{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T17:46:15Z","timestamp":1793727975236,"version":"4.6.1"},"reference-count":116,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,10,23]],"date-time":"2025-10-23T00:00:00Z","timestamp":1761177600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,10,23]],"date-time":"2025-10-23T00:00:00Z","timestamp":1761177600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["npj Parkinsons Dis."],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>This systematic review and meta-analysis synthesized evidence of glymphatic dysfunction in Parkinson\u2019s disease (PD) and related Parkinsonian syndromes using the diffusion tensor imaging along the perivascular space (DTI-ALPS) index. Following the PRISMA 2020 guidelines, 28 studies published up to May 12, 2025, were included. The primary meta-analysis of 21 studies (1678 patients with PD and 1088 HCs) demonstrated a significant reduction in the DTI-ALPS index in patients with PD (Cohen\u2019s d\u2009=\u2009\u22120.57; 95% CI: \u22120.67 to \u22120.47; p\u2009&lt;\u20090.001), indicating moderate glymphatic dysfunction. This impairment was significantly associated with clinical progression, including longer disease duration (\u03b2\u2009=\u2009\u22120.08, p\u2009=\u20090.005) and higher Hoehn and Yahr (H-Y) stages (\u03b2\u2009=\u2009\u22120.18, p\u2009=\u20090.057). This association was particularly strong in patients with early-stage PD (H-Y\u2009&lt;\u20092.5). Phenotypic analyses revealed a gradient of dysfunction, with the most severe impairment found in patients with PD with dementia (Glass\u2019s \u0394\u2009=\u2009\u22121.04) and atypical Parkinsonian syndromes (\u0394\u2009=\u2009\u22121.01). Technical subgroup analyses showed consistent findings, with region-of-interest size significantly moderating effect size (p\u2009=\u20090.04). The methodological quality of the included studies was high, with no evidence of publication bias. The methodological quality was high, with no evidence of publication bias (p\u2009\u2265\u20090.88). These findings underscore the progressive glymphatic decline with PD severity and duration, independent of age or cognition, and highlight distinct impairment patterns across different clinical phenotypes.<\/jats:p>","DOI":"10.1038\/s41531-025-01151-4","type":"journal-article","created":{"date-parts":[[2025,10,23]],"date-time":"2025-10-23T10:32:39Z","timestamp":1761215559000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":29,"title":["A systematic review and meta-analysis on glymphatic flow dysfunction in Parkinson\u2019s disease and Parkinsonism spectrum"],"prefix":"10.1038","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1334-8826","authenticated-orcid":false,"given":"Sadegh","family":"Ghaderi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2286-9052","authenticated-orcid":false,"given":"Sana","family":"Mohammadi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6838-929X","authenticated-orcid":false,"given":"Ali Fathi","family":"Jouzdani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2133-4283","authenticated-orcid":false,"given":"Amir Mahmoud","family":"Ahmadzadeh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6774-7825","authenticated-orcid":false,"given":"Farzad","family":"Fatehi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,10,23]]},"reference":[{"key":"1151_CR1","unstructured":"Kouli, A., Torsney, K. M. & Kuan, W.-L. Parkinson\u2019s Disease: Etiology, Neuropathology, And Pathogenesis. in Parkinson\u2019s Disease: Pathogenesis and Clinical Aspects (eds Stoker, T. B. & Greenland, J. C.) (Codon Publications, Brisbane (AU), 2018)."},{"key":"1151_CR2","doi-asserted-by":"publisher","unstructured":"Su, D. et al. Projections for prevalence of Parkinson\u2019s disease and its driving factors in 195 countries and territories to 2050: modelling study of Global Burden of Disease Study 2021 https:\/\/doi.org\/10.1136\/bmj-2024-080952 (2025).","DOI":"10.1136\/bmj-2024-080952"},{"key":"1151_CR3","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1038\/s41531-021-00272-w","volume":"8","author":"AW Willis","year":"2022","unstructured":"Willis, A. W. et al. Incidence of Parkinson disease in North America. Npj Park. Dis. 8, 1\u20137 (2022).","journal-title":"Npj Park. Dis."},{"key":"1151_CR4","doi-asserted-by":"crossref","unstructured":"Hopfner, F., H\u00f6glinger, G., & Trenkwalder, C. Definition and diagnosis of Parkinson\u2019s disease: guideline \u2018Parkinson\u2019s disease\u2019 of the German Society of Neurology. J. Neurol. 271, 7102\u20137119 (2024).","DOI":"10.1007\/s00415-024-12687-5"},{"key":"1151_CR5","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1038\/s41572-020-00234-1","volume":"7","author":"D Aarsland","year":"2021","unstructured":"Aarsland, D. et al. Parkinson disease-associated cognitive impairment. Nat. Rev. Dis. Prim. 7, 1\u201321 (2021).","journal-title":"Nat. Rev. Dis. Prim."},{"key":"1151_CR6","doi-asserted-by":"publisher","first-page":"200","DOI":"10.3934\/Neuroscience.2023017","volume":"10","author":"S Ramesh","year":"2023","unstructured":"Ramesh, S. & Arachchige, A. S. P. M. Depletion of dopamine in Parkinson\u2019s disease and relevant therapeutic options: A review of the literature. AIMS Neurosci. 10, 200\u2013231 (2023).","journal-title":"AIMS Neurosci."},{"key":"1151_CR7","doi-asserted-by":"publisher","first-page":"e27950","DOI":"10.1016\/j.heliyon.2024.e27950","volume":"10","author":"S Mohammadi","year":"2024","unstructured":"Mohammadi, S. & Ghaderi, S. Parkinson\u2019s disease and Parkinsonism syndromes: Evaluating iron deposition in the putamen using magnetic susceptibility MRI techniques - A systematic review and literature analysis. Heliyon 10, e27950 (2024).","journal-title":"Heliyon"},{"key":"1151_CR8","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1186\/s40035-017-0099-z","volume":"6","author":"P Maiti","year":"2017","unstructured":"Maiti, P., Manna, J. & Dunbar, G. L. Current understanding of the molecular mechanisms in Parkinson\u2019s disease: targets for potential treatments. Transl. Neurodegener. 