Psychological, neuropsychological, and electrocortical effects of mixed mold exposure

Crago BR, Gray MR, Nelson LA +3 more2004Archives of Environmental Health An International JournalJournal Article

Immune/InnateNeurologicalRespiratory/Sinus

Indoor Mold (Stachybotrys, Aspergillus, etc.)MycotoxinsWater-Damaged Buildings (WDB)

Abstract

The authors assessed the psychological, neuropsychological, and electrocortical effects of human exposure to mixed colonies of toxigenic molds. Patients (N = 182) with confirmed mold-exposure history completed clinical interviews, a symptom checklist (SCL-90-R), limited neuropsychological testing, quantitative electroencephalogram (QEEG) with neurometric analysis, and measures of mold exposure. Patients reported high levels of physical, cognitive, and emotional symptoms. Ratings on the SCL-90-R were "moderate" to "severe," with a factor reflecting situational depression accounting for most of the variance. Most of the patients were found to suffer from acute stress, adjustment disorder, or post-traumatic stress. Differential diagnosis confirmed an etiology of a combination of external stressors, along with organic metabolically based dysregulation of emotions and decreased cognitive functioning as a result of toxic or metabolic encephalopathy. Measures of toxic mold exposure predicted QEEG measures and neuropsychological test performance. QEEG results included narrowed frequency bands and increased power in the alpha and theta bands in the frontal areas of the cortex. These findings indicated a hypoactivation of the frontal cortex, possibly due to brainstem involvement and insufficient excitatory input from the reticular activating system. Neuropsychological testing revealed impairments similar to mild traumatic brain injury. In comparison with premorbid estimates of intelligence, findings of impaired functioning on multiple cognitive tasks predominated. A dose-response relationship between measures of mold exposure and abnormal neuropsychological test results and QEEG measures suggested that toxic mold causes significant problems in exposed individuals. Study limitations included lack of a comparison group, patient selection bias, and incomplete data sets that did not allow for comparisons among variables.

Key Biomarkers

Abnormal nerve conduction studiesAbnormal T and B cell subsetsAntinuclear autoantibodies (ANA)Autoantibodies against CNS and PNS myelinElevated neural autoantibodies (anti-myelin basic protein, anti-MAG, anti-GM1)QEEG abnormalities (increased alpha/theta bands, frontal hypoactivation)Trichothecene toxins in urine and serum

Symptom Clusters

Autonomic nervous system dysfunctionBalance and motor coordination impairmentCognitive impairment (memory loss, concentration deficits)Mood disturbance and emotional dysregulationNeuropsychological dysfunction (mild traumatic brain injury-like)Peripheral neuropathy (numbness, tingling, tremors, muscle weakness)Psychological symptoms (depression, acute stress, adjustment disorder, PTSD)Respiratory symptoms (rhinorrhea, wheezing, airway obstruction)

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