Imaging Indicators of the Glymphatic System in T2DM: Correlation with Cognition, and Choroid Plexus Volume-Mediated Impact on WMH-Cognition

Motivation: Research on the glymphatic system in T2DM and its relation to cognition and cerebral small vessel disease (CSVD) is lacking. Goal(s): Comparing glymphatic imaging indicators between T2DM and healthy controls, assess their relationship with cognitive function, CSVD burden, and whether they mediate the link between CSVD and cognition . Approach: The glymphatic imaging indicators include choroid plexus volume, perivascular spaces, and diffusion tensor imaging analysis along perivascular spaces (DTI-ALPS). The CSVD burden refers to white matter hyperintensities(WMH). Results: Compared to controls, T2DM shows significant differences in glymphatic imaging indicators, correlating with cognitive scores and WMH. Choroid plexus volume mediates the CSVD-cognition link. Impact: In T2DM, limited literature evaluates the glymphatic system multidimensionally. Our study pioneers mediation analysis of the glymphatic system's role in CSVD-cognition link.