6, 28 (2017).","journal-title":"Transl. Neurodegener."},{"key":"1151_CR9","doi-asserted-by":"publisher","first-page":"1529","DOI":"10.1126\/science.1240514","volume":"340","author":"M Nedergaard","year":"2013","unstructured":"Nedergaard, M. Neuroscience. Garbage truck of the brain. Science 340, 1529\u20131530 (2013).","journal-title":"Science"},{"key":"1151_CR10","doi-asserted-by":"publisher","first-page":"1299","DOI":"10.1172\/JCI67677","volume":"123","author":"JJ Iliff","year":"2013","unstructured":"Iliff, J. J. et al. Brain-wide pathway for waste clearance captured by contrast-enhanced MRI. J. Clin. Invest. 123, 1299\u20131309 (2013).","journal-title":"J. Clin. Invest."},{"key":"1151_CR11","doi-asserted-by":"publisher","first-page":"147ra111","DOI":"10.1126\/scitranslmed.3003748","volume":"4","author":"JJ Iliff","year":"2012","unstructured":"Iliff, J. J. et al. A paravascular pathway facilitates CSF flow through the brain parenchyma and the clearance of interstitial solutes, including amyloid. Sci. Transl. Med. 4, 147ra111 (2012).","journal-title":"Sci. Transl. Med."},{"key":"1151_CR12","doi-asserted-by":"publisher","first-page":"7698","DOI":"10.1523\/JNEUROSCI.0619-21.2021","volume":"41","author":"LM Hablitz","year":"2021","unstructured":"Hablitz, L. M. & Nedergaard, M. The glymphatic system: a novel component of fundamental neurobiology. J. Neurosci. 41, 7698\u20137711 (2021).","journal-title":"J. Neurosci."},{"key":"1151_CR13","doi-asserted-by":"publisher","first-page":"106791","DOI":"10.1016\/j.nbd.2025.106791","volume":"205","author":"Y-R Sun","year":"2025","unstructured":"Sun, Y.-R., Lv, Q.-K., Liu, J.-Y., Wang, F. & Liu, C.-F. New perspectives on the glymphatic system and the relationship between glymphatic system and neurodegenerative diseases. Neurobiol. Dis. 205, 106791 (2025).","journal-title":"Neurobiol. Dis."},{"key":"1151_CR14","doi-asserted-by":"publisher","first-page":"1016","DOI":"10.1016\/S1474-4422(18)30318-1","volume":"17","author":"MK Rasmussen","year":"2018","unstructured":"Rasmussen, M. K., Mestre, H. & Nedergaard, M. The glymphatic pathway in neurological disorders. Lancet Neurol. 17, 1016\u20131024 (2018).","journal-title":"Lancet Neurol."},{"key":"1151_CR15","doi-asserted-by":"publisher","first-page":"142","DOI":"10.1007\/s11064-025-04388-w","volume":"50","author":"X Zhao","year":"2025","unstructured":"Zhao, X. et al. OAB-14 attenuated glymphatic system disorder, neuroinflammation and Dyskinesia in Parkinson\u2019s disease model mice induced by rotenone. Neurochem. Res. 50, 142 (2025).","journal-title":"Neurochem. Res."},{"key":"1151_CR16","doi-asserted-by":"publisher","first-page":"2261","DOI":"10.3390\/biomedicines10092261","volume":"10","author":"FR Buccellato","year":"2022","unstructured":"Buccellato, F. R., D\u2019Anca, M., Serpente, M., Arighi, A. & Galimberti, D. The role of glymphatic system in alzheimer\u2019s and Parkinson\u2019s disease pathogenesis. Biomedicines 10, 2261 (2022).","journal-title":"Biomedicines"},{"key":"1151_CR17","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1186\/s40035-019-0147-y","volume":"8","author":"W Zou","year":"2019","unstructured":"Zou, W. et al. Blocking meningeal lymphatic drainage aggravates Parkinson\u2019s disease-like pathology in mice overexpressing mutated \u03b1-synuclein. Transl. Neurodegener. 8, 7 (2019).","journal-title":"Transl. Neurodegener."},{"key":"1151_CR18","doi-asserted-by":"publisher","first-page":"125","DOI":"10.1016\/j.jare.2023.03.004","volume":"56","author":"X Si","year":"2024","unstructured":"Si, X. et al. Matrix metalloproteinase-9 inhibition prevents aquaporin-4 depolarization-mediated glymphatic dysfunction in Parkinson\u2019s disease. J. Adv. Res. 56, 125\u2013136 (2024).","journal-title":"J. Adv. Res."},{"key":"1151_CR19","doi-asserted-by":"publisher","first-page":"182","DOI":"10.2463\/mrms.rev.2020-0122","volume":"21","author":"S Naganawa","year":"2020","unstructured":"Naganawa, S. & Taoka, T. The glymphatic system: a review of the challenges in visualizing its structure and function with MR imaging. Magn. Reson. Med. Sci. 21, 182\u2013194 (2020).","journal-title":"Magn. Reson. Med. Sci."},{"key":"1151_CR20","doi-asserted-by":"publisher","first-page":"40","DOI":"10.1002\/jmri.29056","volume":"60","author":"GS Drenthen","year":"2024","unstructured":"Drenthen, G. S. et al. Imaging interstitial fluid with MRI: a narrative review on the associations of altered interstitial fluid with vascular and neurodegenerative abnormalities. J. Magn. Reson. Imaging 60, 40\u201353 (2024).","journal-title":"J. Magn. Reson. Imaging"},{"key":"1151_CR21","doi-asserted-by":"publisher","first-page":"e70212","DOI":"10.1002\/alz.70212","volume":"21","author":"G Sol\u00e9-Guardia","year":"2025","unstructured":"Sol\u00e9-Guardia, G. et al. Imaging brain fluid dynamics and waste clearance involving perivascular spaces in cerebral small vessel disease. Alzheimers Dement 21, e70212 (2025).","journal-title":"Alzheimers Dement"},{"key":"1151_CR22","doi-asserted-by":"publisher","first-page":"172","DOI":"10.1007\/s11604-017-0617-z","volume":"35","author":"T Taoka","year":"2017","unstructured":"Taoka, T. et al. Evaluation of glymphatic system activity with the diffusion MR technique: diffusion tensor image analysis along the perivascular space (DTI-ALPS) in Alzheimer\u2019s disease cases. Jpn. J. Radiol. 35, 172\u2013178 (2017).","journal-title":"Jpn. J. Radiol."},{"key":"1151_CR23","doi-asserted-by":"publisher","first-page":"106558","DOI":"10.1016\/j.parkreldis.2024.106558","volume":"123","author":"X Wang","year":"2024","unstructured":"Wang, X. et al. MRI index of glymphatic system mediates the influence of locus coeruleus on cognition in Parkinson\u2019s disease. Parkinsonism Relat. Disord. 