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This study evaluated glymphatic function in 146 participants, including non-stroke (healthy controls, n\u2009=\u200948; nonvascular cognitive impairment patients, n\u2009=\u200947) and ischemic stroke cohorts (n\u2009=\u200951). The bilateral diffusion tensor imaging analysis along the perivascular space (DTI-ALPS) index, choroid plexus (CP), and perivascular space (PVS) volume ratio, which represent the glymphatic system, were compared across two cohorts and between pre-rehabilitation (Time 1) and 30\u00a0days post-rehabilitation (Time 2). Post-stroke cognitive impairment (PSCI) was characterized as enduring cognitive deficits persisting six months after a stroke. Stroke patients exhibited significantly lower bilateral DTI-ALPS index compared with the non-stroke population (\n                    <jats:italic>P<\/jats:italic>\n                    \u2009&lt;\u20090.05), while the infarct side showed post-rehabilitation improvement (\n                    <jats:italic>P<\/jats:italic>\n                    \u2009&lt;\u20090.05). The DTI-ALPS index of infarct side at Time 1 did not predict poor outcome but was correlated with 6-month PSCI (\n                    <jats:italic>P<\/jats:italic>\n                    \u2009&lt;\u20090.05). These results indicate that ischemic stroke diminishes glymphatic function, partially recovering post-rehabilitation, and suggest that the DTI-ALPS index could serve as a predictor for cognitive impairment following ischemic stroke.\n                  <\/jats:p>","DOI":"10.1038\/s41598-025-04054-9","type":"journal-article","created":{"date-parts":[[2025,6,3]],"date-time":"2025-06-03T02:13:06Z","timestamp":1748916786000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Glymphatic dysfunction as a biomarker for post-stroke cognitive impairment"],"prefix":"10.1038","volume":"15","author":[{"given":"Sheng","family":"Zhang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weitao","family":"Yu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaofan","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haoyue","family":"Cheng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zheyu","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shouxuan","family":"Gao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jie","family":"Zheng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liang","family":"Yu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peng","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Geng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jie","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Faliang","family":"Gao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,6,3]]},"reference":[{"key":"4054_CR1","first-page":"795","volume":"20","author":"GBD 2019 Stroke Collaborators","year":"2019","unstructured":"GBD 2019 Stroke Collaborators. 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