Liya Gong, Jing He, Ziqi Wu, Mingxuan Gao, Yanmei Zeng, Wei Cui, Jingwen Luo, Junyan Wen, Ge Wen
{"title":"Association of Glymphatic Dysfunction with Cognitive Performance in Type 2 Diabetes Mellitus and Prediabetes.","authors":"Liya Gong, Jing He, Ziqi Wu, Mingxuan Gao, Yanmei Zeng, Wei Cui, Jingwen Luo, Junyan Wen, Ge Wen","doi":"10.1159/000551127","DOIUrl":null,"url":null,"abstract":"<p><p><p>Introduction: The glymphatic system (GS) is a brain-wide clearance pathway whose dysfunction has been implicated in cognitive decline. This study was designed to assess GS alterations in prediabetes and type 2 diabetes mellitus (T2DM) using multiple MRI-derived metrics and to examine their associations with cognitive performance.</p><p><strong>Methods: </strong>This cross-sectional study was conducted from October 2023 to June 2024 at Nanfang Hospital, a tertiary care center. A total of 147 participants were recruited, including 52 patients with T2DM, 44 with prediabetes, and 51 healthy controls (HC). All participants underwent brain MRI, laboratory examinations, and cognitive function assessments. GS function was evaluated using MRI-derived metrics, including choroid plexus (CP) volume, perivascular space (PVS) volume, free water (FW) index, and the diffusion tensor imaging analysis along the PVS (DTI-ALPS) index. Group differences were tested with general linear models adjusted for sex, age, and education, and associations with clinical variables were evaluated using partial correlations.</p><p><strong>Results: </strong>Compared with HC, prediabetes showed increased CP volume and FW index, without significant changes in DTI-ALPS index or PVS volume. T2DM showed reduced DTI-ALPS index, increased CP volume, and higher FW index, with unchanged PVS volume. In both groups, lower DTI-ALPS index and higher CP volume or FW index correlated with poorer cognitive performance.</p><p><strong>Conclusion: </strong>Prediabetes and T2DM exhibit GS alterations, including reduced DTI-ALPS index and increased CP volume and FW index, which are associated with poorer cognition. GS metrics may serve as potential neuroimaging biomarkers for cognitive impairment in this population. </p>.</p>","PeriodicalId":19117,"journal":{"name":"Neuroendocrinology","volume":" ","pages":"189-199"},"PeriodicalIF":2.4000,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13143255/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Neuroendocrinology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1159/000551127","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2026/3/5 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"ENDOCRINOLOGY & METABOLISM","Score":null,"Total":0}
引用次数: 0
Abstract
Introduction: The glymphatic system (GS) is a brain-wide clearance pathway whose dysfunction has been implicated in cognitive decline. This study was designed to assess GS alterations in prediabetes and type 2 diabetes mellitus (T2DM) using multiple MRI-derived metrics and to examine their associations with cognitive performance.
Methods: This cross-sectional study was conducted from October 2023 to June 2024 at Nanfang Hospital, a tertiary care center. A total of 147 participants were recruited, including 52 patients with T2DM, 44 with prediabetes, and 51 healthy controls (HC). All participants underwent brain MRI, laboratory examinations, and cognitive function assessments. GS function was evaluated using MRI-derived metrics, including choroid plexus (CP) volume, perivascular space (PVS) volume, free water (FW) index, and the diffusion tensor imaging analysis along the PVS (DTI-ALPS) index. Group differences were tested with general linear models adjusted for sex, age, and education, and associations with clinical variables were evaluated using partial correlations.
Results: Compared with HC, prediabetes showed increased CP volume and FW index, without significant changes in DTI-ALPS index or PVS volume. T2DM showed reduced DTI-ALPS index, increased CP volume, and higher FW index, with unchanged PVS volume. In both groups, lower DTI-ALPS index and higher CP volume or FW index correlated with poorer cognitive performance.
Conclusion: Prediabetes and T2DM exhibit GS alterations, including reduced DTI-ALPS index and increased CP volume and FW index, which are associated with poorer cognition. GS metrics may serve as potential neuroimaging biomarkers for cognitive impairment in this population.
glymphatic system （GS）是一种全脑清除通路，其功能障碍与认知能力下降有关。本研究旨在使用多种mri衍生指标评估糖尿病前期（PDM）和2型糖尿病（T2DM）的GS改变，并检查其与认知表现的关系。方法：本横断面研究于2023年10月至2024年6月在三级保健中心南方医院进行。总共招募了147名参与者，包括52名T2DM患者，44名PDM患者和51名健康对照（HC）。所有参与者都接受了脑MRI、实验室检查和认知功能评估。使用mri衍生指标评估GS功能，包括CP体积、pv体积、FW指数和DTI-ALPS指数。通过调整性别、年龄和教育程度的一般线性模型检验组间差异，并使用偏相关评估与临床变量的关联。结果：与HC相比，PDM的CP体积和FW指数增加，DTI-ALPS指数和PVS体积无明显变化。T2DM表现为DTI-ALPS指数降低，CP体积增加，FW指数升高，PVS体积不变。在两组中，较低的DTI-ALPS指数和较高的CP容积或FW指数与较差的认知表现相关。结论：PDM和T2DM均表现为GS改变，DTI-ALPS指数降低，CP容积和FW指数升高，与认知能力下降有关。GS指标可以作为该人群认知障碍的潜在神经成像生物标志物。
期刊介绍：
''Neuroendocrinology'' publishes papers reporting original research in basic and clinical neuroendocrinology. The journal explores the complex interactions between neuronal networks and endocrine glands (in some instances also immunecells) in both central and peripheral nervous systems. Original contributions cover all aspects of the field, from molecular and cellular neuroendocrinology, physiology, pharmacology, and the neuroanatomy of neuroendocrine systems to neuroendocrine correlates of behaviour, clinical neuroendocrinology and neuroendocrine cancers. Readers also benefit from reviews by noted experts, which highlight especially active areas of current research, and special focus editions of topical interest.
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