123, 106558 (2024).","journal-title":"Parkinsonism Relat. Disord."},{"key":"1151_CR24","doi-asserted-by":"publisher","first-page":"1504","DOI":"10.1002\/mds.29908","volume":"39","author":"KH Wood","year":"2024","unstructured":"Wood, K. H. et al. Diffusion tensor imaging-along the perivascular-space index is associated with disease progression in Parkinson\u2019s disease. Mov. Disord. J. Mov. Disord. Soc. 39, 1504\u20131513 (2024).","journal-title":"Mov. Disord. J. Mov. Disord. Soc."},{"key":"1151_CR25","doi-asserted-by":"publisher","first-page":"105767","DOI":"10.1016\/j.parkreldis.2023.105767","volume":"114","author":"YJ Bae","year":"2023","unstructured":"Bae, Y. J. et al. Glymphatic function assessment in Parkinson\u2019s disease using diffusion tensor image analysis along the perivascular space. Parkinsonism Relat. Disord. 114, 105767 (2023).","journal-title":"Parkinsonism Relat. Disord."},{"key":"1151_CR26","doi-asserted-by":"publisher","first-page":"98","DOI":"10.1016\/j.parkreldis.2021.06.004","volume":"89","author":"CD McKnight","year":"2021","unstructured":"McKnight, C. D. et al. Diffusion along perivascular spaces reveals evidence supportive of glymphatic function impairment in Parkinson disease. Parkinsonism Relat. Disord. 89, 98\u2013104 (2021).","journal-title":"Parkinsonism Relat. Disord."},{"key":"1151_CR27","doi-asserted-by":"publisher","first-page":"62","DOI":"10.1038\/s41531-025-00909-0","volume":"11","author":"R Lin","year":"2025","unstructured":"Lin, R. et al. Association of glymphatic system function with peripheral inflammation and motor symptoms in Parkinson\u2019s disease. NPJ Park. Dis. 11, 62 (2025).","journal-title":"NPJ Park. Dis."},{"key":"1151_CR28","doi-asserted-by":"publisher","first-page":"4034509","DOI":"10.1155\/2021\/4034509","volume":"2021","author":"H-L Chen","year":"2021","unstructured":"Chen, H.-L. et al. Associations among Cognitive Functions, Plasma DNA, and Diffusion Tensor Image along the Perivascular Space (DTI-ALPS) in Patients with Parkinson\u2019s Disease. Oxid. Med. Cell. Longev. 2021, 4034509 (2021).","journal-title":"Oxid. Med. Cell. Longev."},{"key":"1151_CR29","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.221848","volume":"307","author":"YJ Bae","year":"2023","unstructured":"Bae, Y. J. et al. Altered brain glymphatic flow at diffusion-tensor MRI in rapid eye movement sleep behavior disorder. Radiology 307, e221848 (2023).","journal-title":"Radiology"},{"key":"1151_CR30","doi-asserted-by":"publisher","first-page":"54","DOI":"10.1038\/s41531-022-00316-9","volume":"8","author":"X Si","year":"2022","unstructured":"Si, X. et al. Neuroimaging evidence of glymphatic system dysfunction in possible REM sleep behavior disorder and Parkinson\u2019s disease. NPJ Park. Dis. 8, 54 (2022).","journal-title":"NPJ Park. Dis."},{"key":"1151_CR31","doi-asserted-by":"publisher","first-page":"106528","DOI":"10.1016\/j.sleep.2025.106528","volume":"131","author":"S Ghaderi","year":"2025","unstructured":"Ghaderi, S., Mohammadi, S. & Fatehi, F. Glymphatic pathway dysfunction in severe obstructive sleep apnea: a meta-analysis. Sleep. Med 131, 106528 (2025).","journal-title":"Sleep. Med"},{"key":"1151_CR32","doi-asserted-by":"publisher","first-page":"1809","DOI":"10.2147\/NDT.S480183","volume":"20","author":"Q Gui","year":"2024","unstructured":"Gui, Q. et al. Relationship of glymphatic function with cognitive impairment, sleep disorders, anxiety and depression in patients with Parkinson\u2019s disease. Neuropsychiatr. Dis. Treat. 20, 1809\u20131821 (2024).","journal-title":"Neuropsychiatr. Dis. Treat."},{"key":"1151_CR33","doi-asserted-by":"publisher","first-page":"105254","DOI":"10.1016\/j.parkreldis.2022.105254","volume":"107","author":"L Gu","year":"2023","unstructured":"Gu, L. et al. Noninvasive neuroimaging provides evidence for deterioration of the glymphatic system in Parkinson\u2019s disease relative to essential tremor. Parkinsonism Relat. Disord. 107, 105254 (2023).","journal-title":"Parkinsonism Relat. Disord."},{"key":"1151_CR34","first-page":"N\/A-N\/A","volume":"4","author":"Y Wang","year":"2024","unstructured":"Wang, Y. et al. Sleep, glymphatic system, and Parkinson\u2019s disease. Ageing Neurodegener. Dis. 4, N\/A-N\/A (2024).","journal-title":"Ageing Neurodegener. Dis."},{"key":"1151_CR35","doi-asserted-by":"publisher","first-page":"1973","DOI":"10.4103\/1673-5374.390970","volume":"19","author":"Y Yue","year":"2023","unstructured":"Yue, Y., Zhang, X., Lv, W., Lai, H.-Y. & Shen, T. Interplay between the glymphatic system and neurotoxic proteins in Parkinson\u2019s disease and related disorders: current knowledge and future directions. Neural Regen. Res. 19, 1973\u20131980 (2023).","journal-title":"Neural Regen. Res."},{"key":"1151_CR36","doi-asserted-by":"publisher","first-page":"2649","DOI":"10.1007\/s00415-023-11594-5","volume":"270","author":"Y Qin","year":"2023","unstructured":"Qin, Y. et al. Neuroimaging uncovers distinct relationships of glymphatic dysfunction and motor symptoms in Parkinson\u2019s disease. J. Neurol. 270, 2649\u20132658 (2023).","journal-title":"J. Neurol."},{"key":"1151_CR37","doi-asserted-by":"publisher","unstructured":"Ota, M. et al. Correlation between the regional brain volume and glymphatic system activity in progressive supranuclear palsy. Dement. Geriatr. Cogn. Disord. https:\/\/doi.org\/10.1159\/000530075 (2023).","DOI":"10.1159\/000530075"},{"key":"1151_CR38","doi-asserted-by":"publisher","first-page":"fcaf029","DOI":"10.1093\/braincomms\/fcaf029","volume":"7","author":"Y Zhao","year":"2025","unstructured":"Zhao, Y. et al. Glymphatic dysfunction exacerbates cognitive decline by triggering cortical degeneration in Parkinson\u2019s disease: evidence from diffusion-tensor MRI. Brain Commun. 7, fcaf029 (2025).","journal-title":"Brain Commun."},{"key":"1151_CR39","doi-asserted-by":"publisher","first-page":"457","DOI":"10.1007\/s00415-023-12004-6","volume":"271","author":"J-C Meng","year":"2024","unstructured":"Meng, J.