Glymphatic dysfunction assessed by DTI-ALPS index predicts early cognitive impairment in acute subcortical infarcts: a prospective clinical cohort study
Bibliographic record
Abstract
Background The glymphatic system (GS), responsible for clearing neurotoxic proteins (such as β-amyloid and tau protein), is critical in stroke pathophysiology. However, its role in acute post-stroke cognitive impairment (PSCI) remains unclear. We investigated GS dysfunction via the DTI-ALPS index in acute subcortical infarct patients and its association with early cognitive decline. Methods This prospective cohort included 29 subcortical infarct patients and 25 healthy controls (HC). Participants underwent 3.0 T MRI (DTI/structural sequences) and Montreal Cognitive Assessment (MoCA) at 7 and 90 days post-stroke. Bilateral DTI-ALPS indices were calculated. Group comparisons and Spearman correlations were analyzed. Results The DTI-ALPS index of the lesion (1.371 ± 0.170) and non-lesion side (1.310 ± 0.198) in the SI group were significantly lower than that in HC group (1.568 ± 0.115) (both of p < 0.001, respectively). While, the DTI-ALPS index of the lesion side was no significant difference than that of the non-lesion side in subcortical infarct group (p = 0.214). The scores of MoCA in 7 days and 90 days after stroke were significantly lower than those in HC group (p < 0.001). In patients with subcortical infarct, MoCA scores at 7 days showed significant correlation with lesion-side DTI-ALPS index (r = 0.510, p = 0.005) but not with non-lesion DTI-ALPS values (r = 0.174, p = 0.259). Notably, we observed significant correlations between MoCA scores at 90 days post-stroke and DTI-ALPS index, which were consistently demonstrated in the lesion, non-lesion, and mean bilateral measurements. The ROC analysis demonstrated that the DTI-ALPS index showed moderate discriminative ability (AUC = 0.868) in differentiating patients with cognitive impairment from those with normal cognition following subcortical infarction, exhibiting excellent sensitivity (96.0%) but suboptimal specificity (65.5%). Conclusion Ischemic stroke leads to glymphatic dysfunction, which is associated with early post-stroke cognitive impairment.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".