Association between diffusion tensor imaging analysis along the perivascular space (DTI-ALPS)-based glial-lymphatic...

To investigate the correlation of glial-lymphatic (glymphatic) system function with cognitive deficits in non-small cell lung cancer (NSCLC).

Data (demographic, clinical, and magnetic resonance imaging [MRI] information) from 83 NSCLC cases and 96 healthy controls were retrospectively analyzed. We evaluated glymphatic activity by using the diffusion tensor imaging analysis along the perivascular space (DTI-ALPS) index and cognitive function with the Montreal Cognitive Assessment (MoCA). Medial Temporal Atrophy (MTA) and Fazekas scores were also rated. Statistical analyses included inter-group comparisons, partial correlation assessments, mediation modeling, and regression to identify predictors of cognitive impairment.

NSCLC patients had higher MTA and Fazekas scores but lower MoCA and ALPS index scores than controls (all P < 0.05). The ALPS index was symmetrically reduced in both hemispheres, correlating positively with MoCA (r = 0.276, P = 0.012). In the mediation model, the ALPS index exhibited a partial mediating role (4.6%) in the NSCLC-MoCA association. Older age was an independent predictor of cognitive impairment (odds ratio [OR]: 1.229; 95% confidence interval [CI]: 1.111-1.360).

In NSCLC patients, glymphatic dysfunction was associated with cognitive impairment, and the DTI-ALPS index may facilitate early detection of these deficits. Advanced age remains a major contributing risk factor.