Glymphatic Function as a Prognostic Biomarker in Prolonged Disorders of Consciousness

Area of Science:

• Neuroscience
• Neurology
• Biomedical Engineering

Background:

• The glymphatic system is crucial for waste clearance in the central nervous system.
• Prolonged disorders of consciousness (pDoC) represent a significant clinical challenge.
• Understanding the underlying pathophysiology of pDoC is essential for developing prognostic tools.

Purpose of the Study:

• To investigate glymphatic system function in patients with pDoC.
• To evaluate the prognostic value of glymphatic function in pDoC.
• To explore the relationship between glymphatic function and consciousness recovery.

Main Methods:

• Prospective cohort study including 40 pDoC patients and 20 healthy controls.
• Glymphatic function assessed using blood-oxygen-level-dependent and cerebrospinal fluid (BOLD-CSF) couplings, measuring time-lags and strengths.
• Clinical outcome determined 6 months post-enrollment using the Coma Recovery Scale-Revised (CRS-R).

Main Results:

• pDoC patients showed significantly delayed BOLD-CSF coupling time-lags and reduced coupling strengths compared to controls.
• Shorter global BOLD-CSF coupling time-lags predicted improved consciousness at 6 months.
• The prognostic model achieved 85.7% accuracy with an area under the curve of 0.837.

Conclusions:

• Glymphatic system function is impaired in patients with pDoC.
• BOLD-CSF coupling serves as a novel prognostic biomarker for consciousness recovery in pDoC.
• This finding may inform future therapeutic strategies targeting the glymphatic system.