Exploring Post-Concussive Glymphatic Dysfunction: Independent Mediation Roles of ALPS and kw Mapping on Working Memory Impairment

Motivation: This study seeks to understand how glymphatic dysfunction after concussion affects working memory, aiming to improve clinical tools for post-concussion cognitive assessment. Goal(s): To investigate whether DTI-ALPS index and water permeability (kw) mediate the relationship between neural integrity (FA) and working memory (WMI) in concussion patients. Approach: We used mediation analysis with DTI-ALPS and kw maps to assess glymphatic disruption in concussion patients, incorporating FA and WMI to model cognitive impacts. Results: Both ALPS and kw mediated the FA-WMI relationship, with kw showing a stronger indirect effect. Findings suggest kw as a critical marker of cognitive dysfunction post-concussion. Impact: This research highlights kw mapping as a crucial metric for assessing post-concussive glymphatic dysfunction, potentially aiding clinicians in predicting cognitive outcomes. The study suggests new directions for investigating neuroimaging biomarkers that link brain microstructure with cognitive function in TBI contexts.