DTI-ALPS index as a predictor of glymphatic system dysfunction in cerebral infarction.

Objectives: To evaluate glymphatic system (GS) dysfunction in patients with cerebral infarction using diffusion tensor imaging - along the perivascular space (DTI-ALPS), and to investigate factors associated with glymphatic function impairment following stroke.

Methods: A retrospective study was conducted on 82 patients diagnosed with cerebral infarction at Zhujiang Hospital of Southern Medical University between July 2019 and June 2022. Based on 90-day modified Rankin Scale (mRS) scores, patients were categorized into a good prognosis group (n = 40) and a poor prognosis group (n = 42). Clinical data, National Institutes of Health Stroke Scale (NIHSS) scores, DTI-ALPS indices (L-ALPS, R-ALPS, mean-ALPS), 90-day mRS scores, and infarct location were compared between groups.

Results: At admission, the L-ALPS, R-ALPS, and mean-ALPS values were significantly higher in the good prognosis group compared to the poor prognosis group (all P < 0.05). At 90 days post-onset, Hamilton Depression (HAMD) and Anxiety (HAMA) scores were significantly lower than baseline in the good prognosis group, indicating better psychological recovery compared to the poor prognosis group (both P < 0.05). Additionally, NIHSS scores were lower, while Glasgow Coma Scale (GCS) and activities of daily living (ADL) scores were higher in the good prognosis group (both P < 0.05). Logistic regression analysis identified L-ALPS, R-ALPS, mean-ALPS, 90-day mRS, ADL, and GCS scores as independent predictors of poor prognosis. Furthermore, ADL, 90-day mRS, and GCS scores were independently associated with GS dysfunction.

Conclusion: Patients with poor prognosis after cerebral infarction exhibit significant GS dysfunction. This dysfunction correlates with the severity of neurological impairment, suggesting that glymphatic impairment is both a marker and a potential contributor to stroke outcomes.