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There is abundant evidence that high levels of lead in blood can have adverse health—including neurologic—outcomes both among children and adults.1 Because of this, to protect the health of workers—some of whom can experience very high exposure levels—the Occupational Health and Safety Administration (OSHA) standard for lead dictates that workers with blood lead concentration higher than 60 μg/dL be removed from work and that they cannot return until their blood lead levels return below 40 μg/dL. These rules make sense, but they do not tell the whole story. The half-life of lead in blood is about 1 month. Thus, blood lead provides an indication of relatively recent exposures, but does not reflect cumulative exposure well. What happens when people are exposed to lead—even low levels, well below OSHA blood lead limits, that most of us might experience in our lives, from, for example, lead in gasoline, paint, or water pipes—for a long period of time?
The article in this issue of Neurology by Shih et al.2 is a major contribution to our understanding of the cognitive effects of cumulative exposure to lead among community-dwelling adults—as distinct from former lead …
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