ArticleAlzheimer's research & therapy2025
Evaluation and interpretation of DTI-ALPS, a proposed surrogate marker for glymphatic clearance, in a large population-based sample.
Article in Alzheimer's research & therapy, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 27 papers, 2 of them syntheses that pooled it.
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Who cites it
27 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Glymphatic dysfunction in Alzheimer's disease: a systematic review and meta-analysis of the DTI-ALPS index as an imaging biomarker.Frontiers in aging neuroscience · 2026Pooled it
- Imaging biomarkers of glymphatic system dysfunction in Alzheimer's disease: a systematic review and meta-analysis with a focus on DTI-ALPS index.Frontiers in aging neuroscience · 2026Pooled it
- Diffusion tensor image analysis along the perivascular space (DTI-ALPS): redefining its interpretation and role.Japanese journal of radiology · 2026Review
- Harnessing Brain Age-Specific Effects on the Associations Between Sleep Quality, Glymphatic Function, and Cognition in Normal Ageing Adults: Insights for Gerotherapeutics.Neurology and therapy · 2026Article
- Shared genetic architecture between DTI-ALPS traits and neurodegenerative diseases.Alzheimer's & dementia : the journal of the Alzheimer's Association · 2026Article
- DTI-ALPS as a marker of glymphatic function: Review of the literature findings, methodology, and interpretation.Neuroimage. Reports · 2026Article
- White Matter and Perivascular Imaging Changes in Alzheimer's Disease and Cerebral Amyloid Angiopathy.Annals of clinical and translational neurology · 2026Article
- Anatomical determinants of DTI-ALPS: effects of ROI definition, ventricular morphology, and periventricular deformation.bioRxiv : the preprint server for biology · 2026Article
- Validation of automated DTI-ALPS and free water index as potential survival stratification markers in IDH-wildtype glioblastoma.Neuroradiology · 2026Article
- Periventricular diffusivity at the ventricular-parenchymal interface across healthy controls, episodic migraine, and chronic migraine: a cross-sectional multimodal MRI study.The journal of headache and pain · 2026Article
- Hierarchical organization of tau topography across the Alzheimer's disease continuum integrates amyloid, connectome, and intrinsic molecular vulnerability.Communications biology · 2026Article
- Glymphatic system impairment in dysthyroid optic neuropathy: relation with ocular cerebrospinal fluid circulation and visual function.Japanese journal of radiology · 2026Article
- The meningeal lymphatic vessel-peripheral immune axis: a novel therapeutic target in neurodegenerative diseases.Journal of neuroinflammation · 2026Review
- Sleep-Dependent Clearance of Brain Metabolites via the Glymphatic System: Implications for Alzheimer's Pathophysiology.Brain and behavior · 2026Review
- Diffusion tensor imaging analysis along the perivascular space suggests impaired glymphatic clearance in Lewy body dementia subtypes.Alzheimer's research & therapy · 2026Article
- Individualized DTI-ALPS Identifies Phase-Specific Glymphatic Dysfunction in Early-Stage Bipolar Disorder.Biomedicines · 2026Article
- Alterations in the DTI-ALPS index and choroid plexus volume as brain-immune interfacing indicators in neuropsychiatric lupus erythematosus with inflammatory phenotype.Lupus science & medicine · 2026Article
- Surrogates of glymphatic metrics decline and coupled sleep rhythms disruption in Alzheimer's disease.Alzheimer's research & therapy · 2026Article
- Altered perivascular space diffusivity dynamics in motor neuron disease.Brain communications · 2026Article
- Operationalizing perioperative clearance reserve: a reserve-load interaction model for neurocognitive outcomes in older surgical patients.Frontiers in medicine · 2026Article
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12 authors.
Funding
Abstract
backgroundThe diffusion tensor imaging along perivascular spaces index (DTI-ALPS), which measures diffusivity in the perivascular spaces along the medullary veins, has gained popularity and controversy as a surrogate marker of glymphatic clearance. The goal of this work is to automatically estimate DTI-ALPS in a large population-based sample, evaluate the correlates of the signal observed in the context of aging and dementia biomarkers, and evaluate its clinical usefulness.
methodsWe identified 2715 participants aged 30 + years in the population-based Mayo Clinic Study of Aging with diffusion MRI. We calculated DTI-ALPS through a modified pipeline of previously published methods. We evaluated DTI-ALPS using different protocols and scanners and reported ICC for agreement. We examined the predictors of longitudinal DTI-ALPS with demographics (age, sex), vascular risk, clinical data (diagnosis, global cognition), and imaging markers (white matter hyperintensity (WMH), global amyloid load from PIB-PET, and temporal meta-ROI Tau-PET SUVR) in a subset of participants aged 50 + years using Pearson correlations, ANCOVA with adjustments for age and sex, and linear mixed effect models. We also compared the utility of DTI-ALPS with WMH for prediction of cognitive decline.
resultsWith modifications to the automated DTI-ALPS pipeline, consistent measurements can be made from data obtained with different protocols on different scanners. DTI-ALPS was negatively correlated with age, vascular risk, and WMH burden and was positively correlated with cognitive scores and higher in females. In the longitudinal models, WMH explained the greatest variability in decline of DTI-ALPS. The age and sex adjusted associations with AD biomarkers (amyloid and tau) were minimal. DTI-ALPS had a significant interaction with WMH on the rate of cognitive decline.
conclusionsDTI-ALPS can be reliably automated in large samples. The computed DTI-ALPS was associated with vascular dysfunction (vascular risk and WMH) and may provide additional complementary information about cognitive decline. The low associations with AD biomarkers suggest that DTI-ALPS may be a poor surrogate of AD.
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