 µg/L (range 4.7 – 21.4 µg/L). The Design Copying – Fine motor score of the NEPSYII was positively associated with blood Mn (linear model β: 0.17 [95% Confidence Interval: 0.03 to 0.32]; adjusted model β: 0.16 [95% Confidence Interval 0.01 to 0.30]). Blood Mn was not associated with diagnosis of ADHD. Sex-stratified analyses indicated potential effect modification by child sex such that manganese had a beneficial association on the Score DT test (a measure of sustained attention), but only among boys (β: 0.29, [95% confidence interval: 0.098 to 0.49]) Conclusions: In agreement with studies from areas with similar environmental Mn levels, our study suggests that blood Mn level does not have wide-ranging associations with cognitive functions, psychomotor skills, or a diagnosis/suspicion of ADHD in school-aged children. To resolve the controversy about toxicity of environmental Mn on the developing brain, further studies should simultaneously focus on several biomarkers of Mn exposure, potential lifestyle protective factors, as well as brain imaging.