Glymphatic dysfunction correlates with severity of small vessel disease and cognitive impairment in cerebral amyloid angiopathy

Background and purpose Cerebral amyloid angiopathy (CAA) is characterized by β‐amyloid deposition in cortical and leptomeningeal arterioles, which might result from glymphatic dysfunction. The aim was to explore glymphatic function in CAA using the non‐invasive diffusion tensor image analysis along the perivascular space method. Methods Sixty‐three patients with CAA were prospectively recruited together with seventy age‐ and sex‐matched normal controls. The Mini‐Mental State Examination and Montreal Cognitive Assessment were applied to screen global cognitive status. Magnetic resonance imaging scans were conducted to calculate the index for diffusivity along the perivascular space (ALPS index), and linear regression models were used to assess its relationships with cerebral small vessel disease (CSVD) markers, cognitive status and blood biomarkers. Cox proportional hazard models were applied to explore the role of the baseline ALPS index in disease recurrence. Results Patients with CAA exhibited a lower ALPS index than controls globally (p