Glymphatic function, deep medullary veins, and cognitive impairment in cerebral small vessel disease: A mediation analysis

IF 1.6 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery Pub Date : 2025-09-01 DOI:10.1016/j.clineuro.2025.109143

Xiao-Li Yang , Yu-Fan Luo , Tian-Yao Wang , Meng-Xiang Wang , Wen-Mei Lu , Joseph Zongen Shen , Hu-Lie Zeng , Dan-Hong Wu

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引用次数: 0

Abstract

Background

The glymphatic system and deep medullary veins (DMV) are closely linked to cognitive impairment in patients with cerebral small vessel disease (CSVD). This study aims to elucidate these complex associations through mediation analysis.

Methods

Patients who underwent multimodal magnetic resonance imaging (MRI) scans and the Montreal Cognitive Assessment (MoCA) were recruited. Glymphatic function was assessed using the diffusion tensor imaging along the perivascular space (DTI-ALPS) index. DMV was identified on susceptibility-weighted imaging (SWI), and a total DMV score was calculated based on segmental continuity and visibility. Regression models were employed to estimate the impact of the DMV score and DTI-ALPS index on cognitive impairment. Mediation analysis was conducted to examine the effect of the DTI-ALPS on DMV score and cognitive function.

Results

A total of 152 participants were included, of whom 65 had normal cognitive function and 87 had cognitive impairment. After adjusting for confounding factors, both the DMV score (OR=1.182, 95 % CI: 1.067–1.308, p = 0.005) and DTI-ALPS index (OR=0.496, 95 % CI: 0.306, 0.806, p = 0.005) were independently associated with cognitive impairment. Mediation analysis revealed that the DTI-ALPS index partially mediated the relationship between the DMV score and cognitive impairment, with an indirect effect of 0.040 (95 % CI: 0.011–0.084, p < 0.001).

Conclusion

Both the DMV score and DTI-ALPS index are independent risk factors for cognitive impairment in patients with CSVD. The DTI-ALPS index significantly and partially mediates the relationship between the DMV score and cognitive impairment.

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脑小血管疾病的淋巴功能、深髓静脉和认知障碍：中介分析

脑小血管疾病（CSVD）患者的认知功能障碍与淋巴系统和深髓静脉（DMV）密切相关。本研究旨在通过中介分析来阐明这些复杂的关联。方法招募接受多模态磁共振成像（MRI）扫描和蒙特利尔认知评估（MoCA）的患者。采用沿血管周围间隙弥散张量成像（DTI-ALPS）指数评估淋巴功能。通过敏感性加权成像（SWI）识别DMV，并根据分段连续性和可见性计算DMV总分。采用回归模型估计DMV评分和DTI-ALPS指数对认知功能障碍的影响。采用中介分析检验DTI-ALPS对DMV评分和认知功能的影响。结果共纳入152例受试者，其中认知功能正常者65例，认知功能障碍者87例。调整混杂因素后，DMV评分（OR=1.182, 95 % CI: 1.067-1.308, p = 0.005）和DTI-ALPS指数（OR=0.496, 95 % CI: 0.306, 0.806, p = 0.005）与认知功能障碍独立相关。中介分析显示，DTI-ALPS指数部分中介DMV评分与认知功能障碍的关系，间接效应为0.040（95 % CI: 0.011-0.084, p <； 0.001）。结论DMV评分和DTI-ALPS指数是CSVD患者认知功能障碍的独立危险因素。DTI-ALPS指数在DMV评分与认知功能障碍之间具有显著和部分的中介作用。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Neurology and Neurosurgery 医学-临床神经学

CiteScore

3.70

自引率

5.30%

发文量

358

审稿时长

46 days

期刊介绍： Clinical Neurology and Neurosurgery is devoted to publishing papers and reports on the clinical aspects of neurology and neurosurgery. It is an international forum for papers of high scientific standard that are of interest to Neurologists and Neurosurgeons world-wide.