Impaired glymphatic system function in pre-cirrhotic NAFLD patients: Evidenced from DTI-ALPS

Motivation: Whether there are novel mechanisms linking liver health, brain waste clearance, and cognition in non-alcoholic fatty liver disease (NAFLD) patients remains unclear Goal(s): To evaluate the alterations of glymphatic function in patients with NAFLD and explore its association with cognition. Approach: We investigate the functionality of glymphatic system (GS) in patients with NAFLD using diffusion tensor imaging analysis along with the perivascular space (DTI-ALPS). Results: Individuals with NAFLD had a significantly lower ALPS index and higher diffusivity of projection fibers in the direction of the y-axis compared to the healthy controls. Moreover, the decreased ALPS index was associated with impaired cognitive function. Impact: The results demonstrate the feasibility of DTI-ALPS, which can be used for research on glymphatic system function in NAFLD. These findings contribute to understanding the link between the GS and NAFLD, along with its connection to cognition and clinical indicators.