-C. et al. Correlation of glymphatic system abnormalities with Parkinson\u2019s disease progression: a clinical study based on non-invasive fMRI. J. Neurol. 271, 457\u2013471 (2024).","journal-title":"J. Neurol."},{"key":"1151_CR40","doi-asserted-by":"publisher","first-page":"111","DOI":"10.1111\/cns.13984","volume":"29","author":"X Cai","year":"2023","unstructured":"Cai, X. et al. Diffusion along perivascular spaces provides evidence interlinking compromised glymphatic function with aging in Parkinson\u2019s disease. CNS Neurosci. Ther. 29, 111\u2013121 (2023).","journal-title":"CNS Neurosci. Ther."},{"key":"1151_CR41","doi-asserted-by":"publisher","first-page":"1411","DOI":"10.21037\/qims-24-1605","volume":"15","author":"C Ni","year":"2025","unstructured":"Ni, C. et al. Diffusion tensor image analysis along the perivascular space and quantitative susceptibility mapping in the diagnosis and severity assessment of Parkinson\u2019s disease. Quant. Imaging Med. Surg. 15, 1411\u20131424 (2025).","journal-title":"Quant. Imaging Med. Surg."},{"key":"1151_CR42","doi-asserted-by":"publisher","first-page":"773951","DOI":"10.3389\/fnagi.2021.773951","volume":"13","author":"X Ma","year":"2021","unstructured":"Ma, X. et al. Diffusion tensor imaging along the perivascular space index in different stages of Parkinson\u2019s disease. Front. Aging Neurosci. 13, 773951 (2021).","journal-title":"Front. Aging Neurosci."},{"key":"1151_CR43","doi-asserted-by":"publisher","first-page":"fcae421","DOI":"10.1093\/braincomms\/fcae421","volume":"6","author":"C Georgiopoulos","year":"2024","unstructured":"Georgiopoulos, C. et al. Diffusion tensor imaging along the perivascular space: the bias from crossing fibres. Brain Commun. 6, fcae421 (2024).","journal-title":"Brain Commun."},{"key":"1151_CR44","doi-asserted-by":"publisher","first-page":"51","DOI":"10.1016\/j.neuroscience.2022.10.013","volume":"506","author":"X Ruan","year":"2022","unstructured":"Ruan, X. et al. Diffusion tensor imaging analysis along the perivascular space index in primary Parkinson\u2019s disease patients with and without freezing of gait. Neuroscience 506, 51\u201357 (2022).","journal-title":"Neuroscience"},{"key":"1151_CR45","doi-asserted-by":"publisher","first-page":"387","DOI":"10.1097\/RLU.0000000000005141","volume":"49","author":"J-L Hsu","year":"2024","unstructured":"Hsu, J.-L. et al. Dominance of Tau burden in cortical over subcortical regions mediates glymphatic activity and clinical severity in PSP. Clin. Nucl. Med. 49, 387\u2013396 (2024).","journal-title":"Clin. Nucl. Med."},{"key":"1151_CR46","doi-asserted-by":"publisher","first-page":"5598","DOI":"10.1007\/s00415-024-12525-8","volume":"271","author":"H Pang","year":"2024","unstructured":"Pang, H. et al. Glymphatic function from diffusion-tensor MRI to predict conversion from mild cognitive impairment to dementia in Parkinson\u2019s disease. J. Neurol. 271, 5598\u20135609 (2024).","journal-title":"J. Neurol."},{"key":"1151_CR47","doi-asserted-by":"publisher","first-page":"106950","DOI":"10.1016\/j.parkreldis.2024.106950","volume":"123","author":"C Shi","year":"2024","unstructured":"Shi, C. et al. Impaired glymphatic clearance in multiple system atrophy: a diffusion spectrum imaging study. Parkinsonism Relat. Disord. 123, 106950 (2024).","journal-title":"Parkinsonism Relat. Disord."},{"key":"1151_CR48","doi-asserted-by":"publisher","first-page":"2209","DOI":"10.1016\/j.acra.2024.11.030","volume":"32","author":"Y Li","year":"2025","unstructured":"Li, Y. et al. The impact of sleep disorders on glymphatic function in Parkinson\u2019s disease using diffusion tensor MRI. Acad. Radiol. 32, 2209\u20132219 (2025).","journal-title":"Acad. Radiol."},{"key":"1151_CR49","doi-asserted-by":"publisher","first-page":"107089","DOI":"10.1016\/j.parkreldis.2024.107089","volume":"127","author":"J Yao","year":"2024","unstructured":"Yao, J. et al. Early detection of dopaminergic dysfunction and glymphatic system impairment in Parkinson\u2019s disease. Parkinsonism Relat. Disord. 127, 107089 (2024).","journal-title":"Parkinsonism Relat. Disord."},{"key":"1151_CR50","doi-asserted-by":"publisher","first-page":"196","DOI":"10.1007\/s00415-025-12944-1","volume":"272","author":"J Ren","year":"2025","unstructured":"Ren, J. et al. Glymphatic system dysfunction as a biomarker of disease progression in Parkinson\u2019s disease: neuroimaging evidence from longitudinal cohort studies. J. Neurol. 272, 196 (2025).","journal-title":"J. Neurol."},{"key":"1151_CR51","doi-asserted-by":"publisher","DOI":"10.1111\/cns.70284","volume":"31","author":"F Jiao","year":"2025","unstructured":"Jiao, F. et al. Relationships between glymphatic system activity and Tau burden, dopaminergic impairment, abnormal glucose metabolism in progressive supranuclear palsy. CNS Neurosci. Ther. 31, e70284 (2025).","journal-title":"CNS Neurosci. Ther."},{"key":"1151_CR52","doi-asserted-by":"publisher","first-page":"1226","DOI":"10.1007\/s11604-023-01454-7","volume":"41","author":"Y Saito","year":"2023","unstructured":"Saito, Y. et al. Glymphatic system impairment in corticobasal syndrome: diffusion tensor image analysis along the perivascular space (DTI-ALPS). Jpn. J. Radiol. 41, 1226\u20131235 (2023).","journal-title":"Jpn. J. Radiol."},{"key":"1151_CR53","doi-asserted-by":"publisher","first-page":"174","DOI":"10.1038\/s41531-022-00437-1","volume":"8","author":"T Shen","year":"2022","unstructured":"Shen, T. et al. Diffusion along perivascular spaces as marker for impairment of glymphatic system in Parkinson\u2019s disease. NPJ Park. Dis. 8, 174 (2022).","journal-title":"NPJ Park. Dis."},{"key":"1151_CR54","doi-asserted-by":"publisher","first-page":"76","DOI":"10.1038\/s41531-025-00921-4","volume":"11","author":"S Marecek","year":"2025","unstructured":"Marecek, S. et al. Exploring glymphatic system alterations in iRBD and Parkinson\u2019s disease using automated DTI-ALPS analysis. NPJ Park. Dis. 11, 76 (2025).","journal-title":"NPJ Park. Dis."