Glymphatic Dysfunction Associated with Cognitive Impairment in Patients with Unilateral Intracranial Atherosclerotic Stenosis
Bibliographic record
Abstract
ABSTRACT BACKGROUND AND PURPOSE: Glymphatic dysfunction, associated with cognitive impairment across various conditions, has not been extensively studied in patients with unilateral intracranial atherosclerotic stenosis (ICAS). This study aims to investigate the relationship among the severity of stenosis, glymphatic function, and cognition. MATERIALS AND METHODS: We recruited 141 participants with ≥50% stenosis of unilateral intracranial internal carotid artery or M1/M2 segments of middle cerebral artery and 282 controls. All participants underwent magnetic resonance imaging along with standardized neuropsychological evaluation. Glymphatic function was assessed by the index for diffusion along the perivascular space (ALPS-index) on diffusion tensor imaging. RESULTS: ICAS participants had lower global cognitive score and all six cognitive domain scores compared with the controls (all P < 0.05). Of note, both ipsilateral and contralateral ALPS indices were lower in participants presenting unilateral ICAS (both P< 0.05). With the stenosis worsening, the ipsilateral ALPS-index decreased (ipsilateral: 95% CI = -0.405 to -0.092, P =0.002). A significant mediation effect of ipsilateral ALPS-index was observed between stenosis degree and global cognition (95% CI = -0.6884 to -0.0515) and executive function (95% CI = -0.8617 to -0.1082). CONCLUSIONS: There is a glymphatic dysfunction associated with the severity of stenosis in participants with unilateral ICAS, which may contribute to the cognitive impairment. Improving glymphatic system might be a helpful alternative therapeutic option in ICAS patients. ABBREVIATIONS: ICAS = Intracranial atherosclerotic stenosis; CMBs = Cerebral microbleeds; CSF = Cerebrospinal fluid; CSVD = Cerebral small vessel disease; DTI–ALPS = Diffusion tensor imaging along the perivascular space; FA = Fractional anisotropy; MMSE = Mini-mental state examination; MOCA = Montreal cognitive assessment; WMHs = White matter hyperintensities.
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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 | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 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".