Reddy Oliver Cameron, van der Werf Ysbrand D
Department of Anatomy and Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, De Boelelaan, 1117 Amsterdam, The Netherlands.
Brain Sci. 2020 Nov 17;10(11):868. doi: 10.3390/brainsci10110868.
The glymphatic system is a "pseudo-lymphatic" perivascular network distributed throughout the brain, responsible for replenishing as well as cleansing the brain. Glymphatic clearance is the macroscopic process of convective fluid transport in which harmful interstitial metabolic waste products are removed from the brain intima. This paper addresses the glymphatic system, its dysfunction and the major consequences of impaired clearance in order to link neurodegeneration and glymphatic activity with lifestyle choices. Glymphatic clearance can be manipulated by sleep deprivation, cisterna magna puncture, acetazolamide or genetic deletion of AQP4 channels, but how lifestyle choices affect this brain-wide clearance system remains to be resolved. This paper will synthesize existing literature on glymphatic clearance, sleep, Alzheimer's disease and lifestyle choices, in order to harness the power of this mass transport system, promote healthy brain ageing and possibly prevent neurodegenerative processes. This paper concludes that 1. glymphatic clearance plays a major role in Alzheimer's pathology; 2. the vast majority of waste clearance occurs during sleep; 3. dementias are associated with sleep disruption, alongside an age-related decline in AQP4 polarization; and 4. lifestyle choices such as sleep position, alcohol intake, exercise, omega-3 consumption, intermittent fasting and chronic stress all modulate glymphatic clearance. Lifestyle choices could therefore alter Alzheimer's disease risk through improved glymphatic clearance, and could be used as a preventative lifestyle intervention for both healthy brain ageing and Alzheimer's disease.
脑淋巴系统是一个分布于整个大脑的“类淋巴”血管周围网络，负责大脑的补充和清洁。脑淋巴清除是对流液体运输的宏观过程，在此过程中，有害的间质代谢废物从脑实质中被清除。本文探讨了脑淋巴系统、其功能障碍以及清除受损的主要后果，以便将神经退行性变和脑淋巴活动与生活方式选择联系起来。脑淋巴清除可通过睡眠剥夺、枕大池穿刺、乙酰唑胺或水通道蛋白4（AQP4）通道的基因缺失来操控，但生活方式选择如何影响这个全脑清除系统仍有待解决。本文将综合关于脑淋巴清除、睡眠、阿尔茨海默病和生活方式选择的现有文献，以便利用这个物质运输系统的力量，促进大脑健康老化并可能预防神经退行性过程。本文得出以下结论：1. 脑淋巴清除在阿尔茨海默病病理学中起主要作用；2. 绝大多数废物清除发生在睡眠期间；3. 痴呆症与睡眠中断有关，同时伴有与年龄相关的AQP4极化下降；4. 睡眠姿势、酒精摄入、运动、ω-3脂肪酸摄入、间歇性禁食和慢性应激等生活方式选择均会调节脑淋巴清除。因此，生活方式选择可通过改善脑淋巴清除来改变患阿尔茨海默病的风险，并可作为促进大脑健康老化和预防阿尔茨海默病的预防性生活方式干预措施。