},{"key":"1151_CR55","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1038\/s41531-024-00865-1","volume":"11","author":"X Ma","year":"2025","unstructured":"Ma, X. et al. Parkinson\u2019s disease with possible REM sleep behavior disorder correlated with more severe glymphatic system dysfunction. Npj Park. Dis. 11, 1\u20136 (2025).","journal-title":"Npj Park. Dis."},{"key":"1151_CR56","doi-asserted-by":"publisher","DOI":"10.1002\/nbm.5162","volume":"37","author":"AM Wright","year":"2024","unstructured":"Wright, A. M., Wu, Y.-C., Feng, L. & Wen, Q. Diffusion magnetic resonance imaging of cerebrospinal fluid dynamics: Current techniques and future advancements. NMR Biomed. 37, e5162 (2024).","journal-title":"NMR Biomed."},{"key":"1151_CR57","doi-asserted-by":"publisher","first-page":"1138769","DOI":"10.3389\/fnmol.2023.1138769","volume":"16","author":"Y Gao","year":"2023","unstructured":"Gao, Y., Liu, K. & Zhu, J. Glymphatic system: an emerging therapeutic approach for neurological disorders. Front. Mol. Neurosci. 16, 1138769 (2023).","journal-title":"Front. Mol. Neurosci."},{"key":"1151_CR58","doi-asserted-by":"publisher","unstructured":"Ayyappan, K., Unger, L., Kitchen, P., Bill, R. M. & Salman, M. M. Measuring glymphatic function: assessing the toolkit. Neural Regen. Res. https:\/\/doi.org\/10.4103\/NRR.NRR-D-24-01013 (2025).","DOI":"10.4103\/NRR.NRR-D-24-01013"},{"key":"1151_CR59","doi-asserted-by":"publisher","DOI":"10.7554\/eLife.34028","volume":"7","author":"IF Harrison","year":"2018","unstructured":"Harrison, I. F. et al. Non-invasive imaging of CSF-mediated brain clearance pathways via assessment of perivascular fluid movement with diffusion tensor MRI. eLife 7, e34028 (2018).","journal-title":"eLife"},{"key":"1151_CR60","doi-asserted-by":"publisher","first-page":"194","DOI":"10.1002\/mrm.29612","volume":"90","author":"GS Drenthen","year":"2023","unstructured":"Drenthen, G. S., Jansen, J. F. A., van der, M. M., Voorter, P. H. M. & Backes, W. H. An optimized b-value sampling for the quantification of interstitial fluid using diffusion-weighted MRI, a genetic algorithm approach. Magn. Reson. Med. 90, 194\u2013201 (2023).","journal-title":"Magn. Reson. Med."},{"key":"1151_CR61","doi-asserted-by":"publisher","first-page":"1476","DOI":"10.1002\/jmri.28977","volume":"59","author":"K Kamagata","year":"2024","unstructured":"Kamagata, K. et al. Noninvasive magnetic resonance imaging measures of glymphatic system activity. J. Magn. Reson. Imaging JMRI 59, 1476\u20131493 (2024).","journal-title":"J. Magn. Reson. Imaging JMRI"},{"key":"1151_CR62","doi-asserted-by":"publisher","first-page":"126","DOI":"10.1016\/j.neuroimage.2017.12.017","volume":"169","author":"AS Becker","year":"2018","unstructured":"Becker, A. S. et al. Investigation of the pulsatility of cerebrospinal fluid using cardiac-gated Intravoxel Incoherent Motion imaging. NeuroImage 169, 126\u2013133 (2018).","journal-title":"NeuroImage"},{"key":"1151_CR63","doi-asserted-by":"publisher","first-page":"758","DOI":"10.1259\/bjr\/66206791","volume":"84","author":"B Battal","year":"2011","unstructured":"Battal, B. et al. Cerebrospinal fluid flow imaging by using phase-contrast MR technique. Br. J. Radiol. 84, 758\u2013765 (2011).","journal-title":"Br. J. Radiol."},{"key":"1151_CR64","doi-asserted-by":"publisher","first-page":"1033","DOI":"10.1177\/0271678X15622047","volume":"36","author":"V Kiviniemi","year":"2016","unstructured":"Kiviniemi, V. et al. Ultra-fast magnetic resonance encephalography of physiological brain activity \u2013 Glymphatic pulsation mechanisms?. J. Cereb. Blood Flow. Metab. 36, 1033\u20131045 (2016).","journal-title":"J. Cereb. Blood Flow. Metab."},{"key":"1151_CR65","doi-asserted-by":"publisher","first-page":"243","DOI":"10.1016\/j.neuroimage.2019.04.070","volume":"197","author":"F Sepehrband","year":"2019","unstructured":"Sepehrband, F. et al. Perivascular space fluid contributes to diffusion tensor imaging changes in white matter. NeuroImage 197, 243\u2013254 (2019).","journal-title":"NeuroImage"},{"key":"1151_CR66","doi-asserted-by":"publisher","first-page":"1000","DOI":"10.1016\/j.neuroimage.2012.03.072","volume":"61","author":"H Zhang","year":"2012","unstructured":"Zhang, H., Schneider, T., Wheeler-Kingshott, C. A. & Alexander, D. C. NODDI: practical in vivo neurite orientation dispersion and density imaging of the human brain. NeuroImage 61, 1000\u20131016 (2012).","journal-title":"NeuroImage"},{"key":"1151_CR67","doi-asserted-by":"publisher","first-page":"236","DOI":"10.1002\/nbm.1020","volume":"19","author":"H Lu","year":"2006","unstructured":"Lu, H., Jensen, J. H., Ramani, A. & Helpern, J. A. Three-dimensional characterization of non-Gaussian water diffusion in humans using diffusion kurtosis imaging. NMR Biomed. 19, 236\u2013247 (2006).","journal-title":"NMR Biomed."},{"key":"1151_CR68","doi-asserted-by":"publisher","first-page":"1590","DOI":"10.4103\/1673-5374.276326","volume":"15","author":"K Kamagata","year":"2020","unstructured":"Kamagata, K. et al. Advanced diffusion magnetic resonance imaging in patients with Alzheimer\u2019s and Parkinson\u2019s diseases. Neural Regen. Res. 15, 1590\u20131600 (2020).","journal-title":"Neural Regen. Res."},{"key":"1151_CR69","doi-asserted-by":"publisher","first-page":"827398","DOI":"10.3389\/fneur.2022.827398","volume":"13","author":"MK Lee","year":"2022","unstructured":"Lee, M. K., Cho, S. J., Bae, Y. J. & Kim, J.-M. MRI-based demonstration of the normal glymphatic system in a human population: a systematic review. Front. Neurol. 13, 827398 (2022).","journal-title":"Front. Neurol."