Shirbandi Kiarash, Jafari Mostafa, Mazaheri Fatemeh, Tahmasbi Marziyeh
Department of Biomedical Engineering, Faculty of Medical Sciences and Technologies, Science and Research Branch, Islamic Azad University, Tehran, Iran.
Department of Radiologic Technology, School of Allied Medical Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
CNS Neurosci Ther. 2025 May;31(5):e70434. doi: 10.1111/cns.70434.
Parkinson's disease (PD) is a chronic, progressive neurodegenerative disorder that primarily affects motor functions. Recently, a diffusion tensor imaging technique called DTI along the perivascular space (DTI-ALPS) has gained attention as a noninvasive biomarker for glymphatic function. This systematic review and meta-analysis aimed to evaluate the potential and implications of the DTI-ALPS index for diagnosing PD.
This study followed the PRISMA 2020 statement. Eligible cohort and cross-sectional studies measured the ALPS index in PD patients versus non-PD participants. Web of Science, Medline, Scopus, Embase, Cochrane, PROSPERO, and ICTRP databases were explored until November 14, 2024. Two researchers independently screened studies, extracted data, and assessed the risk of bias using the Newcastle-Ottawa Scale (NOS). The meta-analysis used a random effects model (REM), assessing heterogeneity (I, Q-test) and publication bias (Egger's test, trim&fill plot). The certainty of the evidence was evaluated using the GRADE approach.
This meta-analysis of 11 studies, involving 1462 patients (855 PD, 607 non-PD of both genders), yielded significant findings. The overall ALPS index differed substantially between PD and non-PD groups (SMD: -0.61, 95% CI: -0.72, -0.50, p < 0.001). Additionally, a significant negative correlation emerged between the ALPS index and Unified PD Rating Scale III (UPDRS III) (r = -0.40, (95% CI: -0.59, -0.18, I: 89.81, p < 0.001)), indicating glymphatic dysfunction's impact on cognitive decline. However, a weak and statistically non-significant correlation was observed between the ALPS index and Montreal Cognitive Assessment (MoCA) (r = 0.24, 95% CI: -0.32 to 0.68), with high heterogeneity across studies (I = 87.37, p < 0.001 for heterogeneity). Publication bias risk was low for the overall ALPS index.
These findings highlight the potential of DTI-ALPS as a noninvasive biomarker for PD diagnosis and progression monitoring. Further studies are warranted to explore its applicability in differentiating PD from other neurodegenerative disorders.
帕金森病（PD）是一种主要影响运动功能的慢性、进行性神经退行性疾病。最近，一种称为沿血管周围间隙的扩散张量成像技术（DTI-ALPS）作为一种用于评估类淋巴功能的非侵入性生物标志物受到了关注。本系统评价和荟萃分析旨在评估DTI-ALPS指数在诊断帕金森病方面的潜力和意义。
本研究遵循PRISMA 2020声明。符合条件的队列研究和横断面研究测量了帕金森病患者与非帕金森病参与者的ALPS指数。检索了Web of Science、Medline、Scopus、Embase、Cochrane、PROSPERO和ICTRP数据库，检索截至2024年11月14日的文献。两名研究人员独立筛选研究、提取数据，并使用纽卡斯尔-渥太华量表（NOS）评估偏倚风险。荟萃分析采用随机效应模型（REM），评估异质性（I²，Q检验）和发表偏倚（Egger检验，trim&fill图）。使用GRADE方法评估证据的确定性。
对11项研究的荟萃分析，涉及1462例患者（855例帕金森病患者，607例非帕金森病患者，包括男性和女性），得出了显著的结果。帕金森病组和非帕金森病组的总体ALPS指数存在显著差异（标准化均数差：-0.61，95%置信区间：-0.72，-0.50，p＜0.001）。此外，ALPS指数与统一帕金森病评定量表III（UPDRS III）之间出现了显著的负相关（r=-0.40，（95%置信区间：-0.59，-0.18，I²=89.81，p＜0.001）），表明类淋巴功能障碍对认知功能下降的影响。然而，观察到ALPS指数与蒙特利尔认知评估量表（MoCA）之间的相关性较弱且无统计学意义（r=0.24，95%置信区间：-0.32至0.68），各研究间异质性较高（I²=87.37，异质性p＜0.001）。总体ALPS指数的发表偏倚风险较低。
这些发现突出了DTI-ALPS作为帕金森病诊断和病情监测的非侵入性生物标志物的潜力。有必要进一步开展研究，以探索其在区分帕金森病与其他神经退行性疾病方面的适用性。
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