Occup Environ Med 64:723-732 doi:10.1136/oem.2006.028209
  • Review

Occupational risk factors in Alzheimers disease: a review assessing the quality of published epidemiological studies

  1. Miguel Santibez1,
  2. Francisco Bolumar2,
  3. Ana M Garca1
  1. 1
    Department of Preventive Medicine and Public Health, University Miguel Hernandez, Spain
  2. 2
    Department of Health Sciences, University of Alcala, Madrid, Spain
  1. Dr M Santibez Margello, Occupational Health Unit, Public Health Centre, Antonio Mora Ferrndez 51, 03202 Elche, Alicante, Spain; santibanyez_mig{at}
  • Accepted 16 February 2007
  • Published Online First 24 May 2007


Epidemiological evidence of an association between Alzheimers disease AD and the most frequently studied occupational exposurespesticides, solvents, electromagnetic fields EMF, lead and aluminiumis inconsistent. Epidemiological studies published up to June of 2003 were systematically searched through PubMed and Toxline. Twenty-four studies 21 casecontrol and 3 cohort studies were included. Median GQI was 36.6 range 19.562.9. Most of the casecontrol studies had a GQI of <50. The study with the highest score was a cohort study. Likelihood of exposure misclassification bias affected 18 of the 24 studies. Opportunity for bias arising from the use of surrogate informants affected 17 studies, followed by disease misclassification 11 studies and selection bias 10 studies. Eleven studies explored the relationship of AD with solvents, seven with EMF, six with pesticides, six with lead and three with aluminium. For pesticides, studies of greater quality and prospective design found increased and statistically significant associations. For the remaining occupational agents, the evidence of association is less consistent for solvents and EMF or absent for lead and aluminium.


  • Competing interests: None

  • Abbreviations:
    Alzheimers disease
    apolipoprotein E genotype epsilon 4 allele
    adjusted relative risk
    electromagnetic fields
    Global Quality Index