},{"key":"1151_CR70","doi-asserted-by":"publisher","first-page":"2296","DOI":"10.21037\/qims-23-1032","volume":"14","author":"S Tian","year":"2024","unstructured":"Tian, S. et al. Association between body mass index and glymphatic function using diffusion tensor image-along the perivascular space (DTI-ALPS) in patients with Parkinson\u2019s disease. Quant. Imaging Med. Surg. 14, 2296\u20132308 (2024).","journal-title":"Quant. Imaging Med. Surg."},{"key":"1151_CR71","doi-asserted-by":"publisher","first-page":"672","DOI":"10.1002\/ana.26729","volume":"94","author":"P He","year":"2023","unstructured":"He, P. et al. The association of the glymphatic function with Parkinson\u2019s disease symptoms: neuroimaging evidence from longitudinal and cross-sectional studies. Ann. Neurol. 94, 672\u2013683 (2023).","journal-title":"Ann. Neurol."},{"key":"1151_CR72","doi-asserted-by":"publisher","DOI":"10.1111\/ene.16521","volume":"31","author":"C Zhou","year":"2024","unstructured":"Zhou, C. et al. Glymphatic system dysfunction and risk of clinical milestones in patients with Parkinson disease. Eur. J. Neurol. 31, e16521 (2024).","journal-title":"Eur. J. Neurol."},{"key":"1151_CR73","doi-asserted-by":"publisher","first-page":"e70434","DOI":"10.1111\/cns.70434","volume":"31","author":"K Shirbandi","year":"2025","unstructured":"Shirbandi, K., Jafari, M., Mazaheri, F. & Tahmasbi, M. Diffusion tensor imaging along the perivascular space is a promising imaging method in Parkinson\u2019s disease: a systematic review and meta-analysis study. CNS Neurosci. Ther. 31, e70434 (2025).","journal-title":"CNS Neurosci. Ther."},{"key":"1151_CR74","doi-asserted-by":"publisher","first-page":"2209","DOI":"10.1007\/s12035-023-03212-2","volume":"60","author":"Y Zhang","year":"2023","unstructured":"Zhang, Y. et al. Interaction between the glymphatic system and \u03b1-synuclein in Parkinson\u2019s disease. Mol. Neurobiol. 60, 2209\u20132222 (2023).","journal-title":"Mol. Neurobiol."},{"key":"1151_CR75","doi-asserted-by":"publisher","first-page":"388","DOI":"10.1111\/ene.12176","volume":"21","author":"KD van Dijk","year":"2014","unstructured":"van Dijk, K. D. et al. Reduced \u03b1-synuclein levels in cerebrospinal fluid in Parkinson\u2019s disease are unrelated to clinical and imaging measures of disease severity. Eur. J. Neurol. 21, 388\u2013394 (2014).","journal-title":"Eur. J. Neurol."},{"key":"1151_CR76","doi-asserted-by":"publisher","first-page":"645","DOI":"10.3109\/00207454.2014.961454","volume":"125","author":"L Gao","year":"2015","unstructured":"Gao, L. et al. Cerebrospinal fluid alpha-synuclein as a biomarker for Parkinson\u2019s disease diagnosis: a systematic review and meta-analysis. Int. J. Neurosci. 125, 645\u2013654 (2015).","journal-title":"Int. J. Neurosci."},{"key":"1151_CR77","doi-asserted-by":"publisher","first-page":"873697","DOI":"10.3389\/fnagi.2022.873697","volume":"14","author":"D Zhang","year":"2022","unstructured":"Zhang, D., Li, X. & Li, B. Glymphatic system dysfunction in central nervous system diseases and mood disorders. Front. Aging Neurosci. 14, 873697 (2022).","journal-title":"Front. Aging Neurosci."},{"key":"1151_CR78","doi-asserted-by":"publisher","first-page":"71","DOI":"10.1016\/j.neuron.2024.09.017","volume":"113","author":"L-F Jiang-Xie","year":"2025","unstructured":"Jiang-Xie, L.-F., Drieu, A. & Kipnis, J. Waste clearance shapes aging brain health. Neuron 113, 71\u201381 (2025).","journal-title":"Neuron"},{"key":"1151_CR79","doi-asserted-by":"publisher","first-page":"101322","DOI":"10.1016\/j.neurad.2025.101322","volume":"52","author":"D Botta","year":"2025","unstructured":"Botta, D. et al. Emerging non-invasive MRI techniques for glymphatic system assessment in neurodegenerative disease. J. Neuroradiol. J. Neuroradiol. 52, 101322 (2025).","journal-title":"J. Neuroradiol. J. Neuroradiol."},{"key":"1151_CR80","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1097\/RLI.0000000000000969","volume":"59","author":"S Naganawa","year":"2024","unstructured":"Naganawa, S., Taoka, T., Ito, R. & Kawamura, M. The glymphatic system in humans: investigations with magnetic resonance imaging. Invest. Radiol. 59, 1\u201312 (2024).","journal-title":"Invest. Radiol."},{"key":"1151_CR81","doi-asserted-by":"publisher","first-page":"1543725","DOI":"10.3389\/fneur.2025.1543725","volume":"16","author":"O Corbali","year":"2025","unstructured":"Corbali, O. & Levey, A. I. Glymphatic system in neurological disorders and implications for brain health. Front. Neurol. 16, 1543725 (2025).","journal-title":"Front. Neurol."},{"key":"1151_CR82","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1038\/nm.4269","volume":"23","author":"YC Wong","year":"2017","unstructured":"Wong, Y. C. & Krainc, D. \u03b1-synuclein toxicity in neurodegeneration: mechanism and therapeutic strategies. Nat. Med. 23, 1\u201313 (2017).","journal-title":"Nat. Med."},{"key":"1151_CR83","doi-asserted-by":"publisher","first-page":"353","DOI":"10.1001\/archneur.62.3.353","volume":"62","author":"JL Eriksen","year":"2005","unstructured":"Eriksen, J. L., Wszolek, Z. & Petrucelli, L. Molecular Pathogenesis of Parkinson Disease. Arch. Neurol. 62, 353\u2013357 (2005).","journal-title":"Arch. Neurol."},{"key":"1151_CR84","doi-asserted-by":"publisher","first-page":"289","DOI":"10.1007\/s10571-016-0343-6","volume":"36","author":"J Ramirez","year":"2016","unstructured":"Ramirez, J. et al. Imaging the perivascular space as a potential biomarker of neurovascular and neurodegenerative diseases. Cell. Mol. Neurobiol. 36, 289\u2013299 (2016).","journal-title":"Cell. Mol. Neurobiol."},{"key":"1151_CR85","doi-asserted-by":"publisher","first-page":"161","DOI":"10.3389\/fnagi.2020.00161","volume":"12","author":"Y Li","year":"2020","unstructured":"Li, Y. et al. Dilated perivascular space in the midbrain may reflect dopamine neuronal degeneration in Parkinson\u2019s disease. Front. Aging Neurosci. 12, 161 (2020).","journal-title":"Front. Aging Neurosci."},{"key":"1151_CR86","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s11604-020-01017-0","volume":"39","author":"T Taoka","year":"2021","unstructured":"Taoka, T. & Naganawa, S. Imaging for central nervous system (CNS) interstitial fluidopathy: disorders with impaired interstitial fluid dynamics. Jpn. J. Radiol. 