Abstract：
BACKGROUND: We aimed to assess evidence of long-term effects of exposure to radiofrequency (RF) electromagnetic fields (EMF) on indicators of cognition, including domains of learning and memory, executive function, complex attention, language, perceptual motor ability and social cognition, and of an exposure-response relationship between RF-EMF and cognition.
METHODS: We searched PubMed, Embase, PsycInfo and the EMF-Portal on September 30, 2022 without limiting by date or language of publication. We included cohort or case-control studies that evaluated the effects of RF exposure on cognitive function in one or more of the cognitive domains. Studies were rated for risk of bias using the OHAT tool and synthesised using fixed effects meta-analysis. We assessed the certainty of the evidence using the GRADE approach and considered modification by OHAT for assessing evidence of exposures.
RESULTS: We included 5 studies that reported analyses of data from 4 cohorts with 4639 participants consisting of 2808 adults and 1831 children across three countries (Australia, Singapore and Switzerland) conducted between 2006 and 2017. The main source of RF-EMF exposure was mobile (cell) phone use measured as calls per week or minutes per day. For mobile phone use in children, two studies (615 participants) that compared an increase in mobile phone use to a decrease or no change were included in meta-analyses. Learning and memory. There was little effect on accuracy (mean difference, MD -0.03; 95% CI -0.07 to 0.02) or response time (MD -0.01; 95% CI -0.04 to 0.02) on the one-back memory task; and accuracy (MD -0.02; 95%CI -0.04 to 0.00) or response time (MD -0.01; 95%CI -0.04 to 0.03) on the one card learning task (low certainty evidence for all outcomes). Executive function. There was little to no effect on the Stroop test for the time ratio ((B-A)/A) response (MD 0.02; 95% CI -0.01 to 0.04, very low certainty) or the time ratio ((D-C)/C) response (MD 0.00; 95% CI -0.06 to 0.05, very low certainty), with both tests measuring susceptibility to interference effects. Complex attention. There was little to no effect on detection task accuracy (MD 0.02; 95% CI -0.04 to 0.08), or response time (MD 0.02;95% CI 0.01 to 0.03), and little to no effect on identification task accuracy (MD 0.00; 95% CI -0.04 to 0.05) or response time (MD 0.00;95% CI -0.01 to 0.02) (low certainty evidence for all outcomes). No other cognitive domains were investigated in children. A single study among elderly people provided very low certainty evidence that more frequent mobile phone use may have little to no effect on the odds of a decline in global cognitive function (odds ratio, OR 0.81; 95% CI 0.42 to 1.58, 649 participants) or a decline in executive function (OR 1.07; 95% CI 0.37 to 3.05, 146 participants), and may lead to a small, probably unimportant, reduction in the odds of a decline in complex attention (OR 0.67;95%CI 0.27 to 1.68, 159 participants) and a decline in learning and memory (OR 0.75; 95% CI 0.29 to 1.99, 159 participants). An exposure-response relationship was not identified for any of the cognitive outcomes.
CONCLUSIONS: This systematic review and meta-analysis found only a few studies that provided very low to low certainty evidence of little to no association between RF-EMF exposure and learning and memory, executive function and complex attention. None of the studies among children reported on global cognitive function or other domains of cognition. Only one study reported a lack of an effect for all domains in elderly persons but this was of very low certainty evidence. Further studies are needed to address all types of populations, exposures and cognitive outcomes, particularly studies investigating environmental and occupational exposure in adults. Future studies also need to address uncertainties in the assessment of exposure and standardise testing of specific domains of cognitive function to enable synthesis across studies and increase the certainty of the evidence.
UNASSIGNED: This review was partially funded by the WHO radioprotection programme and prospectively registered on PROSPERO CRD42021257548.
METHODS: We searched PubMed, Embase, PsycInfo and the EMF-Portal on September 30, 2022 without limiting by date or language of publication. We included cohort or case-control studies that evaluated the effects of RF exposure on cognitive function in one or more of the cognitive domains. Studies were rated for risk of bias using the OHAT tool and synthesised using fixed effects meta-analysis. We assessed the certainty of the evidence using the GRADE approach and considered modification by OHAT for assessing evidence of exposures.
