Hein Zaw Myo, Arbain Muhammad Faqhrul Fahmy, Che Ramli Muhammad Danial, Jaffer Usman, Che Mohd Nassir Che Mohd Nasril
Department of Basic Medical Sciences, College of Medicine, Ajman University, Ajman P.O. Box 346, United Arab Emirates.
Department of Anatomy and Physiology, School of Basic Medical Sciences, Faculty of Medicine, Universiti Sultan Zainal Abidin, Kuala Terengganu 20400, Malaysia.
J Clin Med. 2025 Aug 26;14(17):6039. doi: 10.3390/jcm14176039.
: Cerebral small vessel disease (CSVD) often manifests as enlarged perivascular spaces (ePVS), which are linked to reduced processing speed even in asymptomatic individuals. Glymphatic dysfunction (or glymphopathy) has been proposed as a mechanism underlying ePVS, with the diffusion tensor image analysis along the perivascular space (DTI-ALPS) index serving as a potential non-invasive surrogate marker. This study aimed to examine the association between DTI-ALPS index, ePVS burden, and processing speed in community-dwelling adults without overt neurological symptoms, stratified by QRISK3 cardio-cerebrovascular risk prediction score. : Sixty young-to-middle-aged adults (aged 25-65 years), classified as low-to-moderate QRISK3 scores, underwent brain 3T diffusion magnetic resonance imaging (MRI) to evaluate ePVS burden and calculate DTI-ALPS indices. Processing speed index (PSI) was assessed using the Wechsler Adult Intelligence Scale-Version IV (WAIS-IV). : Approximately 43% of subjects reported having ePVS with significantly lower DTI-ALPS indices and PSI compared to those without ePVS. The DTI-ALPS index was inversely correlated with ePVS burden and positively correlated with PSI. Mediation analysis showed that the lower DTI-ALPS partially mediated the association between ePVS burden and slower processing speed. : Visible ePVS in our cohort may reflect early glymphopathy and subtle cognitive slowing, while the DTI-ALPS index may serve as an early biomarker for preclinical CSVD-related cognitive vulnerability, supporting targeted prevention strategies.
脑小血管病（CSVD）常表现为血管周围间隙扩大（ePVS），即使在无症状个体中，这也与处理速度降低有关。淋巴系统功能障碍（或淋巴病变）被认为是ePVS的潜在机制，沿血管周围间隙的扩散张量图像分析（DTI-ALPS）指数可作为一种潜在的非侵入性替代标志物。本研究旨在探讨在无明显神经症状的社区成年人中，DTI-ALPS指数、ePVS负荷与处理速度之间的关联，并根据QRISK3心血管风险预测评分进行分层。60名年龄在25至65岁之间、QRISK3评分低至中等的中青年成年人接受了脑部3T扩散磁共振成像（MRI），以评估ePVS负荷并计算DTI-ALPS指数。使用韦氏成人智力量表第四版（WAIS-IV）评估处理速度指数（PSI）。约43%的受试者报告有ePVS，与无ePVS的受试者相比，其DTI-ALPS指数和PSI显著更低。DTI-ALPS指数与ePVS负荷呈负相关，与PSI呈正相关。中介分析表明，较低的DTI-ALPS部分介导了ePVS负荷与处理速度减慢之间的关联。在我们的队列中，可见的ePVS可能反映了早期淋巴病变和轻微的认知减慢，而DTI-ALPS指数可能作为临床前CSVD相关认知易损性的早期生物标志物，支持有针对性的预防策略。
