From the Lerner College of Medicine (S.L.), Cleveland Clinic, OH; and Neurological Institute (A.K.C., A.S., J.R., M.M., D.O., A.D.), Cleveland Clinic, OH.
Neurology. 2023 Mar 7;100(10):474-483. doi: 10.1212/WNL.0000000000201630. Epub 2022 Nov 16.
Although the international community collectively seeks to reduce global temperature rise to less than 1.5°C before 2100, irreversible environmental changes have already occurred, and as the planet warms, these changes will continue to occur. As we witness the effects of a warming planet on human health, it is imperative that neurologists anticipate how the epidemiology and incidence of neurologic disease may change. In this review, we organized our analysis around 3 key themes related to climate change and neurologic health: extreme weather events and temperature fluctuations, emerging neuroinfectious diseases, and pollutant impacts. Across each of these themes, we appraised and reviewed recent literature relevant to neurologic disease and practice.
Studies were identified using search terms relating to climate change, pollutants, and neurologic disease in PubMed, OVID MEDLINE, EMBASE, PsycInfo, and gray literature. Studies published between 1990 and 2022 were included if they pertained to human incidence or prevalence of disease, were in English, and were relevant to neurologic disease.
We identified a total of 364 articles, grouped into the 3 key themes of our study: extreme weather events and temperature fluctuations (38 studies), emerging neuroinfectious diseases (37 studies), and pollutant impacts (289 studies). The included studies highlighted the relationships between neurologic symptom exacerbation and temperature variability, tick-borne infections and warming climates, and airborne pollutants and cerebrovascular disease incidence and severity.
Temperature extremes and variability both associated with stroke incidence and severity, migraine headaches, hospitalization in patients with dementia, and multiple sclerosis exacerbations. Exposure to airborne pollutants, especially PM2.5 and nitrates, associated with stroke incidence and severity, headaches, dementia risk, Parkinson disease, and MS exacerbation. Climate change has demonstrably expanded favorable conditions for zoonotic diseases beyond traditional borders and poses the risk of disease in new, susceptible populations. Articles were biased toward resource-rich regions, suggesting a discordance between where research occurs and where changes are most acute. As such, 3 key priorities emerged for further study: neuroinfectious disease risk mitigation, understanding the pathophysiology of airborne pollutants on the nervous system, and methods to improve delivery of neurologic care in the face of climate-related disruptions.
尽管国际社会共同致力于将 2100 年前全球升温幅度控制在 1.5°C 以下，但不可逆转的环境变化已经发生，随着地球变暖，这些变化将继续发生。随着我们目睹地球变暖对人类健康的影响，神经学家必须预测神经疾病的流行病学和发病率可能会发生怎样的变化。在本综述中，我们围绕与气候变化和神经健康相关的 3 个关键主题组织了分析：极端天气事件和温度波动、新兴的神经传染性疾病和污染物影响。在每个主题中，我们评估和审查了与神经疾病和实践相关的最新文献。
使用与气候变化、污染物和神经疾病相关的搜索词在 PubMed、OVID MEDLINE、EMBASE、PsycInfo 和灰色文献中搜索研究。如果研究涉及疾病的人类发病率或患病率、用英文撰写且与神经疾病相关，则将其纳入 1990 年至 2022 年期间发表的研究。
我们共确定了 364 篇文章，分为我们研究的 3 个关键主题：极端天气事件和温度波动（38 篇研究）、新兴的神经传染性疾病（37 篇研究）和污染物影响（289 篇研究）。纳入的研究强调了神经症状恶化与温度变化、蜱传感染与气候变暖以及空气污染物与脑血管疾病发病率和严重程度之间的关系。
极端温度和温度变化均与中风的发病率和严重程度、偏头痛、痴呆患者住院和多发性硬化症恶化有关。暴露于空气污染物，特别是 PM2.5 和硝酸盐，与中风的发病率和严重程度、头痛、痴呆风险、帕金森病和多发性硬化症恶化有关。气候变化显然扩大了人畜共患病的有利条件，超出了传统边界，并对新的易感人群构成了疾病风险。文章存在偏向资源丰富地区的偏见，表明研究开展的地点与变化最明显的地点之间存在不一致。因此，出现了 3 个优先事项，需要进一步研究：神经传染性疾病风险缓解、了解空气污染物对神经系统的病理生理学影响，以及在面对与气候相关的破坏时改善神经护理的方法。
