Department of Neurology, Guangdong Neuroscience Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China.
Guangzhou Key Laboratory of Diagnosis and Treatment for Neurodegenerative Diseases, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China.
Ann Neurol. 2023 Oct;94(4):672-683. doi: 10.1002/ana.26729. Epub 2023 Jul 18.
Emerging pathological evidence suggests that there is an association between glymphatic dysfunction and the progression of Parkinson's disease (PD). However, the clinical evidence of this association remains lacking.
In this study, the index for diffusion tensor image analysis along the perivascular space (ALPS index) was calculated to evaluate glymphatic function.
Overall, 289 patients with PD were enrolled in the cross-sectional study. The ALPS index was found to be negatively correlated with age, disease severity, and dyskinesia. In the longitudinal study, the information on a total of 95 PD patients with 5-year follow-up examinations was collected from the Parkinson's Progression Marker Initiative, 33 of which were classified into the low ALPS index group, and all others were classified into the mid-high ALPS index group based on the first tertile of the baseline ALPS index. The results of longitudinal regression indicated that there was a significant main group effect on autonomic dysfunction, as well as on activities of daily living. In addition, the low ALPS index group had faster deterioration in MDS-UPDRS part III and part II, Symbol Digit Modalities Test and Hopkins Verbal Learning Test. Path analysis showed that ALPS index acted as a significant mediator between tTau/ Aβ and cognitive change in the Symbol Digit Modalities Test score at year 4 and year 5.
The ALPS index, an neuroimaging marker of glymphatic function, is correlated with PD disease severity, motor symptoms, and autonomic function, and is predictive of faster deterioration in motor symptoms and cognitive function. Additionally, glymphatic function may mediate the pathological role of toxic protein in cognitive decline. ANN NEUROL 2023;94:672-683.
新出现的病理学证据表明，糖液功能障碍与帕金森病（PD）的进展之间存在关联。然而，这种关联的临床证据仍然缺乏。
在这项研究中，通过计算沿血管周围空间的扩散张量图像分析指标（ALPS 指数）来评估糖液功能。
总体而言，这项横断面研究纳入了 289 例 PD 患者。ALPS 指数与年龄、疾病严重程度和运动障碍呈负相关。在纵向研究中，共收集了帕金森进展标志物倡议中 95 例 PD 患者的 5 年随访信息，其中 33 例被归入低 ALPS 指数组，其余均归入基线 ALPS 指数三分位第一分位的中高 ALPS 指数组。纵向回归结果表明，自主神经功能障碍以及日常生活活动方面存在显著的主组效应。此外，低 ALPS 指数组的 MDS-UPDRS 第 III 部分和第 II 部分、符号数字模态测试和霍普金斯言语学习测试的恶化速度更快。路径分析表明，ALPS 指数在第 4 年和第 5 年的符号数字模态测试评分中的 tTau/Aβ与认知变化之间起显著的中介作用。
ALPS 指数作为糖液功能的神经影像学标志物，与 PD 疾病严重程度、运动症状和自主神经功能相关，并可预测运动症状和认知功能的恶化速度更快。此外，糖液功能可能在毒性蛋白导致认知下降的病理作用中起中介作用。神经病学年鉴 2023；94:672-683。
