Divergent Glymphatic Dysfunction and Free Water Pathology Underpin Distinct Mechanisms and Enable Differential Diagnosis in Parkinson's Disease and Multiple System Atrophy
Cross-sectional and longitudinal neuroimaging analyses reveal distinct biomarkers for Parkinson's and MSA, suggesting new diagnostic approaches.
Key Points
Evaluate glymphatic function and free water pathology in Parkinson's disease and multiple system atrophy to identify differential diagnostic biomarkers.
Conducted a cross-sectional and longitudinal neuroimaging study with 231 participants including healthy controls, PD, and MSA patients.
Analyzed glymphatic function using diffusion tensor imaging and choroid plexus volume metrics from MRI scans.
Evaluated diagnostic performance with receiver operating characteristic curves and performed mediation analyses.
Both PD and MSA showed reduced glymphatic function and expanded choroid plexus volume compared to healthy controls.
Free water accumulation patterns differed: cortical/midline in PD and cerebellar in MSA.
Longitudinal studies indicated progressive free water accumulation in specific regions.
Strong coupling between glymphatic dysfunction and free water was evident in PD but absent in MSA.
An integrated model combining imaging and clinical metrics demonstrated high diagnostic accuracy with an area under the curve of 0.994.