Glymphatic dysfunction assessed by DTI-ALPS index predicts early cognitive impairment in acute subcortical infarcts: a prospective clinical cohort study
BackgroundThe glymphatic system (GS), responsible for clearing neurotoxic proteins (such as β-amyloid and tau protein), is critical in stroke pathophysiology. However, its role in acute post-stroke cognitive impairment (PSCI) remains unclear. We investigated GS dysfunction via the DTI-ALPS index in...
Saved in:
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2025-07-01
|
| Series: | Frontiers in Neurology |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2025.1605889/full |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850116457803808768 |
|---|---|
| author | Yirong Wang Mei Yang Xingmao Zeng Shuai Wang Wenmin Zhang Weidong Wang Yang Du Jurong Ding Xin Ding |
| author_facet | Yirong Wang Mei Yang Xingmao Zeng Shuai Wang Wenmin Zhang Weidong Wang Yang Du Jurong Ding Xin Ding |
| author_sort | Yirong Wang |
| collection | DOAJ |
| description | BackgroundThe glymphatic system (GS), responsible for clearing neurotoxic proteins (such as β-amyloid and tau protein), is critical in stroke pathophysiology. However, its role in acute post-stroke cognitive impairment (PSCI) remains unclear. We investigated GS dysfunction via the DTI-ALPS index in acute subcortical infarct patients and its association with early cognitive decline.MethodsThis prospective cohort included 29 subcortical infarct patients and 25 healthy controls (HC). Participants underwent 3.0 T MRI (DTI/structural sequences) and Montreal Cognitive Assessment (MoCA) at 7 and 90 days post-stroke. Bilateral DTI-ALPS indices were calculated. Group comparisons and Spearman correlations were analyzed.ResultsThe DTI-ALPS index of the lesion (1.371 ± 0.170) and non-lesion side (1.310 ± 0.198) in the SI group were significantly lower than that in HC group (1.568 ± 0.115) (both of p < 0.001, respectively). While, the DTI-ALPS index of the lesion side was no significant difference than that of the non-lesion side in subcortical infarct group (p = 0.214). The scores of MoCA in 7 days and 90 days after stroke were significantly lower than those in HC group (p < 0.001). In patients with subcortical infarct, MoCA scores at 7 days showed significant correlation with lesion-side DTI-ALPS index (r = 0.510, p = 0.005) but not with non-lesion DTI-ALPS values (r = 0.174, p = 0.259). Notably, we observed significant correlations between MoCA scores at 90 days post-stroke and DTI-ALPS index, which were consistently demonstrated in the lesion, non-lesion, and mean bilateral measurements. The ROC analysis demonstrated that the DTI-ALPS index showed moderate discriminative ability (AUC = 0.868) in differentiating patients with cognitive impairment from those with normal cognition following subcortical infarction, exhibiting excellent sensitivity (96.0%) but suboptimal specificity (65.5%).ConclusionIschemic stroke leads to glymphatic dysfunction, which is associated with early post-stroke cognitive impairment. |
| format | Article |
| id | doaj-art-4575b0cc8a3c47c4ab05d8bb0f0bb823 |
| institution | OA Journals |
| issn | 1664-2295 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Neurology |
| spelling | doaj-art-4575b0cc8a3c47c4ab05d8bb0f0bb8232025-08-20T02:36:19ZengFrontiers Media S.A.Frontiers in Neurology1664-22952025-07-011610.3389/fneur.2025.16058891605889Glymphatic dysfunction assessed by DTI-ALPS index predicts early cognitive impairment in acute subcortical infarcts: a prospective clinical cohort studyYirong Wang0Mei Yang1Xingmao Zeng2Shuai Wang3Wenmin Zhang4Weidong Wang5Yang Du6Jurong Ding7Xin Ding8Department of Neurology, Chengdu Second People’s Hospital, Chengdu, ChinaSchool of Automation and Information Engineering, Sichuan University of Science and Engineering, Zigong, ChinaDepartment of Neurology, Chengdu Fifth People's Hospital, Chengdu, Sichuan, ChinaDepartment of Outpatient, General Hospital of Western Theater Command, Chengdu, Sichuan, ChinaDepartment of Neurology, Chengdu Second People’s Hospital, Chengdu, ChinaDepartment of Neurology, Chengdu Second People’s Hospital, Chengdu, ChinaDepartment of Neurology, Chengdu Second People’s Hospital, Chengdu, ChinaSchool of Automation and Information Engineering, Sichuan University of Science and Engineering, Zigong, ChinaDepartment of Neurology, Chengdu Second People’s Hospital, Chengdu, ChinaBackgroundThe glymphatic system (GS), responsible for clearing neurotoxic proteins (such as β-amyloid and tau protein), is critical in stroke pathophysiology. However, its role in acute post-stroke cognitive impairment (PSCI) remains unclear. We investigated GS dysfunction via the DTI-ALPS index in acute subcortical infarct patients and its association