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Diffusion tensor image analysis along the perivascular space (DTI\u2010ALPS) has been proposed as an indirect proxy for glymphatic clearance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To clarify DTI\u2010ALPS' relationship with cognition in PD, and its relationship with established imaging markers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We assessed DTI\u2010ALPS in 98 PD patients (31 PD poor outcomes: dementia, mild cognitive impairment, frailty, or death within a 3\u2010year follow\u2010up; 67 PD good outcomes) and 28 controls. We assessed DTI\u2010ALPS' relationship to cognition, white matter (fiber cross\u2010section), cortical thickness, iron accumulation (quantitative susceptibility mapping [QSM]), and plasma markers [phosphorylated tau\u2010181 (\n                      <jats:italic>p<\/jats:italic>\n                      \u2010tau181 and neurofilament light (NfL)] cross\u2010sectionally and longitudinally).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      DTI\u2010ALPS was lower in PD\u2010poor outcomes compared with PD good outcomes and controls (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.005) with further longitudinal reductions only in PD poor outcomes (group\u2009\u00d7\u2009time interaction:\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009=\u2009\u22120.013,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.021). Lower DTI\u2010ALPS was associated with lower fiber cross\u2010section in PD, at baseline and longitudinally but with different spatial distribution from white matter changes relating to PD cognition. There was no correlation between baseline DTI\u2010ALPS and plasma\n                      <jats:italic>p<\/jats:italic>\n                      \u2010tau181 (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.642), NFL (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.448), or baseline cortical thickness. Lower DTI\u2010ALPS was associated with accelerated cortical thinning within left precentral gyrus and changes in brain iron distribution.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      PD patients who develop poor outcomes show lower DTI\u2010ALPS, potentially reflecting impaired glymphatic clearance. DTI\u2010ALPS correlated with white matter integrity and brain iron accumulation. However, both showed different spatial distribution than that seen in PD dementia, suggesting DTI\u2010ALPS captures a distinct contribution to cognitive decline. \u00a9 2025 The Author(s).\n                      <jats:italic>Movement Disorders<\/jats:italic>\n                      published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/mds.30325","type":"journal-article","created":{"date-parts":[[2025,8,8]],"date-time":"2025-08-08T06:40:09Z","timestamp":1754635209000},"page":"2367-2380","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Impaired Glymphatic Clearance, Measured Using Diffusion Tensor Image Analysis Along the Perivascular Space (\n                    <scp>DTI<\/scp>\n                    \u2010\n                    <scp>ALPS)<\/scp>\n                    , is Linked to Poor 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