The role of glymphatic system dysfunction in multiple system atrophy and its impact on disease-related pathological changes

Motivation: In the central nervous system, the dysfunction of " glymphatic system " potentially hinders α-synuclein clearance. Multiple system atrophy (MSA) as α-synucleinopathy diseases, the glymphatic system not been evaluated. Goal(s): ALPS-index has been proposed as a new techology to evaluate the glymphatic system function. Approach: DTI-ALPS index to evaluate the glymphatic system function. Structural MRI features of each subject were extract. Group comparison, correlation analysis and granger causality test, mediation analysis were performed. Results: MSA patients exhibited lower ALPS-index, and correlated with clinical symptoms and MSA-related neuropathological changes. The causality test indicated the ALPS-index changes may be the primary cause of the structural MRI changes. Impact: Changes in glymphatic system status closely related to disease-related pathological in patients with multiple system atrophy.