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Neurodegenerative disease: The next occupational disease epidemic?
  1. Neil Pearce1,2,
  2. Hans Kromhout3
  1. 1Centre for Global NCDs, London School of Hygiene and Tropical Medicine, London, UK
  2. 2Centre for Public Health Research, Massey University Wellington Campus, Wellington, New Zealand
  3. 3Division of Environmental Epidemiology, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
  1. Correspondence to Professor Neil Pearce, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK; neil.pearce{at}lshtm.ac.uk

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Globally, neurological disorders account for about 4% of all deaths and about 5% of disability-adjusted life-years from non-communicable disease.1 Diagnosis of a neurological disease can be devastating, and in most instances there is no cure. A recent editorial in the Lancet2 commented that neurological diseases remain neglected and ignored: ‘unlike cancer, stroke, and diabetes, which all have strategies and clinical champions, degenerative disorders are heterogeneous and complex’.

Neurological disease includes a broad spectrum of conditions, several of which have occupational causes.

The motor neurone diseases (MND) are a spectrum of neurodegenerative disorders characterised by progressive muscular paralysis due to degeneration of motor neurones in the primary motor cortex, brainstem and spinal cord.3 Although the vast majority of cases of (MND) are ‘sporadic’ (ie, non-genetic), most current research into the causes of MND involves primarily or solely genetic factors and few studies of occupational or environmental causes of MND have been conducted. However, a number of occupational exposures are suspected of contributing to the risk of MND,4 including agricultural chemicals, welding, electrical occupations, electric shocks and extremely low-frequency electromagnetic fields, various metals and organic solvents and formaldehyde, although the evidence to date is inconsistent. Recently, a cluster of MND cases has been linked to exposure to methyl bromide.5 Other putative risk factors include military service, rural or urban residence and history of head injury including sporting injuries.6

Parkinson's disease (PD) is a neurodegenerative disease leading to multiple motor and non-motor symptoms with a progressive course and increasing disability. The causes remain largely unknown, although PD is the neurological condition which has been studied most intensively with regard to occupational exposures.7 Perhaps the only known causative occupational exposure is exposure to manganese,8 although …

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