The incidence of neurodegenerative diseases (NDs) has been increasing. Current drugs targeting NDs are mainly based on relieving symptoms rather than effecting a cure, and fail to prevent disease progression. Exosomes are a subset of extracellular vesicles that can be produced by almost all cells in the human body and exert biological effects in a variety of ways after their release into the extracellular environment. Many studies have shown that the unique biological characteristics of exosomes mean that they can be used as a tool for the prevention, remission, treatment and diagnosis of NDs. This article reviews the biogenesis of exosomes and their roles in ND, to provide new ideas for the clinical treatment of these conditions.