Si Xiaoli, Guo Tao, Wang Zhiyun, Fang Yi, Gu Luyan, Cao Lanxiao, Yang Wenyi, Gao Ting, Song Zhe, Tian Jun, Yin Xinzhen, Guan Xiaojun, Zhou Cheng, Wu Jingjing, Bai Xueqin, Liu Xiaocao, Zhao Guohua, Zhang Minming, Pu Jiali, Zhang Baorong
Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, 310009, Hangzhou, Zhejiang, China.
Department of Neurology, Fourth Affiliated Hospital, School of Medicine, Zhejiang University, N1 Avenue, 322000, Yiwu, Zhejiang, China.
NPJ Parkinsons Dis. 2022 Apr 29;8(1):54. doi: 10.1038/s41531-022-00316-9.
Alpha-synucleinopathy is postulated to be central to both idiopathic rapid eye movement sleep behaviour disorder (iRBD) and Parkinson's disease (PD). Growing evidence suggests an association between the diminished clearance of α-synuclein and glymphatic system dysfunction. However, evidence accumulating primarily based on clinical data to support glymphatic system dysfunction in patients with iRBD and PD is currently insufficient. This study aimed to use diffusion tensor image analysis along the perivascular space (DTI-ALPS) to evaluate glymphatic system activity and its relationship to clinical scores of disease severity in patients with possible iRBD (piRBDs) and those with PD. Further, we validated the correlation between the ALPS index and the prognosis of PD longitudinally. Overall, 168 patients with PD, 119 piRBDs, and 129 healthy controls were enroled. Among them, 50 patients with PD had been longitudinally reexamined. Patients with PD exhibited a lower ALPS index than those with piRBDs (P = 0.036), and both patient groups showed a lower ALPS index than healthy controls (P < 0.001 and P = 0.001). The ALPS index and elevated disease severity were negatively correlated in the piRBD and PD subgroups. Moreover, the ALPS index was correlated with cognitive decline in patients with PD in the longitudinal analyses. In conclusion, DTI-ALPS provided neuroimaging evidence of glymphatic system dysfunction in piRBDs and patients with PD; however, the potential of assessing the pathological progress of α-synucleinopathies as an indicator is worth verifying. Further development of imaging methods for glymphatic system function is also warranted.
α-突触核蛋白病被认为是特发性快速眼动睡眠行为障碍（iRBD）和帕金森病（PD）的核心。越来越多的证据表明，α-突触核蛋白清除减少与类淋巴系统功能障碍之间存在关联。然而，目前主要基于临床数据积累的证据，尚不足以支持iRBD和PD患者存在类淋巴系统功能障碍。本研究旨在利用沿血管周围间隙的扩散张量图像分析（DTI-ALPS），评估可能患有iRBD（piRBD）的患者和PD患者的类淋巴系统活性及其与疾病严重程度临床评分的关系。此外，我们纵向验证了ALPS指数与PD预后之间的相关性。总共纳入了168例PD患者、119例piRBD患者和129名健康对照者。其中，50例PD患者接受了纵向复查。PD患者的ALPS指数低于piRBD患者（P = 0.036），且两组患者的ALPS指数均低于健康对照者（P < 0.001和P = 0.001）。在piRBD和PD亚组中，ALPS指数与疾病严重程度升高呈负相关。此外，在纵向分析中，ALPS指数与PD患者的认知衰退相关。总之，DTI-ALPS为piRBD患者和PD患者的类淋巴系统功能障碍提供了神经影像学证据；然而，将其作为评估α-突触核蛋白病病理进展指标的潜力值得验证。类淋巴系统功能成像方法的进一步发展也很有必要。
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