Neurodegenerative Diseases: An Overview of Environmental Risk Factors
Brown, Rebecca C., Lockwood, Alan H., Sonawane, Babasaheb R., Environmental Health Perspectives
The population of the United States is aging, and an ever-increasing number of Americans are afflicted with neurodegenerative diseases. Because the pathogenesis of many of these diseases remains unknown, we must consider that environmental factors may play a causal role. This review provides an overview of the epidemiologic evidence for environmental etiologies for neurodegenerative diseases such as Alzheimer disease, Parkinson disease, parkinsonian syndromes (multiple system atrophy and progressive supranuclear palsy), and amyotrophic lateral sclerosis. Epidemiologic evidence for an association between environmental agents' exposure and neurodegenerative diseases is not conclusive. However, there are indications that there may be causal links, and the need for more research is obvious. Key words: Alzheimer disease, amyotrophic lateral sclerosis, electromagnetic fields, metals, multiple system atrophy, neurodegeneration, Parkinson disease, pesticides, progressive supranuclear palsy, solvents. doi: 10.1289/ehp.7567 available via http://dx.doi.org/[Online 26 May 2005]
The population of the United States is aging, and an ever-increasing number of Americans are afflicted with neurodegenerative diseases. Neurodegenerative diseases result from the gradual and progressive loss of neural cells, leading to nervous system dysfunction. According to the National Institute of Neurological Disorders and Stroke, there are more than 600 neurologic disorders, with approximately 50 million Americans affected each year.
These diseases cost the U.S. economy billions of dollars each year in direct health care costs and lost opportunities; it is estimated that $100 billion per year is spent on Alzheimer disease (AD) alone (Meek et al. 1998). In addition to the financial costs, there is an immense emotional burden on patients and their caregivers. As the number of elderly citizens increases, these costs to society also will increase.
Until recently, most concerns about environmental agents have centered on their potential for causing cancer. Cancer and neurodegeneration represent opposite ends of a spectrum: whereas cancer is an uncontrolled proliferation of cells, neurodegeneration is the result of the death of cells, whether due to direct cell death by necrosis or the delayed process of apoptosis. Attention is now being focused on environmental agents' potential for damaging the developing and mature nervous system, resulting in neurodegenerative diseases.
Known risk factors for neurodegenerative disease include certain genetic polymorphisms and increasing age. Other possible causes may include gender, poor education, endocrine conditions, oxidative stress, inflammation, stroke, hypertension, diabetes, smoking, head trauma, depression, infection, tumors, vitamin deficiencies, immune and metabolic conditions, and chemical exposure. Because the pathogenesis of many of these diseases remains unknown, we must consider the role of environmental factors in these diseases.
In this review we examine the human evidence for environmental etiologies for some diagnosed neurodegenerative diseases. Epidemiologic literature, not case studies or experimental animal research, was searched for relevance to an association between neurodegenerative diseases and environmental agents. We briefly review genetics and lifestyle habits (e.g., smoking, coffee, alcohol) but not other potential risk factors such as age at onset, socioeconomic status, gender, ethnicity, and education. Although it is acknowledged that the etiology of neurodegenerative diseases is often multifactorial (particularly gene-environment interactions), the purpose of this review is to examine the extent of the available epidemiologic literature solely on environmental agents.
Study Type Selection
The greatest assurance for causality comes when the exposure to the environmental agent can be determined before the outcome. …