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Distinct spatial patterns of perivascular spaces enlargement for multiple and Co-existing pathologies of cognitive

Woosik Kim1, Yejin Hwang2, Yelim Yang2

  • 1School of Biomedical Engineering, Korea University, 145, Anam-ro, Seongbuk-gu, Seoul, South Korea; AI Imaging Research Center, NeuroXT, Inc., 48, Achasan-ro 17-gil, Seongdong-gu, Seoul, South Korea.

The Journal of Prevention of Alzheimer'S Disease
|July 1, 2026
PubMed
Abstract

Insights

Vascular pathology increases basal ganglia perivascular spaces (PVS), while amyloid-β and vascular issues affect lobar PVS differently. These findings highlight PVS as a biomarker for cognitive impairment pathways.

Area of Science:

  • Neuroimaging
  • Neuropathology
  • Biomarker Discovery

Background:

  • Cognitive impairment is often associated with amyloid-β and vascular pathologies.
  • Perivascular spaces (PVS) on MRI may reflect glymphatic system dysfunction.
  • Understanding the interplay of these pathologies and PVS is crucial for diagnosis.

Purpose of the Study:

  • To investigate the independent and combined effects of amyloid-β and vascular pathology on regional PVS burden.
  • To determine if PVS patterns differ based on the presence and combination of amyloid-β and vascular pathologies.
  • To assess PVS as a potential imaging biomarker in cognitively impaired individuals.

Main Methods:

  • Retrospective analysis of 307 cognitively impaired participants.
  • Automatic quantification of PVS in basal ganglia and lobar white matter using T2-weighted MRI.
  • Classification of participants based on amyloid-β and vascular pathology status using PET and small vessel disease markers.
  • Statistical analysis using ANCOVA and multivariable linear regression to assess group differences and interactions.

Main Results:

  • Vascular pathology was associated with increased basal ganglia PVS, independent of amyloid-β.
  • Lobar PVS were elevated in participants with single pathologies compared to those with no pathology.
  • Amyloid-β retention correlated with lobar PVS in vascular pathology-negative individuals, while vascular burden correlated with basal ganglia PVS in amyloid-β-negative individuals.
  • Less-than-additive interactions between amyloid-β and vascular pathology were observed for lobar PVS.

Conclusions:

  • Regional PVS patterns are distinct and reflect spatially selective glymphatic alterations.
  • PVS burden is associated with amyloid-β and vascular pathologies in a severity-dependent manner.
  • Perivascular spaces serve as a quantitative imaging biomarker for differentiating mixed pathways contributing to cognitive impairment.
Keywords:
Alzheimer’s diseaseCerebral small vessel diseaseGlymphatic dysfunctionMRI segmentationPerivascular spaces

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