Does T2DM impair glymphatic flow on DTI-ALPS?
In 30 adults, longer T2DM history tracked with lower ALPS-index values, suggesting reduced perivascular water diffusivity.
Source
Evaluation of Glymphatic System Using Diffusion MR Technique in T2DM Cases
Study at a glance
- Design
- Case-control — DTI-ALPS comparison of T2DM duration groups vs controls
- N
- N=30 · 10 ≥10 y T2DM, 10 <10 y T2DM, 10 controls
- Population
- Adults with type 2 diabetes and age-matched controls imaged at lateral ventricle body plane
- Outcome
- Directional diffusivities and ALPS-index as glymphatic activity markers
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Does T2DM impair glymphatic flow on DTI-ALPS?
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Sample comprised 30 participants (mean age ~66).
We studied 30 patients (14 males and 17 females; mean 66 years old; age range 56–75 years ), 10 T2DM patients with a history of more than 10 years, 10 T2DM patients with a history of fewer than 10 years, and 10 normal people in the control group.
ALPS-index differed between <10 y and ≥10 y T2DM groups at P < 0.001.
significant difference in the ALPS-index values between <10 y T2DM group and ≥10 y T2DM group ( P < 0.001)
What they did
Calculated directional diffusivities and ALPS-index from DTI at the lateral ventricle body in ≥10 y T2DM, <10 y T2DM, and controls (n=10 each).
What they found
ALPS-index and perivascular-aligned diffusivity differed by T2DM history (key contrasts P < 0.001); authors interpret lower ALPS as glymphatic impairment.
The limits
What it doesn't show
Causal proof that diabetes damages glymphatics, or that ALPS equals true CSF clearance; sample is small and cross-sectional.
Key terms
- Glymphatic system
- Perivascular CSF–ISF clearance pathway for brain waste including Aβ.
- DTI-ALPS
- Diffusion tensor analysis along the perivascular space.
- ALPS-index
- Ratio indexing diffusivity along vs across perivascular orientations.
- Perivascular space
- Fluid sheath around vessels where glymphatic flow occurs.
- T2DM
- Type 2 diabetes mellitus, a risk factor for cognitive decline.
- Projection/association fibers
- White-matter bundles used as landmarks for ALPS ROI placement.
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Quiz yourself
DTI-ALPS primarily indexes diffusivity along which anatomy?
Common questions
What was N?
30 (10 per group).
Main imaging metric?
ALPS-index from DTI.
Key pattern?
Longer T2DM → lower ALPS / impaired perivascular diffusivity.
Clinical takeaway?
Non-invasive marker candidate for diabetes-related glymphatic change.
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