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Choroid plexus alterations correlate with cognitive impairment in multiple system atrophy.

Zhenghong Ren¹, Lingling Cui², Jibin Cao²

¹Department of Ophthalmology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China.

Parkinsonism & Related Disorders

|March 19, 2026

Summary

Enlarged choroid plexus (CP) and increased free water fraction (FWf) in multiple system atrophy (MSA) patients suggest glymphatic dysfunction. These CP changes correlate with cognitive deficits in MSA.

Keywords:

Choroid plexus Free water fraction Mild cognitive impairment Multiple system atrophy Volume

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Area of Science:

Neuroimaging
Neurology
Neuroscience

Background:

The choroid plexus (CP) plays a role in cerebrospinal fluid regulation and barrier function, potentially impacting cognitive function.
The imaging characteristics of the CP in multiple system atrophy (MSA) are not well understood.
Investigating CP alterations in MSA is crucial for understanding its contribution to cognitive dysfunction.

Purpose of the Study:

To investigate structural and microstructural changes in the choroid plexus (CP) in patients with multiple system atrophy (MSA).
To examine the association between CP alterations and cognitive performance in MSA patients.

Main Methods:

Eighty-six MSA patients (MSA-MCI and MSA-NC) and 40 healthy controls (HC) underwent T1-weighted and multi-shell diffusion MRI.
Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE).
CP volume and free water fraction (FWf) were quantified and correlated with cognitive scores, adjusting for covariates.

Main Results:

Both MSA groups exhibited significantly larger CP volumes compared to HC.
MSA patients with mild cognitive impairment (MSA-MCI) showed greater CP volume and FWf than those with normal cognition (MSA-NC).
Increased CP volume and FWf were negatively correlated with MoCA and MMSE scores.

Conclusions:

Choroid plexus (CP) enlargement and elevated free water fraction (FWf) in MSA patients may indicate impaired glymphatic function.
These CP abnormalities are associated with cognitive impairment in individuals with MSA.