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Effect of occupational aluminum exposure on cognitive function among informal aluminum foundry industry workers

  • Nelmi Silvia ,
  • Adi Heru Sutomo ,
  • Indwiani Astuti ,


Background: Occupational exposure to aluminum can potentially cause health problems for workers in the aluminum foundry industry, which might associate with cognitive impairment. However, studies in the informal aluminum foundry industry are still very limited. This study aimed to determine the relationship between aluminum exposure and cognitive impairment in informal aluminum foundry workers.

Methods: This study used a cross sectional design with logistic regression analysis. Seventy-nine workers in the informal aluminum foundry industry participated in this study. Aluminum in urine was measured using Inductively Coupled Plasma-Mass Spectrometry (ICP-MS). Cognitive function was measured using the Montreal Cognitive Assessment-Indonesian version (MoCA-Ina) instrument.

Results: A total of 69.6% of the subjects experienced cognitive impairment. There was a statistically significant relationship between urinary aluminum levels and cognitive impairment. Multivariate logistic regression analysis showed that urinary aluminum levels (adjusted odds ratio (aOR) = 6.550; 95% confidence interval (CI) = 1.281-33.499) and length of education (aOR = 16.885; 95% CI = 2.042 – 139.604) were associated with cognitive impairment, with cut-off value set at 45.985 µg/L. Other results showed that workers with less than 7 years of formal education have a 16.885 times higher risk of experiencing cognitive impairment.

Conclusion: Workers with urinary aluminum levels ≥45.985µg/L and formal education fewer than 7 years have a higher risk of having cognitive impairment. Regular bio-monitoring of workers' urinary aluminum levels and adequate aluminum exposure control efforts are needed to prevent cognitive impairment in informal aluminum foundry workers.


