Amyloid and Vascular Pathology Show Distinct, Less-Than-Additive Perivascular Space Patterns

In 307 cognitively impaired patients, vascular pathology independently linked to larger basal ganglia perivascular spaces (PVS) (Cohen d=1.28), while amyloid-β burden linked to lobar PVS. Mixed pathology showed less-than-additive effects, suggesting spatially distinct glymphatic…

• Retrospective study of 307 participants from a single-center dementia cohort using automatic PVS quantification on T2-weighted MRI and [18F]Florbetaben PET/CT.
• Amyloid-vascular interactions in parietal, temporal, and occipital PVS were less-than-additive (e.g., parietal β [95% CI]= -0.65 [-1.08, -0.23]), indicating a plateau of glymphatic dysfunction in mixed disease.
• Key limitation: single-center retrospective design with a small pathology-negative reference group (n=36); not yet externally validated.

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