Open Access Maced J Med Sci. 2020 Apr 25; 8(E):81-86. 81 Scientifc Foundation SPIROSKI, Skopje, Republic of Macedonia Open Access Macedonian Journal of Medical Sciences. 2020 Apr 25; 8(E):81-86. https://doi.org/10.3889/oamjms.2020.3985 eISSN: 1857-9655 Category: E - Public Health Section: Public Health Disease Control Blood Cholinesterase Level is Associated with Cognitive Function in Indonesian School-age Children Exposed to Pesticides Rusdy Ghazali Malueka 1 *, Andrianor Rahman 1 , Ery Kus Dwianingsih 2 , Andre Stefanus Panggabean 1 , Halwan Fuad Bayuangga 1 , Sarastiti Alifaningdyah 1 , Meutia Rizki Innayah 1 , Sri Awalia Febriana 3 , Indarwati Setyaningsih 1 , Cempaka Thursina Srie Setyaningrum 1 , Abdul Gofr 1 , Sri Sutarni 1 , Ismail Setyopranoto 1 1 Department of Neurology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Dr Sardjito General Hospital, Yogyakarta, Indonesia; 2 Department of Anatomical Pathology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Dr Sardjito General Hospital, Yogyakarta, Indonesia; 3 Department of Dermatology and Venereology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Dr Sardjito General Hospital, Yogyakarta, Indonesia Abstract BACKGROUND: Pesticides are known as depressors of acetylcholinesterase (AChE) activity, resulting in the nervous system toxicity. The previous studies have described associations between AChE, a stable marker of pesticide poisoning, and cognitive performance in children. AIM: This study aimed to identify the association between blood AChE level and cognitive function in children exposed to pesticides in the Magelang Regency, Indonesia. METHODS: A cross-sectional study involving school-age children with a history of pesticide exposure in Ngablak, Magelang Regency, Central Java, Indonesia, was conducted. Blood AChE level was evaluated, and the Modifed Mini–Mental State Examination for Children (MMMSEC) was used to analyze the cognitive function of the children. RESULTS: In total, 56 subjects aged between 9 and 11 years were included in this study. Median blood AChE level was 9.64 kIU/L, and 24 subjects (42.9%) had low blood AChE levels. Median MMMSEC score was 33. Eleven subjects (19.6%) were found to have abnormal cognitive function. Bivariate analysis showed that blood AChE level was associated with MMMSEC score (r = 0.343, p = 0.010). Multiple linear regression showed that blood AChE level had a positive association with cognitive function in children, assessed using the MMMSEC score (β = 0.360; p = 0.006). Further analysis showed that the attention and orientation (memory function) domains of the MMMSEC were signifcantly associated with blood AChE level (β: 0.371 and 0.297, respectively, p < 0.05). CONCLUSIONS: Blood AChE level, a stable marker of pesticide poisoning, was positively associated with cognitive function in children, as assessed using the MMMSEC score. In particular, the orientation and attention domains of the MMMSEC were associated with blood AChE level. Introduction Indonesia is an agricultural country and approximately 40 million of its population work in the agricultural sector. The Indonesian government promotes the use of pesticides to increase the production of agricultural goods. As such, the use of pesticides in Indonesia shows an annual increase of approximately 6–20% [1], [2]. A previous study showed that the most common pesticides used by Indonesian farmers are organophosphates [3]. Cholinesterase inhibitors (organophosphates and carbamates) are known to reduce the activity of acetylcholinesterase (AChE), the primary enzyme responsible for the metabolism of acetylcholine [4]. The inhibition of AChE causes an increase in synaptic acetylcholine concentration, leading to nicotinic and muscarinic symptoms, and central peripheral nervous system toxicity [3]. Children are particularly vulnerable to pesticide intoxication. In agricultural areas, children can be exposed to pesticides by helping their parents on farms [2], or by simply living in agricultural communities that use pesticides (non-occupational pesticide exposure) [5]. Chronic and subacute pesticide exposure has been shown to afect neurobehavioral performance. The previous cohort studies have described positive associations between AChE activity and neurobehavioral performance [4], [5]. Furthermore, prenatal organophosphate exposure has been shown to be associated with mental and motor developmental retardation, general developmental disorders, and reduced attention, working memory, and intelligence in children [4]. This early exposure Edited by: Mirko Spiroski Citation: Malueka RG, Rahman A, Dwianingsih EK, Panggabean AS, Bayuangga HF, Alifaningdyah S, Innayah MR, Febriana SA, Setyaningsih I, Setyaningrum CTS, Gofr A, Sutarni S, Setyopranoto I. Blood Cholinesterase Level is Associated with Cognitive Function in Indonesian School-age Children Exposed to Pesticides. Open-Access Maced J Med Sci. 2020 Apr 25; 8(E):81-86. https://doi.org/10.3889/oamjms.2020.3985. Keywords: Ankle-brachial index; Lower extremity exercises; Type 2 diabetes mellitus patients *Correspondence: Rusdy Ghazali Malueka, Department of Neurology, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Dr Sardjito General Hospital, Jl. Kesehatan No. 1 Sekip, Yogyakarta 55284, Indonesia. Tel.: +62274543472. Fax.: +62274543472. E-mail: rusdy_gm@ugm.ac.id Received: 03-Nov-2019 Revised: 20-Feb-2020 Accepted: 31-Mar-2020 Copyright: © 2020 Rusdy Ghazali Malueka, Andrianor Rahman, Ery Kus Dwianingsih, Andre Stefanus Panggabean, Halwan Fuad Bayuangga, Sarastiti Alifaningdyah, Meutia Rizki Innayah, Sri Awalia Febriana, Indarwati Setyaningsih, Cempaka Thursina Srie Setyaningrum, Abdul Gofr, Sri Sutarni, Ismail Setyopranoto Funding: This study was supported by a grant from the Indonesian Ministry of Research, Technology, and Higher Education Competing Interests: The authors have declared that no competing interests exist Open Access: This is an open-access article distributed under the terms of the Creative Commons Attribution- NonCommercial 4.0 International License (CC BY-NC 4.0)