类淋巴功能障碍可能在神经退行性疾病的发展中发挥重要作用。我们的目的是评估类淋巴功能障碍与帕金森病 (PD) 恶性事件/临床里程碑风险之间的关联。这项研究纳入了 2014 年 8 月至 2020 年 12 月的 236 名患者。沿血管周围空间的扩散张量成像分析 (DTI-ALPS)指数被计算为类淋巴功能的近似测量。主要结局是四个临床里程碑，包括反复跌倒、轮椅依赖、痴呆以及入住住院或疗养院护理。使用多变量 Cox 比例风险回归模型检查了 DTI-ALPS 与临床里程碑风险的关联。然后，单独使用临床变量和 DTI-ALPS 指数以及两者结合重复逻辑回归，以探索区分在 5 年内达到临床里程碑的患者的能力。共有 175 名具有基线 DTI-ALPS 的 PD 患者包括指数和后续临床评估。较低的 DTI-ALPS 与反复跌倒、轮椅依赖和痴呆的风险增加独立相关。此外，在超过 5 年监测的 103 名患者中，结合临床变量和 DTI-ALPS 指数的逻辑回归模型在预测 5 年内的轮椅依赖方面显示出比单独使用临床变量或 DTI-ALPS 指数的模型更好的性能。 测量的淋巴功能障碍根据 DTI-ALPS 指数，与 PD 患者临床里程碑风险增加相关。这一发现意味着针对类淋巴系统的治疗可能是减缓 PD 进展的可行策略。© 2024 作者。约翰·威利出版的《欧洲神经病学杂志》

Glymphatic dysfunction may play a significant role in the development of neurodegenerative diseases. We aimed to evaluate the association between glymphatic dysfunction and the risk of malignant event/clinical milestones in Parkinson disease (PD).This study included 236 patients from August 2014 to December 2020. Diffusion tensor imaging analysis along the perivascular space (DTI-ALPS) index was calculated as an approximate measure of glymphatic function. The primary outcomes were four clinical milestones including recurrent falls, wheelchair dependence, dementia, and placement in residential or nursing home care. The associations of DTI-ALPS with the risk of clinical milestones were examined using multivariate Cox proportional hazards regression models. Then, logistic regression was repeated using clinical variables and DTI-ALPS index individually and in combination of the two to explore the ability to distinguish patients who reached clinical milestones within a 5-year period.A total of 175 PD patients with baseline DTI-ALPS index and follow-up clinical assessments were included. A lower DTI-ALPS was independently associated with increased risk of recurrent falls, wheelchair dependence, and dementia. Additionally, in 103 patients monitored over 5 years, a logistic regression model combining clinical variables and DTI-ALPS index showed better performance for predicting wheelchair dependence within 5 years than a model using clinical variables or DTI-ALPS index alone.Glymphatic dysfunction, as measured by the DTI-ALPS index, was associated with increased risk of clinical milestones in patients with PD. This finding implies that therapy targeting the glymphatic system may serve as a viable strategy for slowing down the progression of PD.© 2024 The Author(s). European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology.