Ke Zhihong, Mo Yuting, Li Jiangnan, Yang Dan, Huang Lili, Yang Zhiyuan, Qin Ruomeng, Mao Chenglu, Lv Weiping, Huang Yanan, Hu Zheqi, Zhang Bing, Xu Yun
Department of Neurology, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing 210008, China.
Department of Neurology, Drum Tower Hospital, Medical School and The State Key Laboratory of Pharmaceutical Biotechnology, Institute of Brain Science, Nanjing University, Nanjing 210008, China.
Brain Sci. 2022 Nov 24;12(12):1611. doi: 10.3390/brainsci12121611.
Glymphatic dysfunction has been linked to cognitive decline in several neurodegenerative diseases. In cerebral small vessel disease (CSVD), the mechanism of white matter hyperintensities (WMH)-related cognitive impairment (CI) is still under investigation. The diffusion tensor image (DTI) analysis along the perivascular space (ALPS) method has been considered to be a reliable parameter to evaluate glymphatic function. Therefore, we applied the ALPS-index to determine the influence of glymphatic function on CI in CSVD. In total, 137 CSVD patients (normal cognitive group, mild CI group, and dementia group) and 52 normal controls were included in this study. The ALPS-index was calculated based on the DTI. Correlation analyses and mediation analysis were conducted to examine the relationship between glymphatic function and cognition. Remarkable differences in the ALPS-index were observed between subjects with and without CI. The ALPS-index was negatively correlated with age, WMH volume, and general cognitive function in all CSVD patients. In the mild CI group, the ALPS-index was independently positively related to episodic memory, and mediated the relationship between WMH volume and episodic memory. In conclusion, the ALPS-index is a potential marker for early recognition of CI in CSVD. Glymphatic dysfunction mediates the relationship between WMH and CI in CSVD.
类淋巴系统功能障碍与多种神经退行性疾病的认知衰退有关。在脑小血管病（CSVD）中，白质高信号（WMH）相关认知障碍（CI）的机制仍在研究中。沿血管周围间隙的扩散张量成像（DTI）分析（ALPS）方法被认为是评估类淋巴系统功能的可靠参数。因此，我们应用ALPS指数来确定类淋巴系统功能对CSVD中CI的影响。本研究共纳入137例CSVD患者（认知正常组、轻度CI组和痴呆组）和52例正常对照。基于DTI计算ALPS指数。进行相关性分析和中介分析以检验类淋巴系统功能与认知之间的关系。在有和没有CI的受试者之间观察到ALPS指数存在显著差异。在所有CSVD患者中，ALPS指数与年龄、WMH体积和总体认知功能呈负相关。在轻度CI组中，ALPS指数与情景记忆独立正相关，并介导WMH体积与情景记忆之间的关系。总之，ALPS指数是CSVD中早期识别CI的潜在标志物。类淋巴系统功能障碍介导了CSVD中WMH与CI之间的关系。
