Schäffer Eva, Piel Johannes
Klinik für Neurologie, Universität Kiel, Universitätsklinikum Schleswig-Holstein, Arnold-Heller-Str. 3, 24105, Kiel, Deutschland.
Nervenarzt. 2023 Oct;94(10):892-903. doi: 10.1007/s00115-023-01538-9. Epub 2023 Aug 28.
Preventive measures addressing the exposome can counteract neurodegenerative diseases.
This article gives an overview on the influence of general and individual exogenous factors (environmental influences and lifestyle changes) as well as endogenous factors (e.g. metabolic alterations) on the development and progression of Alzheimer's disease (AD) and Parkinson's disease (PD).
Summary and evaluation of current scientific studies and evidence regarding the exposome and prevention of AD and PD.
Numerous studies could demonstrate a potential influence of environmental influences associated with industrialization (general exogenous factors), such as pesticides, solvents or air pollution on the development of AD and PD. Additionally, individually addressable changes of lifestyle (individual exogenous factors, e.g. physical activity, cognitive stimulation, nutrition and sleep) contribute to disease protection and modification and are becoming increasingly more important in light of still limited therapeutic interventions. Moreover, other exogenous factors (medication, noise pollution, head trauma and heavy metals) are discussed as risk factors for AD and/or PD. Endogenous factors (e.g., changes of the enteral microbiome, systemic inflammation and neuroinflammation, metabolic changes) can contribute to disease development by a higher potential for interacting with exogenous factors.
Despite the comprehensive scientific evidence confirming the significance of the exposome for the pathogenesis of AD and PD, the great potential of preventive measures has not yet been exploited. A clarification of the high potential of lifestyle changes should be a therapeutic standard not only for individuals with manifest PD/AD but also for individuals with a risk profile or with suspected prodromal disease. Further investigations on the influence of environmental factors and the implementation of preventive strategies to avoid exposure should be the focus of international efforts.
针对暴露组的预防措施可对抗神经退行性疾病。
本文概述一般和个体外源性因素（环境影响和生活方式改变）以及内源性因素（如代谢改变）对阿尔茨海默病（AD）和帕金森病（PD）发生和进展的影响。
总结和评估当前有关暴露组以及AD和PD预防的科学研究及证据。
众多研究表明，与工业化相关的环境影响（一般外源性因素），如农药、溶剂或空气污染，对AD和PD的发生有潜在影响。此外，可个体调节的生活方式改变（个体外源性因素，如体育活动、认知刺激、营养和睡眠）有助于疾病预防和改善，鉴于目前治疗干预措施仍然有限，其重要性日益凸显。此外，其他外源性因素（药物、噪音污染、头部创伤和重金属）也被讨论为AD和/或PD的风险因素。内源性因素（如肠道微生物群变化、全身炎症和神经炎症、代谢变化）可通过与外源性因素更高的相互作用潜力促进疾病发展。
尽管有全面的科学证据证实暴露组对AD和PD发病机制的重要性，但预防措施的巨大潜力尚未得到充分利用。阐明生活方式改变的巨大潜力不仅应成为确诊PD/AD患者的治疗标准，也应成为具有风险特征或疑似前驱疾病患者的治疗标准。对环境因素影响的进一步研究以及实施预防策略以避免暴露应成为国际努力的重点。
