NEFH and Mental deterioration: In vivo, it alleviated HNF and cognitive decline, reduced Aβ<sub>1-42</sub> and Tau deposition, elevated BDNF and MAP2, and suppressed neuroinflammation and glial activation.<h4>Conclusions</h4>D-Exo is enriched with specific proteins, attenuates neuroinflammation and cognitive decline by regulating microglial M1/M2 polarization and AMPK pathway, highlighting its preventive potential.