Chen Yilei, Zhang Yingying, Yang Mei, Zhu Xuying, Zhang Jiejing, Kong Yingnan, Kang Yingjie, Gong Zhigang, Wang Hui, Huang Yanwen, Zhan Songhua, Shi Feng, Tan Wenli
Department of Radiology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China (Y.C., M.Y., J.Z., Y.K., Y.K., Z.G., H.W., Y.H., S.Z., W.T.).
Department of Acupuncture and Moxibustion, China - Japan Friendship Hospital, Beijing 100029, China (Y.Z.).
Acad Radiol. 2025 Aug 7. doi: 10.1016/j.acra.2025.07.045.
Cerebral small vessel disease (CSVD) is a major contributor to vascular cognitive impairment, with respective changes in neurovascular coupling (NVC) and glymphatic function, but the association between them has not been illustrated. This study aimed to investigate the relationship between NVC and glymphatic function in patients with CSVD coexisting cognitive impairment.
We prospectively enrolled 78 patients with CSVD with cognitive impairment (CSVD-CI) and 57 with normal cognition (CSVD-NC). NVC metrics were assessed by calculating correlation coefficients and ratios between cerebral blood flow (CBF) and voxel-wise concordance (VWC) maps. Glymphatic function was evaluated using the diffusion tensor image along the perivascular space (DTI-ALPS) index, choroid plexus volume (CPV), and perivascular space (PVS) volume fraction. Partial correlation and mediation analyses were performed to investigate the relationships among imaging metrics and clinical parameters.
Patients with CSVD-CI exhibited reduced global NVC coefficients and lower CBF/VWC ratios in multiple cortical regions, including the left inferior frontal gyrus, paracentral lobule, inferior temporal gyrus, middle occipital gyrus, and middle temporal gyrus. The ALPS-index was significantly lower in CSVD-CI compared to CSVD-NC, while PVS volume fraction and CPV were increased. ROC analyses demonstrated that the NVC and glymphatic function metrics effectively distinguished between patients with CSVD-CI and CSVD-NC. Mediation analysis revealed that the ALPS-index significantly mediated the relationship between NVC metrics and cognitive function and sleep.
Our findings suggest that NVC leading to glymphatic dysfunction may underlie the mechanisms responsible for the decline in cognitive performance and sleep quality in patients with CSVD.
脑小血管病（CSVD）是导致血管性认知障碍的主要因素，伴有神经血管耦合（NVC）和类淋巴功能的相应改变，但它们之间的关联尚未阐明。本研究旨在探讨合并认知障碍的CSVD患者中NVC与类淋巴功能之间的关系。
我们前瞻性纳入了78例合并认知障碍的CSVD患者（CSVD-CI）和57例认知正常的患者（CSVD-NC）。通过计算脑血流量（CBF）与体素一致性（VWC）图之间的相关系数和比率来评估NVC指标。使用沿血管周围间隙的扩散张量图像（DTI-ALPS）指数、脉络丛体积（CPV）和血管周围间隙（PVS）体积分数来评估类淋巴功能。进行偏相关和中介分析以研究成像指标与临床参数之间的关系。
CSVD-CI患者在多个皮质区域，包括左侧额下回、中央旁小叶、颞下回、枕中回和颞中回，表现出整体NVC系数降低和CBF/VWC比率降低。与CSVD-NC相比，CSVD-CI患者的ALPS指数显著降低，而PVS体积分数和CPV增加。ROC分析表明，NVC和类淋巴功能指标可有效区分CSVD-CI患者和CSVD-NC患者。中介分析显示，ALPS指数显著介导了NVC指标与认知功能和睡眠之间的关系。
我们的研究结果表明，导致类淋巴功能障碍的NVC可能是CSVD患者认知能力下降和睡眠质量下降机制的基础。
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