RESULTS: We included 5 studies that reported analyses of data from 4 cohorts with 4639 participants consisting of 2808 adults and 1831 children across three countries (Australia, Singapore and Switzerland) conducted between 2006 and 2017. The main source of RF-EMF exposure was mobile (cell) phone use measured as calls per week or minutes per day. For mobile phone use in children, two studies (615 participants) that compared an increase in mobile phone use to a decrease or no change were included in meta-analyses. Learning and memory. There was little effect on accuracy (mean difference, MD -0.03; 95% CI -0.07 to 0.02) or response time (MD -0.01; 95% CI -0.04 to 0.02) on the one-back memory task; and accuracy (MD -0.02; 95%CI -0.04 to 0.00) or response time (MD -0.01; 95%CI -0.04 to 0.03) on the one card learning task (low certainty evidence for all outcomes). Executive function. There was little to no effect on the Stroop test for the time ratio ((B-A)/A) response (MD 0.02; 95% CI -0.01 to 0.04, very low certainty) or the time ratio ((D-C)/C) response (MD 0.00; 95% CI -0.06 to 0.05, very low certainty), with both tests measuring susceptibility to interference effects. Complex attention. There was little to no effect on detection task accuracy (MD 0.02; 95% CI -0.04 to 0.08), or response time (MD 0.02;95% CI 0.01 to 0.03), and little to no effect on identification task accuracy (MD 0.00; 95% CI -0.04 to 0.05) or response time (MD 0.00;95% CI -0.01 to 0.02) (low certainty evidence for all outcomes). No other cognitive domains were investigated in children. A single study among elderly people provided very low certainty evidence that more frequent mobile phone use may have little to no effect on the odds of a decline in global cognitive function (odds ratio, OR 0.81; 95% CI 0.42 to 1.58, 649 participants) or a decline in executive function (OR 1.07; 95% CI 0.37 to 3.05, 146 participants), and may lead to a small, probably unimportant, reduction in the odds of a decline in complex attention (OR 0.67;95%CI 0.27 to 1.68, 159 participants) and a decline in learning and memory (OR 0.75; 95% CI 0.29 to 1.99, 159 participants). An exposure-response relationship was not identified for any of the cognitive outcomes.
CONCLUSIONS: This systematic review and meta-analysis found only a few studies that provided very low to low certainty evidence of little to no association between RF-EMF exposure and learning and memory, executive function and complex attention. None of the studies among children reported on global cognitive function or other domains of cognition. Only one study reported a lack of an effect for all domains in elderly persons but this was of very low certainty evidence. Further studies are needed to address all types of populations, exposures and cognitive outcomes, particularly studies investigating environmental and occupational exposure in adults. Future studies also need to address uncertainties in the assessment of exposure and standardise testing of specific domains of cognitive function to enable synthesis across studies and increase the certainty of the evidence.
