DTI-ALPS as a non-invasive glymphatic imaging marker linked to cognitive decline

A narrative review finds lower DTI-ALPS, an MRI marker of glymphatic clearance, is consistently tied to worse memory and global cognition across Alzheimer's, small vessel disease, Parkinson's, and other conditions. Longitudinal data suggests DTI-ALPS decline may precede detectab…

• The strongest cognitive associations are with memory and global cognition, followed by executive function and processing speed.
• Three mechanistic pathways are proposed: disrupted sleep-dependent waste clearance, gray matter compromise from metabolite buildup, and impaired perivascular clearance of amyloid and tau.
• Key limitations include the indirect nature of the DTI-ALPS measure, predominantly cross-sectional studies, and small sample sizes.

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