PDF(Pubmed)
Abstract：
Traumatic brain injury (TBI) even in the mild form may result in long-lasting post-concussion symptoms. TBI is also a known risk to late-life neurodegeneration. Recent studies suggest that dysfunction in the glymphatic system, responsible for clearing protein waste from the brain, may play a pivotal role in the development of dementia following TBI. Given the diverse nature of TBI, longitudinal investigations are essential to comprehending the dynamic changes in the glymphatic system and its implications for recovery. In this prospective study, we evaluated two promising glymphatic imaging markers, namely the enlarged perivascular space (ePVS) burden and Diffusion Tensor Imaging-based ALPS index, in 44 patients with mTBI at two early post-injury time points: approximately 14 days (14Day) and 6-12 months (6-12Mon) post-injury, while also examining their associations with post-concussion symptoms. Additionally, 37 controls, comprising both orthopedic patients and healthy individuals, were included for comparative analysis. Our key findings include: 1) White matter ePVS burden (WM-ePVS) and ALPS index exhibit significant correlations with age. 2) Elevated WM-ePVS burden in acute mTBI (14Day) is significantly linked to a higher number of post-concussion symptoms, particularly memory problems. 3) The increase in the ALPS index from acute (14Day) to the chronic (6-12Mon) phases in mTBI patients correlates with improvement in sleep measures. Furthermore, incorporating WM-ePVS burden and the ALPS index from acute phase enhances the prediction of chronic memory problems beyond socio-demographic and basic clinical information, highlighting their distinct roles in assessing glymphatic structure and activity. Early evaluation of glymphatic function could be crucial for understanding TBI recovery and developing targeted interventions to improve patient outcomes.
摘要：
即使是轻度形式的创伤性脑损伤(TBI)也可能导致长期持续的脑震荡后症状。TBI也是晚期神经变性的已知风险。最近的研究表明，在淋巴系统的功能障碍，负责清除大脑中的蛋白质废物，可能在TBI后痴呆的发展中起关键作用。鉴于TBI的多样性，纵向调查对于理解淋巴系统的动态变化及其对恢复的影响至关重要。在这项前瞻性研究中，我们评估了两个有希望的淋巴淋巴成像标记，即扩大的血管周围间隙（ePVS）负荷和基于扩散张量成像的ALPS指数，44例mTBI患者在受伤后两个早期时间点：受伤后约14天（14天）和6-12个月（6-12月），同时检查它们与脑震荡后症状的关系。此外,37个控件，包括骨科患者和健康个体，进行比较分析。我们的主要发现包括：1）白质ePVS负荷（WM-ePVS）和ALPS指数与年龄显着相关。2）急性mTBI（14天）中WM-ePVS负荷升高与脑震荡后症状的数量增加显着相关，尤其是记忆问题。3）mTBI患者的ALPS指数从急性（14天）到慢性（6-12Mon）阶段的增加与睡眠措施的改善有关。此外，纳入WM-ePVS负担和急性期ALPS指数可增强对慢性记忆问题的预测，超出社会人口统计学和基本临床信息，强调它们在评估类淋巴结构和活性方面的不同作用。早期评估淋巴功能对于了解TBI恢复和制定针对性干预措施以改善患者预后至关重要。
