"퇴행성 뇌질환 예방 연구 결과 소개"

"Clinical trials for prevention of neurodegenerative diseases"

학습목표(Learning Objectives)

1. 교정이 가능한 치매의 위험인자를 숙지한다.

2. 파킨슨병의 위험인자와 보호인자를 숙지한다.

1. Please study the risk factors for   dementia that can be corrected.

2. Please study the potential protective   factors and risk factors for Parkinson’s diseae.

초록(Abstract)

Neurodegenerative diseases continue to increase because of extensions in lifespan, and are characterized by progressive neuronal death or dysfunction, resulting in debilitating and life-altering disabilities and significantly shortening life spans. Alzheimer's disease (AD) and Parkinson's disease (PD) are the first and second most common neurodegenerative diseases.

Potential protective factors of PD include tobacco abuse, physical activity, urate levels, NSAID use, calcium channel blocker use, statin use, use of some α1-adrenergic antagonists, and coffee-tea-caffeine consumption. Potential risk factors of PD include traumatic brain injury, pesticide exposure, organic solvent exposure, lead exposure, air pollution, Type 2 Diabetes, whole dairy products, cardiovascular disease, and some infections including Hepatitis C, H. pylori, and COVID-19. Potential non-environmental risk factors include bipolar disorder, essential tremor, bullous pemphigoid, and inflammatory bowel disease. Although many potential protective and risk factors for PD have been identified, none have yet led to unique, rigorous prevention trials or successful disease-modifying interventions.

A recent meta-analysis of population-based observational studies revealed that modifying risk factors may prevent or delay dementia by up to 45%. Those are less education in early life, hearing loss, traumatic brain injury, hypertension, diabetes mellitus, high LDL-cholesterol, smoking, excessive alcohol, obesity, physical inactivity, and depression in midlife, and visual loss, social isolation, and air pollution in later life. The Finnish geriatric intervention study to prevent cognitive impairment and disability, a two-year randomized controlled trial, demonstrated that it is possible to improve the cognitive function of older adults at risk of developing dementia through multidomain lifestyle interventions, including dietary counseling, physical exercise, cognitive training, and vascular and metabolic risk monitoring. The World Health Organization emphasized the importance of further research regarding the feasibility and efficacy of multidomain interventions, adjusted to specific geographical and cultural contexts.

In the south Korean study to prevent cognitive impairment and protect brain health through lifestyle intervention in at-risk elderly people, participants without dementia and with one or more modifiable dementia risk factors, aged 60-79 years, were randomly assigned to the facility-based multidomain intervention (MI) (FMI), the home-based MI (HMI), or the control group receiving general health advice. The total scale index score of Repeatable Battery for the Assessment of Neuropsychological Status improved significantly in the FMI and HMI groups compared to the control group. Serum brain-derived neurotrophic factor levels were significantly increased in the intervention group compared to the control group. Compared to the control group, plasma cortisol levels were significantly decreased in the intervention groups at the study endpoint. Compared with the control group, the mean global cortical thickness increased in the intervention group; particularly, cortical thickness of the bilateral frontotemporal lobes, cingulate gyri, and insula increased. In another randomized controlled trial, multidomain intervention with nutritional supplements improved cognition and gut microbiota in patients with early symptomatic AD who were amyloid-positive by PET. These results show thatmultidomain lifestyle interventions may prevent cognitive impairment in at-risk older people.