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Abstract Environmental exposure to trace elements and heavy metals has been implicated in the pathogenesis of Parkinson’s disease (PD) through mechanisms including oxidative stress and neuroinflammation. Hair analysis provides a non-invasive tool for assessing long-term elemental exposure. A total of 100 PD patients—including 11 on Device-aided therapies (DAT) 7 Levodopa-Carbidopa intestinal gel (LCIG), 4 Deep Brain Stimulation (DBS)—and 35 healthy controls were enrolled in this prospective cross-sectional study to evaluate the relationship between hair trace element concentrations and clinical features. Hair samples were analyzed using inductively coupled plasma mass spectrometry (ICP-MS) to determine the concentrations of a multi-element panel, including trace elements such as Aluminum (Al), Arsenic (As), Mercury (Hg), Lead (Pb), Copper (Cu), Vanadium (V), Boron (B), Barium (Ba) and others. Among the elements screened, significant elevations were observed particularly in Al and B levels in PD patients compared to controls. (p = 0.044 and p = 0.016, respectively). Notably, patients receiving DAT exhibited significantly higher Al, V, and Ba levels than those receiving oral therapy alone. Subgroup analysis further revealed that these concentrations were significantly more pronounced in patients with DBS than in those receiving LCIG infusion. (p
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