Abstract
Objective: To investigate whether the number of cerebral microbleeds (CMB) could be a useful indicator to predict glymphatic system dysfunction in Alzheimer’s disease (AD) patients, by comparing the degree of cerebral spinal fluid (CSF) and interstitial fluid (ISF) stasis.Methods: Forty probable AD patients were included, with those exhibiting two or more CMB were included in the multiple CMB group (mCMB, n = 21, mean = 11.1), and none or one CMB included in the non-multiple CMB group (nmCMB, n = 19, mean = 0.84). CMB was defined in axial gradient recalled echo (GRE) T2*-weighted images. Evans index (EI) was calculated to measure lateral ventricle enlargement, Voxel-based Specific Regional Analysis System for Alzheimer’s Disease (VSRAD) software was used to determine the extent of gray and white matter atrophy, and Fazekas scale (FS) was used to determine white matter hyperintensities (WMH).Results: EI was significantly larger in mCMB than in nmCMB, while the gray and white matter volume was not different between groups. Thus, the difference in lateral ventricle enlargement between AD with and without multiple CMB reflects a combination of the degree of brain atrophy and the extent of CSF stasis. FS was higher in mCMB than in the nmCMB, suggesting the failure of ISF elimination was more severe in mCMB cases.Conclusion: The difference in lateral ventricle enlargement and WMH between AD with or without multiple CMB may reflect a difference in the degree of CSF/ISF stagnation.
Highlights
The lymphatic drainage system is essential for the maintenance of water and solute balance, homeostasis, metabolism, and immunity within the tissue
The difference in lateral ventricle enlargement between Alzheimer’s disease (AD) with and without multiple cerebral microbleeds (CMB) reflects a combination of the degree of brain atrophy and the extent of cerebrospinal fluid (CSF) stasis
Fazekas scale (FS) was higher in mCMB than in the nmCMB, suggesting the failure of interstitial fluid (ISF) elimination was more severe in mCMB cases
Summary
The lymphatic drainage system is essential for the maintenance of water and solute balance, homeostasis, metabolism, and immunity within the tissue This system is made up of a network of blind-ended capillaries that drain into larger vessels. These vessels are responsible for removing the lymph from the interstitial fluid (ISF) that surrounds tissues and most organs, which contains waste materials, fluid, proteins, and cells (Dissing-Olesen et al, 2015). The glymphatic system, a recently discovered glialdependent CSF/ISF system for waste clearance, is composed of a network of peri- and para-vascular spaces throughout the brain (Sun et al, 2018). The movement of CSF/ISF has important implications for understanding basic physiological processes (Simon and Iliff, 2016)
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