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In Vivo Imaging of Cerebrospinal Fluid Transport through the Intact Mouse Skull using Fluorescence Macroscopy

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The Relationship between Glymphatic Dysfunction and Post-stroke Cognitive Impairment.

Hongjie Huang¹, Hongqian Tian², Zihuai Fang¹

¹Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China.

Current Medical Imaging

|June 16, 2026

Summary

Glymphatic dysfunction, marked by reduced DTI-ALPS and increased CPV, is evident in post-stroke patients and linked to cognitive decline. This supports glymphatic impairment as a key factor in post-stroke cognitive impairment (PSCI).

Keywords:

ALPS index Choroid plexus volume Diffusion tensor imaging Glymphatic system Perivascular space Post-stroke cognitive impairment

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Area of Science:

Neuroscience
Radiology
Gerontology

Background:

Glymphatic dysfunction is implicated as a common pathway to dementia.
Post-stroke cognitive impairment (PSCI) can worsen over time, potentially leading to dementia.
This study investigates glymphatic function changes in post-stroke patients and their cognitive impact.

Purpose of the Study:

To examine glymphatic function alterations in post-stroke patients using MRI-based markers.
To explore the relationship between glymphatic markers and cognitive performance in this population.
To investigate the role of glymphatic dysfunction in the development of PSCI.

Main Methods:

Thirty-two post-stroke patients and 27 healthy controls underwent MRI and cognitive assessments.
Glymphatic markers quantified: Diffusion Tensor Image Analysis along the Perivascular Space (DTI-ALPS) index, choroid plexus volume (CPV), and enlarged perivascular spaces (PVS) volume.
Statistical analyses correlated glymphatic markers with cognitive scores, adjusting for confounders.

Main Results:

Post-stroke patients showed significantly reduced DTI-ALPS index and increased CPV compared to controls.
DTI-ALPS index correlated positively with Digit Span and Digit Symbol Substitution Test scores.
Enlarged PVS volume was independently associated with poorer performance on the Trail Making Test-B.

Conclusions:

Reduced DTI-ALPS and increased CPV indicate glymphatic dysfunction in post-stroke patients.
Glymphatic dysfunction is significantly associated with impairments in working memory, processing speed, and executive function.
Glymphatic impairment may be a crucial mechanism underlying PSCI, warranting further longitudinal research.