Aluminum exposure and cognitive performance: A meta-analysis

Background: Aluminum is increasingly used in various industrial processes due to its beneficial properties. Occupational exposure to aluminum, however, has been linked to several adverse health effects. The impact of occupational aluminum exposure on worker's cognitive performance and its contribution in developing neurodegenerative diseases is highly discussed with competing results.Method: We conducted a literature search via online databases until June 2023. Applicable studies fulfilling inclusion criteria investigating the effects of occupational aluminum exposure on cognitive functions were gathered. Results were aggregated using random effects meta-analysis and the effect size g. We further explored types of publication biases, moderating variables and exposure-effect relationships using meta-regressions.Results: The final sample consisted of 18 studies with 87 effect sizes for seven cognitive functions. We found significant worse performances in workers occupationally exposed to aluminum regarding processing speed, working memory, attention, and reaction time after exclusion of outliers. Additionally, we found increased blood plasma aluminum significantly predicting decreased cognitive performance in exposed workers.Conclusion: Our results show decreased performance levels in processing speed, working memory, attention and reaction time in workers occupationally exposed to aluminum compared to controls. Furthermore, we found that aluminum in blood plasma was the only biomarker as significant predictor of cognitive performance. We discuss recommendations for further research in relation to occupational health and safety. Finally, we extend the discourse between occupational aluminum exposure and development of neurodegenerative diseases like Alzheimer's disease.