Physiology and Clinical Relevance of Enlarged Perivascular Spaces in the Aging Brain

Area of Science:

• Neuroscience
• Cerebrovascular Biology
• Radiology

Background:

• Perivascular spaces (PVS) are fluid-filled brain compartments crucial for fluid transport.
• Enlarged PVS (ePVS) are pathological findings on MRI, potentially impacting cognition.
• Arterial stiffening and protein aggregation are implicated in ePVS development.

Purpose of the Study:

• To comprehensively review the clinical consequences, anatomy, fluid dynamics, physiology, risk factors, and quantification of ePVS.
• To present competing theories on PVS physiology.
• To examine associations between ePVS and other small vessel disease markers.

Main Methods:

• Literature review and synthesis of existing research on ePVS.
• Description of in vivo quantification techniques for ePVS.
• Analysis of theoretical models of PVS physiology.

Main Results:

• ePVS are associated with cognitive impairment.
• Arterial stiffening and protein aggregation are potential drivers of ePVS.
• ePVS are a marker of small vessel disease, with higher burden in Alzheimer disease.

Conclusions:

• A thorough understanding of ePVS is essential for developing prevention and treatment strategies for neurological disorders.
• ePVS represent a significant area of research in small vessel disease and neurodegenerative conditions.
• Further research into ePVS mechanisms and associations is warranted.