Chen Qingwen, Zhong Tao, Liu Jian, Yuan Binke, Gao Han
Department of Neurosurgery, The Affiliated Qingyuan Hospital (Qingyuan People's Hospital), Guangzhou Medical University, Qingyuan, China.
Department of Neurosurgery, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China.
CNS Neurosci Ther. 2025 Jul;31(7):e70512. doi: 10.1111/cns.70512.
Glymphatic dysfunction may exacerbate post-stroke cognitive impairment (PSCI) via impaired metabolic waste clearance. However, longitudinal dynamics of glymphatic function during the chronic stroke phase (3-12 months) and links to cognitive recovery remain unclear. This study aimed to characterize chronic glymphatic remodeling dynamics using the DTI-ALPS index while exploring its temporal associations with cognitive outcomes and assessing lesion location effects.
In this retrospective cohort study, 51 chronic stroke patients (3-12 months post-stroke) and 27 matched healthy controls underwent DTI scans and neuropsychological assessments (evaluating language, memory, motor, attention) at 3 months (3 M-S) and 1 year (1Y-S) post-stroke. The DTI-ALPS index was calculated for lesioned/contralateral hemispheres. Patients were stratified by lesion location (cortical [n = 17] vs. subcortical [n = 34]). Group comparisons and Spearman correlations (FDR-corrected) were performed.
Stroke patients showed significantly lower DTI-ALPS index versus controls at both 3 M-S and 1Y-S (FDR-p < 0.001). At 3 M-S, the lesioned hemisphere ALPS index was significantly lower than the contralateral hemisphere (FDR-p < 0.05); this difference resolved by 1Y-S. No significant differences existed between cortical/subcortical subgroups. Weak correlations emerged at 3 M-S between lesioned-hemisphere ALPS index and Motor/Memory scores (r = 0.280-0.316, uncorrected p < 0.05), but these did not survive FDR correction and disappeared by 1Y-S. Lesion volume did not correlate with ALPS index.
Chronic stroke patients exhibit persistent glymphatic dysfunction. The affected hemisphere showed more severe impairment at 3 months post-stroke, with partial improvement observed by the 1-year mark. Transient cognitive associations observed at 3 months diminished by the 1-year follow-up, suggesting stabilization of recovery patterns in later stages. Despite study limitations, these findings validate the utility of the DTI-ALPS index for chronic-phase assessments and highlight the importance of targeting glymphatic dysfunction as a therapeutic strategy for PSCI.
类淋巴系统功能障碍可能通过损害代谢废物清除而加重中风后认知障碍（PSCI）。然而，慢性中风阶段（3 - 12个月）类淋巴系统功能的纵向动态变化及其与认知恢复的关系仍不清楚。本研究旨在使用扩散张量成像-动脉自旋标记灌注成像（DTI-ALPS）指数来描述慢性类淋巴系统重塑动态变化，同时探索其与认知结果的时间关联，并评估病变位置的影响。
在这项回顾性队列研究中，51例慢性中风患者（中风后3 - 12个月）和27例匹配的健康对照在中风后3个月（3M-S）和1年（1Y-S）接受了DTI扫描和神经心理学评估（评估语言、记忆、运动、注意力）。计算病变/对侧半球的DTI-ALPS指数。患者按病变位置分层（皮质[n = 17]与皮质下[n = 34]）。进行组间比较和Spearman相关性分析（经错误发现率校正）。
中风患者在3M-S和1Y-S时的DTI-ALPS指数均显著低于对照组（错误发现率校正P < 0.001）。在3M-S时病变半球的ALPS指数显著低于对侧半球（错误发现率校正P < 0.05）；这种差异在1Y-S时消失。皮质/皮质下亚组之间无显著差异。在3M-S时，病变半球ALPS指数与运动/记忆评分之间出现弱相关性（r = 0.280 - 0.316，未校正P < 0.05），但这些相关性在错误发现率校正后未保留，并在1Y-S时消失。病变体积与ALPS指数无相关性。
慢性中风患者存在持续的类淋巴系统功能障碍。受影响半球在中风后3个月时损伤更严重，到1年时观察到部分改善。在3个月时观察到的短暂认知关联在1年随访时减弱，表明后期恢复模式趋于稳定。尽管存在研究局限性，但这些发现验证了DTI-ALPS指数在慢性期评估中的实用性，并强调了将类淋巴系统功能障碍作为PSCI治疗策略的重要性。
