Choroid plexus enlargement correlates with cognitive impairment and brain atrophy in patients with temporal lobe epilepsy.

As a component of the glymphatic system, the choroid plexus (CP) plays a role in the clearance of metabolic waste and its enlargement is associated with chronic inflammation and glymphatic system dysfunction. We investigated the relationship between choroid plexus volume and cognitive impairment in patients with temporal lobe epilepsy (TLE). Brain MRI, clinical evaluation, and cognition assessment were obtained from patients with TLE and healthy controls. Automatic segmentation was performed to acquire brain regions and CP volumes. The relationship between CP volume and Montreal Cognitive Assessment (MoCA) score and gray matter volume was analyzed using multivariate linear regression. The mediating effects of crucial brain regions on the association between CP volume and MoCA score in the TLE group were examined. Random forests were used to identify predictors of cognitive impairment. Compared to the HC group, patients with TLE exhibited significantly larger CP volume. CP volume enlargement correlated with low MoCA score and decreased gray matter volume. Hippocampal and thalamic volumes had a substantial mediating effect on the association of CP volume and cognitive function. Education level and volume of hippocampus, CP and thalamus were selected as the most relevant factors for diagnosing cognitive impairment in patients with TLE. CP volume could be a non-invasive and reliable neuroimaging marker for the diagnosis of cognitive impairment in patients with temporal lobe epilepsy.