journal articles
DISTINCT SPATIAL PATTERNS OF PERIVASCULAR SPACES ENLARGEMENT FOR MULTIPLE AND CO-EXISTING PATHOLOGIES OF COGNITIVE IMPAIRMENT
Woosik Kim, Yejin Hwang, Yelim Yang, Min Gyeong Kim, Hyemin Jang, Seung Hong Choi, Joon-Kyung Seong, Roh-Eul Yoo, Wha Jin Lee
BACKGROUND: This study examines how amyloid-β and vascular pathology independently and jointly relate to regional perivascular space (PVS) burden on T2-weighted MRI.
METHODS: In 307 cognitively impaired participants retrospectively identified from the Seoul National University dementia cohort, PVS were automatically quantified in the basal ganglia (BG) and lobar white matter regions from 2D T2-weighted MRI. Amyloid-β and vascular pathology positivity were defined by [18F]Florbetaben PET and small vessel disease markers. Group differences among pathology-negative (n=36), vascular-only (n=106), amyloid-only (n=48), and mixed (n=117) subgroups, as well as amyloid–vascular interactions, were assessed using analysis of covariance and multivariable linear regression.
RESULTS: BG PVS were greater in participants with vascular burden than in pathology-negative participants (F=26.97, p<0.001; Cohen's d=1.28), independent of amyloid-β. Lobar PVS were higher in single-pathology than pathology-negative participants across the parietal, temporal, and occipital regions (F=8.25–18.04, Cohen's d=0.66–0.98, all p≤0.014), with no additional increase in the mixed group. Greater amyloid-β retention was associated with parietal, temporal, and occipital PVS in VB− participants (β [95% CI]=0.55 [0.19, 0.92], 0.69 [0.35, 1.02], 0.40 [0.16, 0.64], respectively). Among AB− participants, vascular burden was associated with BG PVS (β [95% CI]=0.65 [0.40, 0.89]). Multivariable regression demonstrated less-than-additive AB×VB interactions in parietal, temporal, and occipital PVS (β [95% CI]=−0.65 [−1.08, −0.23], −0.74 [−1.13, −0.35], −0.42 [−0.70, −0.14], respectively).
CONCLUSIONS: Distinct regional PVS patterns reflect spatially selective and severity-dependent glymphatic-related structural alterations associated with amyloid-β and vascular pathologies, supporting PVS as a quantitative imaging biomarker for disentangling mixed pathways of cognitive impairment.
CITATION:
Woosik Kim ; Yejin Hwang ; Yelim Yang ; Min Gyeong Kim ; Hyemin Jang ; Seung Hong Choi ; Joon-Kyung Seong ; Roh-Eul Yoo ; Wha Jin Lee (2026): Distinct spatial patterns of perivascular spaces enlargement for multiple and Co-existing pathologies of cognitive impairment. The Journal of Prevention of Alzheimer’s Disease (JPAD). https://doi.org/10.1016/j.tjpad.2026.100631