  1. ATSDR. Toxicological Profile for Aluminum. Atlanta, Georgia: U.S. Department of Health and Human Services, Public Health Service; 2008.
  2. Frank WB, Haupin WE, Vogt H, Bruno M, Thonstad J, Dawless RK, et al. aluminum. In: Ullmann’s Encyclopedia of Industrial Chemistry. Weinheim, Germany: Wiley-VCH Verlag GmbH & Co. KGaA; 2009. Available from:
  3. Krewski D, Yokel RA, Nieboer E, Borchelt D, Cohen J, Harry J, et al. Human health risk assessment for aluminum, aluminum oxide, and aluminum hydroxide. J Toxicol Environ Heal Part B. 2007;10(sup1):1–269. Available from:
  4. King JF. Aluminum products. In: The Aluminum Industry. Elsevier; 2001. p. 6–36. Available from:
  5. Mgonja CT. A review on effects of hazards in foundries to workers and environment. IJISET-International J Innov Sci Eng Technol. 2017;4(6):326–34.
  6. Willhite CC, Karyakina NA, Yokel RA, Yenugadhati N, Wisniewski TM, Arnold IMF, et al. Systematic review of potential health risks posed by pharmaceutical, occupational and consumer exposures to metallic and nanoscale aluminum, aluminum oxides, aluminum hydroxide and its soluble salts. Crit Rev Toxicol. 2014;44(sup4):1–80. Available from:
  7. Meyer-Baron M, Schäper M, Knapp G, van Thriel C. Occupational aluminum exposure: evidence in support of its neurobehavioral impact. Neurotoxicology. 2007;28(6):1068–78. Available from:
  8. Longstreth WT, Rosenstock L, Heyer NJ. Potroom palsy?: Neurologic disorder in three aluminum smelter workers. Arch Intern Med. 1985;145(11):1972–5. Available from:
  9. White DM, Longstreth WT, Rosenstock L, Claypoole KH, Brodkin CA, Townes BD. Neurologic syndrome in 25 workers from an aluminum smelting plant. Arch Intern Med. 1992;152(7):1443–8. Available from:
  10. Sińczuk-Walczak H, Szymczak M, Raźniewska G, Matczak W, Szymczak W. Effects of occupational exposure to aluminum on nervous system: clinical and electroencephalographic findings. Int J Occup Med Environ Health. 2003;16(4):301–10. Available from:
  11. Lu X, Liang R, Jia Z, Wang H, Pan B, Zhang Q, et al. Cognitive disorders and tau-protein expression among retired aluminum smelting workers. J Occup Environ Med. 2014;56(2):155–60. Available from:
  12. CDC. Laboratory Procedure Manual. Multi-Element in urine. NHANES 2011–2012. 2012.
  13. Husein N, Lumempouw S, Ramli Y, Herqutanto. Uji validitas dan reliabilitas Montreal Cognitive Assesment versi Indonesia (MoCA-Ina) untuk skrining gangguan fungsi kognitif. Neurona. 2010;27(4):15–22.
  14. World Health Organization. Regional Office for the Western Pacific. The AsiaPacific perspective: Redefining obesity and its treatment. Sydney: Health Communications Australia; 2000.
  15. Bast-Pettersen R, Drabløs PA, Goffeng LO, Thomassen Y, Torres CG. Neuropsychological deficit among elderly workers in aluminum production. Am J Ind Med. 1994;25(5):649–62. Available from:
  16. Yang HG, Lee BL, Liang YX, Zheng YX, Ong CN. The effects of exposure to aluminum on neurobehavioural function and dopaminergic metabolism. Int J Environ Health Res. 1998;8(2):101–10. Available from:
  17. Deschamps FJ, Lesage FX, Chobriat J, Py N, Novella JL. Exposure Risk Assessment in an Aluminum Salvage Plant. J Occup Environ Med. 2009;51(11):1267–74. Available from:
  18. Guo G, Ma H, Wang X, Liang Y. Age-dependent differences of neurobehavioural function among workers exposed to aluminum. J Environ Med. 1999;1(2):81–5. Available from:;2-W
  19. Polizzi S, Pira E, Ferrara M, Bugiani M, Papaleo A, Albera R, et al. Neurotoxic effects of aluminum among foundry workers and Alzheimer’s disease. Neurotoxicology. 2002;23(6):761–74. Available from:
  20. Kilburn KH. Neurobehavioral impairment and symptoms associated with aluminum remelting. Arch Environ Heal An Int J. 1998;53(5):329–35. Available from:
  21. Zawilla NH, Taha FM, Kishk NA, Farahat SA, Farghaly M, Hussein M. Occupational exposure to aluminum and its amyloidogenic link with cognitive functions. J Inorg Biochem. 2014;139:57–64. Available from:
  22. Sjogren B, Gustavsson P, Hogstedt C. Neuropsychiatric symptoms among welders exposed to neurotoxic metals. Occup Environ Med. 1990;47(10):704–7. Available from:
  23. Akila R, Stollery BT, Riihimaki V. Decrements in cognitive performance in metal inert gas welders exposed to aluminum. Occup Environ Med. 1999;56(9):632–9. Available from:
  24. Riihimäki V, Hänninen H, Akila R, Kovala T, Kuosma E, Paakkulainen H, et al. Body burden of aluminum in relation to central nervous system function among metal inert-gas welders. Scand J Work Environ Health. 2000;26(2):118–30. Available from:
  25. Giorgianni CM, D’Arrigo G, Brecciaroli R, Abbate A, Spatari G, Tringali MA, et al. Neurocognitive effects in welders exposed to aluminum. Toxicol Ind Health. 2014;30(4):347–56. Available from:
  26. Yokel RA. The toxicology of aluminum in the brain: a review. In: NeuroToxicology. 2000. p. 813–28. Available from:
  27. Yokel RA, McNamara PJ. Aluminum toxicokinetics: an updated minireview. Pharmacol Toxicol. 2001;88(4):159–67. Available from:
  28. Yokel RA. Blood-brain barrier flux of aluminum, manganese, iron and other metals suspected to contribute to metal-induced neurodegeneration. Miu AC, Benga O, editors. J Alzheimer’s Dis. 2006;10(2–3):223–53. Available from:
  29. Maya S, Prakash T, Madhu K Das, Goli D. Multifaceted effects of aluminum in neurodegenerative diseases: a review. Biomed Pharmacother. 2016;83:746–54. Available from:
  30. Verstraeten S V., Aimo L, Oteiza PI. Aluminum and lead: molecular mechanisms of brain toxicity. Arch Toxicol. 2008;82(11):789–802. Available from:
  31. Kumar V, Gill KD. Aluminum neurotoxicity: neurobehavioural and oxidative aspects. Arch Toxicol. 2009;83(11):965–78. Available from:
  32. Kumar V, Gill KD. Oxidative stress and mitochondrial dysfunction in aluminum neurotoxicity and its amelioration: a review. Neurotoxicology. 2014;41:154–66. Available from:
  33. Bondy SC. The neurotoxicity of environmental aluminum is still an issue. Neurotoxicology. 2010;31(5):575–81. Available from:
  34. Bondy SC. Prolonged exposure to low levels of aluminum leads to changes associated with brain aging and neurodegeneration. Toxicology. 2014;315:1–7. Available from:
  35. Bondy SC. Low levels of aluminum can lead to behavioral and morphological changes associated with Alzheimer’s disease and age-related neurodegeneration. Neurotoxicology. 2016;52:222–9. Available from:
  36. Kawahara M. Effects of aluminum on the nervous system and its possible link with neurodegenerative diseases. J Alzheimer’s Dis. 2005;8(2):171–82. Available from:

How to Cite

Silvia, N., Adi Heru Sutomo, & Indwiani Astuti. (2022). Effect of occupational aluminum exposure on cognitive function among informal aluminum foundry industry workers . Bali Medical Journal, 11(2), 1034–1040.




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