ArticleNeurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology2026
Association of the DTI-ALPS index with motor and non-motor symptoms in Parkinson's disease with postural instability/gait difficulty: a diffusion tensor MRI study.
Article in Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveTo explore brain perivascular fluid diffusivity dynamics indirectly applying diffusion tensor image analysis along the perivascular space (DTI-ALPS) and to elucidate its relationship between motor and non-motor symptoms in Parkinson's disease with postural instability/gait difficulty (PIGD).
methods105 PD patients (categorized into PIGD and non-PIGD subgroups) and 51 healthy control participants (HCs) received brain MRI examinations with DTI and clinical evaluations. Statistical comparisons of DTI-ALPS indices were performed between groups. Associations involving DTI-ALPS indices, motor scores, cognitive function, and sleep quality were examined using partial correlation and mediation analyses.
resultsCompared to HCs, PD subgroups exhibited notably reduced left-hemispheric DTI-ALPS index (PIGD: p = 0.006; non-PIGD: p = 0.013). A lower right-hemispheric index was observed exclusively within PIGD group relative to HCs (p = 0.040). With covariates adjusted, left DTI-ALPS index showed inverse association with Unified Parkinson's Disease Rating Scale III (r=-0.347, p = 0.023, p-FDR = 0.046) and PIGD score (r=-0.451, p = 0.002, p-FDR = 0.008), and positive correlation with Frontal Assessment Battery (r = 0.451, p = 0.002, p-FDR = 0.008) scores. After adjustment for education, left ALPS index significantly mediated the association between PIGD score and FAB score, with a significant indirect effect (a*b=-0.140, 95% CI -0.278 to -0.032).
conclusionsThe results indicate that impaired perivascular diffusivity, is more pronounced in PIGD subtype and is markedly linked to motor symptoms intensity and cognitive abilities. DTI-ALPS index may present a possible neural substrate mediating the interplay between motor/non-motor manifestations in PIGD subtype.
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