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Glymphatic System Function and Cognition: Converging Evidence from DTI-ALPS Imaging - A Narrative Review
Anna B Marcinkowska1,2, Małgorzata Grzywińska3, Paweł J Winklewski2,4
1Applied Cognitive Neuroscience Lab, Department of Neurophysiology, Neuropsychology and Neuroinformatics, Medical University of Gdansk, Gdansk, Poland.
Aging and Disease
|August 11, 2026
Summary
The glymphatic system
Area of Science:
- Neuroscience
- Radiology
- Cognitive Science
Background:
- The glymphatic system facilitates brain waste clearance, impacting cognitive health.
- Diffusion Tensor Imaging Analysis along the Perivascular Space (DTI-ALPS) measures glymphatic activity non-invasively.
- Understanding DTI-ALPS's link to cognition and disease is crucial.
Purpose of the Study:
- To synthesize evidence on DTI-ALPS and cognitive performance across aging and neurological diseases.
- To explore potential mechanistic pathways linking DTI-ALPS to cognitive decline.
- To identify limitations and future research directions for DTI-ALPS.
Main Methods:
- Narrative review of studies linking DTI-ALPS to cognitive outcomes.
- Informed by PRISMA 2020 principles (not a formal systematic review).
- Included studies on healthy aging and various neurological conditions.
Main Results:
- Lower DTI-ALPS values consistently correlate with poorer cognitive function, especially memory and global cognition.
- DTI-ALPS decline may precede amyloid pathology, suggesting early prognostic potential.
- Associations were strongest for memory and global cognition, followed by executive functions and processing speed.
Conclusions:
- DTI-ALPS is a promising non-invasive marker for assessing glymphatic function and cognitive health.
- Impaired glymphatic clearance via DTI-ALPS may contribute to neurodegeneration and cognitive impairment.
- Further longitudinal and intervention studies are needed to validate DTI-ALPS and standardize its use.
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