39, 1\u201314 (2021).","journal-title":"Jpn. J. Radiol."},{"key":"1151_CR87","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1186\/s40035-022-00293-2","volume":"11","author":"DM Lopes","year":"2022","unstructured":"Lopes, D. M., Llewellyn, S. K. & Harrison, I. F. Propagation of tau and \u03b1-synuclein in the brain: therapeutic potential of the glymphatic system. Transl. Neurodegener. 11, 19 (2022).","journal-title":"Transl. Neurodegener."},{"key":"1151_CR88","doi-asserted-by":"publisher","first-page":"3251","DOI":"10.1002\/alz.13789","volume":"20","author":"S Huang","year":"2024","unstructured":"Huang, S. et al. Glymphatic system dysfunction predicts amyloid deposition, neurodegeneration, and clinical progression in Alzheimer\u2019s disease. Alzheimers Dement 20, 3251\u20133269 (2024).","journal-title":"Alzheimers Dement"},{"key":"1151_CR89","doi-asserted-by":"publisher","first-page":"576091","DOI":"10.1155\/2013\/576091","volume":"2013","author":"NC Palavra","year":"2013","unstructured":"Palavra, N. C., Naismith, S. L. & Lewis, S. J. G. Mild cognitive impairment in Parkinson\u2019s disease: a review of current concepts. Neurol. Res. Int. 2013, 576091 (2013).","journal-title":"Neurol. Res. Int."},{"key":"1151_CR90","doi-asserted-by":"publisher","first-page":"zsae251","DOI":"10.1093\/sleep\/zsae251","volume":"48","author":"J Nepozitek","year":"2025","unstructured":"Nepozitek, J., Dusek, P. & Sonka, K. Glymphatic system, sleep, and Parkinson\u2019s disease: interconnections, research opportunities, and potential for disease modification. Sleep 48, zsae251 (2025).","journal-title":"Sleep"},{"key":"1151_CR91","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1038\/s12276-019-0299-y","volume":"51","author":"H-J Lee","year":"2019","unstructured":"Lee, H.-J., Ricarte, D., Ortiz, D. & Lee, S.-J. Models of multiple system atrophy. Exp. Mol. Med. 51, 1\u201310 (2019).","journal-title":"Exp. Mol. Med."},{"key":"1151_CR92","doi-asserted-by":"publisher","first-page":"585","DOI":"10.1007\/s00702-023-02653-2","volume":"131","author":"J Sian-Hulsmann","year":"2024","unstructured":"Sian-Hulsmann, J. & Riederer, P. The \u2018\u03b1-synucleinopathy syndicate\u2019: multiple system atrophy and Parkinson\u2019s disease. J. Neural Transm. 131, 585\u2013595 (2024).","journal-title":"J. Neural Transm."},{"key":"1151_CR93","doi-asserted-by":"publisher","first-page":"305","DOI":"10.1016\/j.neubiorev.2019.05.016","volume":"103","author":"S Sundaram","year":"2019","unstructured":"Sundaram, S. et al. Establishing a framework for neuropathological correlates and glymphatic system functioning in Parkinson\u2019s disease. Neurosci. Biobehav. Rev. 103, 305\u2013315 (2019).","journal-title":"Neurosci. Biobehav. Rev."},{"key":"1151_CR94","doi-asserted-by":"publisher","first-page":"50","DOI":"10.1126\/science.abb8739","volume":"370","author":"M Nedergaard","year":"2020","unstructured":"Nedergaard, M. & Goldman, S. A. Glymphatic failure as a final common pathway to dementia. Science 370, 50\u201356 (2020).","journal-title":"Science"},{"key":"1151_CR95","doi-asserted-by":"publisher","first-page":"e232899","DOI":"10.1148\/radiol.232899","volume":"310","author":"S Haller","year":"2024","unstructured":"Haller, S., Moy, L. & Anzai, Y. Evaluation of diffusion tensor imaging analysis along the perivascular space as a marker of the glymphatic system. Radiology 310, e232899 (2024).","journal-title":"Radiology"},{"key":"1151_CR96","doi-asserted-by":"publisher","first-page":"157","DOI":"10.1007\/s00234-023-03270-2","volume":"66","author":"G Ringstad","year":"2024","unstructured":"Ringstad, G. Glymphatic imaging: a critical look at the DTI-ALPS index. Neuroradiology 66, 157\u2013160 (2024).","journal-title":"Neuroradiology"},{"key":"1151_CR97","doi-asserted-by":"publisher","first-page":"147","DOI":"10.1007\/s11604-021-01187-5","volume":"40","author":"T Taoka","year":"2022","unstructured":"Taoka, T. et al. Reproducibility of diffusion tensor image analysis along the perivascular space (DTI-ALPS) for evaluating interstitial fluid diffusivity and glymphatic function: CHanges in Alps index on Multiple conditiON acquIsition eXperiment (CHAMONIX) study. Jpn. J. Radiol. 40, 147\u2013158 (2022).","journal-title":"Jpn. J. Radiol."},{"key":"1151_CR98","doi-asserted-by":"publisher","first-page":"393","DOI":"10.1007\/s11604-022-01370-2","volume":"41","author":"H Tatekawa","year":"2023","unstructured":"Tatekawa, H. et al. Improved reproducibility of diffusion tensor image analysis along the perivascular space (DTI-ALPS) index: an analysis of reorientation technique of the OASIS-3 dataset. Jpn. J. Radiol. 41, 393\u2013400 (2023).","journal-title":"Jpn. J. Radiol."},{"key":"1151_CR99","first-page":"2745","volume":"131","author":"H Dobson","year":"2017","unstructured":"Dobson, H. et al. The perivascular pathways for influx of cerebrospinal fluid are most efficient in the midbrain. Clin. Sci. Lond. Engl. 1979 131, 2745\u20132752 (2017).","journal-title":"Clin. Sci. Lond. Engl. 1979"},{"key":"1151_CR100","doi-asserted-by":"publisher","DOI":"10.7554\/eLife.40070","volume":"7","author":"H Mestre","year":"2018","unstructured":"Mestre, H. et al. Aquaporin-4-dependent glymphatic solute transport in the rodent brain. eLife 7, e40070 (2018).","journal-title":"eLife"},{"key":"1151_CR101","doi-asserted-by":"publisher","first-page":"219","DOI":"10.1111\/j.1552-6569.2012.00704.x","volume":"23","author":"Y Suzuki","year":"2013","unstructured":"Suzuki, Y. et al. Aquaporin-4 positron emission tomography imaging of the human brain: first report. J. Neuroimaging J. Am. Soc. Neuroimaging 23, 219\u2013223 (2013).","journal-title":"J. Neuroimaging J. Am. Soc. Neuroimaging"},{"key":"1151_CR102","doi-asserted-by":"publisher","first-page":"1148","DOI":"10.1007\/s11547-023-01675-w","volume":"128","author":"Y-C Wei","year":"2023","unstructured":"Wei, Y.