SynthesisFrontiers in aging neuroscience2026
Glymphatic dysfunction in Alzheimer's disease: a systematic review and meta-analysis of the DTI-ALPS index as an imaging biomarker.
Synthesis in Frontiers in aging neuroscience, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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7 authors.
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Abstract
Introduction: Although the diffusion tensor image analysis along the perivascular space (DTI-ALPS) index is widely utilized as a proxy for glymphatic function in Alzheimer's Disease (AD) research, its association with core AD pathological biomarkers remains inconclusive due to inter-study heterogeneity. This systematic review aimed to investigate associations between the DTI-ALPS index and AD biomarkers and to elucidate potential sources of heterogeneity. Methods: The study protocol adhered to PRISMA guidelines and was registered with PROSPERO (CRD420251266067). We systematically searched Web of Science, PubMed, and ScienceDirect from January 1, 2017 to September 18, 2025 for studies examining the relationship between the DTI-ALPS index and core AD biomarkers. Random-effects meta-analyses were conducted when studies employed comparable methodologies and reported effect sizes while narrative synthesis was performed otherwise. Methodological quality was assessed using the Newcastle-Ottawa Scale (NOS) and the risk of bias was evaluated using the Risk of Bias in Systematic reviews (ROBIS) tool. Results: Thirty-six studies were included. Meta-analyses revealed significant correlations between the DTI-ALPS index ( Discussion: Consequently, we proposed the "GS Hub Integrative Framework." This framework posits that vascular, genetic, lifestyle, and environmental risk factors converge on glymphatic dysfunction (DTI-ALPS index) as a central hub, accelerating Aβ/tau accumulation, neurodegeneration, and cognitive decline. Future methodological standardization and refined patient stratification are essential for clinical translation. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251266067, identifier: CRD420251266067.
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