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. 2024 Sep;39(9):1504-1513.
doi: 10.1002/mds.29908. Epub 2024 Jul 11.

Diffusion Tensor Imaging-Along the Perivascular-Space Index Is Associated with Disease Progression in Parkinson's Disease

Kimberly H Wood  1   2   3 , Rodolphe Nenert  1 , Aya M Miften  4 , George W Kent  3 , Madison Sleyster  4 , Raima A Memon  5 , Allen Joop  1 , Jennifer Pilkington  1 , Adeel A Memon  6 , Riis N Wilson  3 , Corina Catiul  1 , Jerzy Szaflarski  1 , Amy W Amara  1   4
Affiliations

Diffusion Tensor Imaging-Along the Perivascular-Space Index Is Associated with Disease Progression in Parkinson's Disease

Kimberly H Wood et al. Mov Disord. 2024 Sep.

Abstract

Background: The glymphatic clearance pathway is a waste clearance system that allows for removal of soluble proteins such as amyloid β (Aβ) from the brain. Higher Aβ levels are associated with cognitive dysfunction in Parkinson's disease (PD). Diffusion tensor imaging-along the perivascular space (DTI-ALPS) is an imaging measure proposed to indirectly measure glymphatic function.

Objectives: Evaluate differences in DTI-ALPS-index between PD and healthy controls (HC) and characterize relationships between this proposed measure of glymphatic clearance, cognition, and disease severity in PD.

Methods: PD (n = 32) and HC (n = 23) participants underwent brain imaging to assess DTI-ALPS. PD participants were classified as PD-normal cognition (PD-NC; n = 20) or PD-mild cognitive impairment (PD-MCI; n = 12) based on a Level II comprehensive cognitive assessment. A subgroup of PD participants (n = 21) returned for annual assessments for up to 4 years after baseline. Longitudinal outcomes included changes in performance on the comprehensive cognitive assessment and changes in the Movement Disorders Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS).

Results: PD participants had lower DTI-ALPS-index compared to HC. PD participants classified as PD-MCI had significantly lower DTI-ALPS-index compared to PD-NC. Lower DTI-ALPS-index at baseline was associated with longitudinal cognitive decline and worse longitudinal disease severity.

Conclusions: Glymphatic clearance, as measured with DTI-ALPS, has potential to serve as a marker of longitudinal disease progression. Interventions targeting glymphatic function should be explored for potential to slow cognitive decline in PD. © 2024 International Parkinson and Movement Disorder Society.

Keywords: DTI‐ALPS; Parkinson's disease; cognition; disease progression; glymphatic function.

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Conflict of interest statement

Financial Disclosure/Conflicts of Interest: None

Figures

Figure 1:
Figure 1:
Regions of interest showing the distribution of the projection and association subcortical areas used for DTI-ALPS-index computation.
Figure 2:
Figure 2:
2A) Mean DTI-ALPS-index is significantly different between PD and HC participants. 2B) DTI-ALPS-index contralateral to side of PD symptom onset is different between PD-NC and PD-MCI. ALPS: Along the perivascular space; PD-MCI: Parkinson’s disease-mild cognitive impairment; PD-NC: Parkinson’s disease-normal cognition
See this image and copyright information in PMC

References

    1. Martinez-Martin P, Rodriguez-Blazquez C, Kurtis MM, Chaudhuri KR, Group NV. The impact of non-motor symptoms on health-related quality of life of patients with Parkinson's disease. Mov Disord. 2011;26(3):399–406. - PubMed
    1. Bock MA, Brown EG, Zhang L, Tanner C. Association of Motor and Nonmotor Symptoms With Health-Related Quality of Life in a Large Online Cohort of People With Parkinson Disease. Neurology. 2022;98(22):e2194–e203. - PMC - PubMed
    1. Pigott K, Rick J, Xie SX, Hurtig H, Chen-Plotkin A, Duda JE, et al. Longitudinal study of normal cognition in Parkinson disease. Neurology. 2015;85(15):1276–82. - PMC - PubMed
    1. Chen HL, Chen PC, Lu CH, Tsai NW, Yu CC, Chou KH, et al. Associations among Cognitive Functions, Plasma DNA, and Diffusion Tensor Image along the Perivascular Space (DTI-ALPS) in Patients with Parkinson's Disease. Oxid Med Cell Longev. 2021;2021:4034509. - PMC - PubMed
    1. Iliff JJ, Wang M, Liao Y, Plogg BA, Peng W, Gundersen GA, et al. A paravascular pathway facilitates CSF flow through the brain parenchyma and the clearance of interstitial solutes, including amyloid beta. Sci Transl Med. 2012;4(147):147ra11. - PMC - PubMed

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