UNASSIGNED: This review was partially funded by the WHO radioprotection programme and prospectively registered on PROSPERO CRD42021257548.
摘要：
背景：我们旨在评估暴露于射频（RF）电磁场（EMF）对认知指标的长期影响的证据，包括学习和记忆领域，执行功能，复杂的注意力,语言,感知运动能力和社会认知，以及RF-EMF与认知之间的暴露-反应关系。
方法：我们搜索了PubMed，Embase,PsycInfo和EMF门户于2022年9月30日发布，不受发布日期或语言的限制。我们纳入了队列或病例对照研究，评估了射频暴露对一个或多个认知领域认知功能的影响。使用OHAT工具对研究进行偏倚风险评级，并使用固定效应荟萃分析进行综合。我们使用GRADE方法评估了证据的确定性，并考虑了OHAT对评估暴露证据的修改。
结果：我们纳入了5项研究，这些研究报告了来自4个队列的数据分析，这些队列中有4639名参与者，包括三个国家的2808名成年人和1831名儿童（澳大利亚，新加坡和瑞士）在2006年至2017年之间进行。RF-EMF暴露的主要来源是移动（手机）电话的使用，以每周通话或每天几分钟的时间来衡量。对于儿童使用手机，两项研究(615名参与者)将手机使用量增加与手机使用量减少或无变化进行比较,纳入荟萃分析.学习和记忆。对准确性影响不大(平均差，MD-0.03；95％CI-0.07至0.02）或单回记忆任务的响应时间（MD-0.01；95％CI-0.04至0.02）；以及单卡学习任务的准确性（MD-0.02；95CI-0.04至0.00）或响应时间（MD-0.01；95CI-0.04至0.03）（所有结果的低确定性证据）。执行功能。对于时间比（（B-A）/A）响应（MD0.02；95％CI-0.01至0.04，非常低的确定性）或时间比（（D-C）/C）响应（MD0.00；95％CI-0.06至0.05，非常低的确定性），对Stroop检验几乎没有影响，两种测试都测量对干扰影响的敏感性。复杂的注意力。对检测任务精度几乎没有影响(MD0.02；95%CI-0.04至0.08)，或响应时间（MD0.02；95%CI0.01至0.03），对识别任务准确性(MD0.00;95%CI-0.04~0.05)或应答时间(MD0.00;95%CI-0.01~0.02)影响很小,甚至没有影响(所有结局的低确定性证据).没有对儿童的其他认知领域进行调查。一项针对老年人的研究提供了非常低的确定性证据，表明更频繁地使用手机可能对全球认知功能下降的几率几乎没有影响（优势比，OR0.81；95%CI0.42至1.58，649名参与者）或执行功能下降（OR1.07；95%CI0.37至3.05，146名参与者），并可能导致一个小的，可能不重要,复杂注意力下降的几率降低(OR0.67;95CI0.27~1.68,159名参与者)和学习和记忆下降的几率降低(OR0.75;95%CI0.29~1.99,159名参与者).没有发现任何认知结果的暴露-反应关系。
结论：这项系统评价和荟萃分析发现，只有少数研究提供了非常低至低确定性的证据，证明RF-EMF暴露与学习和记忆之间几乎没有关联，执行功能和复杂的注意力。儿童中没有一项研究报道了整体认知功能或其他认知领域。只有一项研究报告对老年人的所有领域都缺乏影响，但这是确定性非常低的证据。需要进一步的研究来解决所有类型的人群，暴露和认知结果，特别是调查成人环境和职业暴露的研究。未来的研究还需要解决暴露评估中的不确定性，并对认知功能的特定领域进行标准化测试，以实现跨研究的综合并增加证据的确定性。
■这项审查部分由世界卫生组织辐射防护计划资助，并在PROSPEROCRD42021257548上进行了前瞻性注册。
方法：我们搜索了PubMed，Embase,PsycInfo和EMF门户于2022年9月30日发布，不受发布日期或语言的限制。我们纳入了队列或病例对照研究，评估了射频暴露对一个或多个认知领域认知功能的影响。使用OHAT工具对研究进行偏倚风险评级，并使用固定效应荟萃分析进行综合。我们使用GRADE方法评估了证据的确定性，并考虑了OHAT对评估暴露证据的修改。
结果：我们纳入了5项研究，这些研究报告了来自4个队列的数据分析，这些队列中有4639名参与者，包括三个国家的2808名成年人和1831名儿童（澳大利亚，新加坡和瑞士）在2006年至2017年之间进行。RF-EMF暴露的主要来源是移动（手机）电话的使用，以每周通话或每天几分钟的时间来衡量。对于儿童使用手机，两项研究(615名参与者)将手机使用量增加与手机使用量减少或无变化进行比较,纳入荟萃分析.学习和记忆。对准确性影响不大(平均差，MD-0.03；95％CI-0.07至0.02）或单回记忆任务的响应时间（MD-0.01；95％CI-0.04至0.02）；以及单卡学习任务的准确性（MD-0.02；95CI-0.04至0.00）或响应时间（MD-0.01；95CI-0.04至0.03）（所有结果的低确定性证据）。执行功能。对于时间比（（B-A）/A）响应（MD0.02；95％CI-0.01至0.04，非常低的确定性）或时间比（（D-C）/C）响应（MD0.00；95％CI-0.06至0.05，非常低的确定性），对Stroop检验几乎没有影响，两种测试都测量对干扰影响的敏感性。复杂的注意力。对检测任务精度几乎没有影响(MD0.02；95%CI-0.04至0.08)，或响应时间（MD0.02；95%CI0.01至0.03），对识别任务准确性(MD0.00;95%CI-0.04~0.05)或应答时间(MD0.00;95%CI-0.01~0.02)影响很小,甚至没有影响(所有结局的低确定性证据).没有对儿童的其他认知领域进行调查。一项针对老年人的研究提供了非常低的确定性证据，表明更频繁地使用手机可能对全球认知功能下降的几率几乎没有影响（优势比，OR0.81；95%CI0.42至1.58，649名参与者）或执行功能下降（OR1.07；95%CI0.37至3.05，146名参与者），并可能导致一个小的，可能不重要,复杂注意力下降的几率降低(OR0.67;95CI0.27~1.68,159名参与者)和学习和记忆下降的几率降低(OR0.75;95%CI0.29~1.99,159名参与者).没有发现任何认知结果的暴露-反应关系。
结论：这项系统评价和荟萃分析发现，只有少数研究提供了非常低至低确定性的证据，证明RF-EMF暴露与学习和记忆之间几乎没有关联，执行功能和复杂的注意力。儿童中没有一项研究报道了整体认知功能或其他认知领域。只有一项研究报告对老年人的所有领域都缺乏影响，但这是确定性非常低的证据。需要进一步的研究来解决所有类型的人群，暴露和认知结果，特别是调查成人环境和职业暴露的研究。未来的研究还需要解决暴露评估中的不确定性，并对认知功能的特定领域进行标准化测试，以实现跨研究的综合并增加证据的确定性。
■这项审查部分由世界卫生组织辐射防护计划资助，并在PROSPEROCRD42021257548上进行了前瞻性注册。