with early cognitive decline.MethodsThis prospective cohort included 29 subcortical infarct patients and 25 healthy controls (HC). Participants underwent 3.0 T MRI (DTI/structural sequences) and Montreal Cognitive Assessment (MoCA) at 7 and 90 days post-stroke. Bilateral DTI-ALPS indices were calculated. Group comparisons and Spearman correlations were analyzed.ResultsThe DTI-ALPS index of the lesion (1.371 ± 0.170) and non-lesion side (1.310 ± 0.198) in the SI group were significantly lower than that in HC group (1.568 ± 0.115) (both of p < 0.001, respectively). While, the DTI-ALPS index of the lesion side was no significant difference than that of the non-lesion side in subcortical infarct group (p = 0.214). The scores of MoCA in 7 days and 90 days after stroke were significantly lower than those in HC group (p < 0.001). In patients with subcortical infarct, MoCA scores at 7 days showed significant correlation with lesion-side DTI-ALPS index (r = 0.510, p = 0.005) but not with non-lesion DTI-ALPS values (r = 0.174, p = 0.259). Notably, we observed significant correlations between MoCA scores at 90 days post-stroke and DTI-ALPS index, which were consistently demonstrated in the lesion, non-lesion, and mean bilateral measurements. The ROC analysis demonstrated that the DTI-ALPS index showed moderate discriminative ability (AUC = 0.868) in differentiating patients with cognitive impairment from those with normal cognition following subcortical infarction, exhibiting excellent sensitivity (96.0%) but suboptimal specificity (65.5%).ConclusionIschemic stroke leads to glymphatic dysfunction, which is associated with early post-stroke cognitive impairment.https://www.frontiersin.org/articles/10.3389/fneur.2025.1605889/fullglymphatic systemDTI-ALPSsubcortical infarctioncognitive impairmentdiffusion tensor imaging |
| spellingShingle | Yirong Wang Mei Yang Xingmao Zeng Shuai Wang Wenmin Zhang Weidong Wang Yang Du Jurong Ding Xin Ding Glymphatic dysfunction assessed by DTI-ALPS index predicts early cognitive impairment in acute subcortical infarcts: a prospective clinical cohort study Frontiers in Neurology glymphatic system DTI-ALPS subcortical infarction cognitive impairment diffusion tensor imaging |
| title | Glymphatic dysfunction assessed by DTI-ALPS index predicts early cognitive impairment in acute subcortical infarcts: a prospective clinical cohort study |
| title_full | Glymphatic dysfunction assessed by DTI-ALPS index predicts early cognitive impairment in acute subcortical infarcts: a prospective clinical cohort study |
| title_fullStr | Glymphatic dysfunction assessed by DTI-ALPS index predicts early cognitive impairment in acute subcortical infarcts: a prospective clinical cohort study |
| title_full_unstemmed | Glymphatic dysfunction assessed by DTI-ALPS index predicts early cognitive impairment in acute subcortical infarcts: a prospective clinical cohort study |
| title_short | Glymphatic dysfunction assessed by DTI-ALPS index predicts early cognitive impairment in acute subcortical infarcts: a prospective clinical cohort study |
| title_sort | glymphatic dysfunction assessed by dti alps index predicts early cognitive impairment in acute subcortical infarcts a prospective clinical cohort study |
| topic | glymphatic system DTI-ALPS subcortical infarction cognitive impairment diffusion tensor imaging |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2025.1605889/full |
| work_keys_str_mv | AT yirongwang glymphaticdysfunctionassessedbydtialpsindexpredictsearlycognitiveimpairmentinacutesubcorticalinfarctsaprospectiveclinicalcohortstudy AT meiyang glymphaticdysfunctionassessedbydtialpsindexpredictsearlycognitiveimpairmentinacutesubcorticalinfarctsaprospectiveclinicalcohortstudy AT xingmaozeng glymphaticdysfunctionassessedbydtialpsindexpredictsearlycognitiveimpairmentinacutesubcorticalinfarctsaprospectiveclinicalcohortstudy AT shuaiwang glymphaticdysfunctionassessedbydtialpsindexpredictsearlycognitiveimpairmentinacutesubcorticalinfarctsaprospectiveclinicalcohortstudy AT wenminzhang glymphaticdysfunctionassessedbydtialpsindexpredictsearlycognitiveimpairmentinacutesubcorticalinfarctsaprospectiveclinicalcohortstudy AT weidongwang glymphaticdysfunctionassessedbydtialpsindexpredictsearlycognitiveimpairmentinacutesubcorticalinfarctsaprospectiveclinicalcohortstudy AT yangdu glymphaticdysfunctionassessedbydtialpsindexpredictsearlycognitiveimpairmentinacutesubcorticalinfarctsaprospectiveclinicalcohortstudy AT jurongding glymphaticdysfunctionassessedbydtialpsindexpredictsearlycognitiveimpairmentinacutesubcorticalinfarctsaprospectiveclinicalcohortstudy AT xinding glymphaticdysfunctionassessedbydtialpsindexpredictsearlycognitiveimpairmentinacutesubcorticalinfarctsaprospectiveclinicalcohortstudy |