Neurocognitive Analysis of Low-level Arsenic Exposure and Executive Function Mediated by Brain Anomalies Among Children, Adolescents, and Young Adults in India
Authors: Vaidya Nilakshi , Holla Bharath , Heron Jon , Sharma Eesha , Zhang Yuning , Fernandes Gwen , Iyengar Udita , Spiers Alex , Yadav Anupa , Das Surajit , Roy Sanjit , Ahuja Chirag K. , Barker Gareth J. , Basu Debasish , Bharath Rose Dawn , Hickman Matthew , Jain Sanjeev , Kalyanram Kartik , Kartik Kamakshi , Krishna Murali , Krishnaveni Ghattu , Kumaran Kalyanaraman , Kuriyan Rebecca , Murthy Pratima , Papadopoulos Orfanos Dimitri , Purushottam Meera , Kurpad Sunita Simon , Singh Lenin , Singh Roshan , Subodh B. N. , Toledano Mireille , Walter Henrik , Desrivières Sylvane , Chakrabarti Amit , Benegal Vivek , Schumann Gunter ,   Consortium on Vulnerability to Externalizing Disorders and Addictions (cVEDA), Varghese Mathew , Thennarasu Kandavel , Metha Urvakhsh , Girimaji Satish , Jacob Preeti , Jayarajan Deepak , Kumar Keshav , Narayanan Gitanjali , Khullar Madhu , Khandelwal Niranjan , Ghosh Abhishek , Joshi Nainesh , Debala Chanu Ningthoujam , M.C. Fujica , Ph. Victoria , Phurailatpam Celina , Bhattacharya Debangana , Haque Bidisha , Nagraj Alisha , Ghosh Arpita , Basu Anirban , Pandit Mriganka , Das Subhadip , Maurya Pawan , Gourisankar Amritha , Rani T Geetha , B Sujatha , Rangaswamy Madhavi , Fall Caroline , KN Kiran , MC Ramya , Urs Chaitra , N Santhosh , R Somashekhara , K Divyashree , Rao Arathi , R Poornima , Tripathy Saswathika , Parashar Neha , K B Nayana , Seshadri Ashwini , Kumar Sathish , Baligar Suneela , Arumugam Thamodaran , Safai Apoorva , Cyril Anthony , Roy Ashika , D Dhanalakshmi , D Shivamma , B R Bhavana 
Published: May 2023

ImportanceArsenic, a contaminant of groundwater and irrigated crops, is a global public health hazard. Exposure to low levels of arsenic through food extends well beyond the areas with high arsenic content in water.ObjectiveTo identify cognitive impairments following commonly prevalent low-level arsenic exposure and characterize their underlying brain mechanisms.Design, Setting, and ParticipantsThis multicenter population-based cohort study analyzed cross-sectional data of the Indian Consortium on Vulnerability to Externalizing Disorders and Addictions (cVEDA) cohort, recruited between November 4, 2016, and May 4, 2019. Participants aged 6 to 23 years were characterized using deep phenotyping measures of behavior, neuropsychology, psychopathology, brain neuroimaging, and exposure to developmental adversities and environmental neurotoxins. All analyses were performed between June 1, 2020, and December 31, 2021.ExposureArsenic levels were measured in urine as an index of exposure.Main Outcomes and MeasuresExecutive function measured using the cVEDA neuropsychological battery, gray matter volume (GMV) from T1-weighted magnetic resonance imaging, and functional network connectivity measures from resting state functional magnetic resonance imaging.ResultsA total of 1014 participants aged 6 to 23 years (589 male [58.1%]; mean [SD] age, 14.86 [4.79] years) were included from 5 geographic locations. Sparse-partial least squares analysis was used to describe a negative association of arsenic exposure with executive function (r = −0.12 [P = 5.4 × 10−4]), brain structure (r = −0.20 [P = 1.8 × 10−8]), and functional connectivity (within network, r = −0.12 [P = 7.5 × 10−4]; between network, r = −0.23 [P = 1.8 × 10−10]). Alterations in executive function were partially mediated by GMV (b = −0.004 [95% CI, −0.007 to −0.002]) and within-network functional connectivity (b = −0.004 [95% CI, −0.008 to −0.002]). Socioeconomic status and body mass index moderated the association between arsenic and GMV, such that the association was strongest in participants with lower socioeconomic status and body mass index.Conclusions and RelevanceThe findings of this cross-sectional study suggest that low-level arsenic exposure was associated with alterations in executive functioning and underlying brain correlates. These results indicate potential detrimental consequences of arsenic exposure that are below the currently recommended guidelines and may extend beyond endemic risk areas. Precision medicine approaches to study global mental health vulnerabilities highlight widespread but potentially modifiable risk factors and a mechanistic understanding of the impact of low-level arsenic exposure on brain development.