-C. et al. Vascular risk factors and astrocytic marker for the glymphatic system activity. Radiol. Med. (Torino) 128, 1148\u20131161 (2023).","journal-title":"Radiol. Med. (Torino)"},{"key":"1151_CR103","doi-asserted-by":"publisher","first-page":"1304","DOI":"10.1038\/s42003-021-02825-4","volume":"4","author":"S Garbarino","year":"2021","unstructured":"Garbarino, S., Lanteri, P., Bragazzi, N. L., Magnavita, N. & Scoditti, E. Role of sleep deprivation in immune-related disease risk and outcomes. Commun. Biol. 4, 1304 (2021).","journal-title":"Commun. Biol."},{"key":"1151_CR104","doi-asserted-by":"publisher","first-page":"n71","DOI":"10.1136\/bmj.n71","volume":"372","author":"MJ Page","year":"2021","unstructured":"Page, M. J. et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 372, n71 (2021).","journal-title":"BMJ"},{"key":"1151_CR105","unstructured":"Ga, W. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. In 3rd Symposium on Systematic Reviews: Beyond the Basics, Oxford, UK, (2000)."},{"key":"1151_CR106","doi-asserted-by":"publisher","first-page":"e0147601","DOI":"10.1371\/journal.pone.0147601","volume":"11","author":"PA Modesti","year":"2016","unstructured":"Modesti, P. A. et al. Panethnic differences in blood pressure in Europe: a systematic review and meta-analysis. PloS One 11, e0147601 (2016).","journal-title":"PloS One"},{"key":"1151_CR107","doi-asserted-by":"publisher","first-page":"603","DOI":"10.1007\/s10654-010-9491-z","volume":"25","author":"A Stang","year":"2010","unstructured":"Stang, A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur. J. Epidemiol. 25, 603\u2013605 (2010).","journal-title":"Eur. J. Epidemiol."},{"key":"1151_CR108","doi-asserted-by":"publisher","first-page":"1088","DOI":"10.2307\/2533446","volume":"50","author":"CB Begg","year":"1994","unstructured":"Begg, C. B. & Mazumdar, M. Operating characteristics of a rank correlation test for publication bias. Biometrics 50, 1088\u20131101 (1994).","journal-title":"Biometrics"},{"key":"1151_CR109","doi-asserted-by":"publisher","first-page":"629","DOI":"10.1136\/bmj.315.7109.629","volume":"315","author":"M Egger","year":"1997","unstructured":"Egger, M., Smith, G. D., Schneider, M. & Minder, C. Bias in meta-analysis detected by a simple, graphical test. BMJ 315, 629\u2013634 (1997).","journal-title":"BMJ"},{"key":"1151_CR110","doi-asserted-by":"publisher","unstructured":"Cohen, J. Statistical Power Analysis for the Behavioral Sciences (Routledge, New York, 1988). https:\/\/doi.org\/10.4324\/9780203771587.","DOI":"10.4324\/9780203771587"},{"key":"1151_CR111","doi-asserted-by":"publisher","first-page":"279","DOI":"10.4300\/JGME-D-12-00156.1","volume":"4","author":"GM Sullivan","year":"2012","unstructured":"Sullivan, G. M. & Feinn, R. Using effect size\u2014or why the p value is not enough. J. Grad. Med. Educ. 4, 279\u2013282 (2012).","journal-title":"J. Grad. Med. Educ."},{"key":"1151_CR112","doi-asserted-by":"publisher","first-page":"345","DOI":"10.1187\/cbe.13-04-0082","volume":"12","author":"JM Maher","year":"2013","unstructured":"Maher, J. M., Markey, J. C. & Ebert-May, D. The other half of the story: effect size analysis in quantitative research. CBE\u2014Life Sci. Educ. 12, 345\u2013351 (2013).","journal-title":"CBE\u2014Life Sci. Educ."},{"key":"1151_CR113","unstructured":"Glass, G. V., McGaw, B. & Smith, M. L. Meta-Analysis in Social Research (Sage Publications, 1981)."},{"key":"1151_CR114","doi-asserted-by":"publisher","first-page":"1539","DOI":"10.1002\/sim.1186","volume":"21","author":"JPT Higgins","year":"2002","unstructured":"Higgins, J. P. T. & Thompson, S. G. Quantifying heterogeneity in a meta-analysis. Stat. Med. 21, 1539\u20131558 (2002).","journal-title":"Stat. Med."},{"key":"1151_CR115","doi-asserted-by":"crossref","unstructured":"Borenstein, M., Hedges, L. V., Higgins, J. & Rothstein, H. R. Introduction to Meta-Analysis (John Wiley & Sons Inc, Chichester, 2009).","DOI":"10.1002\/9780470743386"},{"key":"1151_CR116","doi-asserted-by":"publisher","DOI":"10.1186\/s12874-024-02356-6","volume":"24","author":"A Abbas","year":"2024","unstructured":"Abbas, A., Hefnawy, M. T. & Negida, A. Meta-analysis accelerator: a comprehensive tool for statistical data conversion in systematic reviews with meta-analysis. BMC Med. Res. Methodol. 24, 243 (2024).","journal-title":"BMC Med. Res. Methodol."}],"container-title":["npj Parkinson's Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41531-025-01151-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41531-025-01151-4","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41531-025-01151-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,23]],"date-time":"2025-10-23T12:02:56Z","timestamp":1761220976000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41531-025-01151-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,23]]},"references-count":116,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["1151"],"URL":"https:\/\/doi.org\/10.1038\/s41531-025-01151-4","relation":{},"ISSN":["2373-8057"],"issn-type":[{"value":"2373-8057","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,23]]},"assertion":[{"value":"17 May 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"6 September 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 October 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"ChatGPT, an OpenAI language model utilizing the GPT-4 architecture, was employed to assist in language refinement during the editing process. This tool contributed to improving the readability and linguistic quality of the manuscript. Nevertheless, the authors assume full responsibility for the final content and have thoroughly reviewed and revised the text following its use.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declaration of Generative AI In Scientific Writing"}}],"article-number":"306"}}