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Perisynaptic astrocytic processes (PAPs) are ultrathin astrocytic leaflets that variably appose synapses and form a major structural interface between astrocytes and neuronal synapses. PAPs are best viewed as a perisynaptic configuration within a broader population of fine astrocytic protrusions, with coverage, geometry, and molecular composition varying across brain regions, developmental stages, and species. In this review, we synthesize current evidence that PAPs define local microdomains around synapses in which astrocytes sense neuronal activity and regulate the synaptic milieu. We discuss how PAP organization and plasticity influence neurotransmitter clearance, ion homeostasis, and structural remodeling at synapses. We also consider how regional differences in PAP organization may contribute to selective circuit vulnerability and how early PAP dysfunction may contribute to synaptic dysfunction in neurodegenerative disease. Finally, we highlight emerging approaches needed to resolve the structure and function of PAP at synapses in vivo and to establish causal mechanisms.<\/jats:p>","DOI":"10.1177\/10738584261445356","type":"journal-article","created":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T12:19:34Z","timestamp":1779711574000},"page":"270-286","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Perisynaptic Astrocytic Processes as Communication Hubs and Early Sites of Dysfunction"],"prefix":"10.1177","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-9060-2184","authenticated-orcid":false,"given":"Francesca","family":"Puletti","sequence":"first","affiliation":[{"name":"UK Dementia Research Institute, Institute of Neurology, University College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-1223-2761","authenticated-orcid":false,"given":"Isabella","family":"Tugulu","sequence":"additional","affiliation":[{"name":"UK Dementia Research Institute, Institute of Neurology, University College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5744-4871","authenticated-orcid":false,"given":"Soyon","family":"Hong","sequence":"additional","affiliation":[{"name":"UK Dementia Research Institute, Institute of Neurology, University College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,5,25]]},"reference":[{"key":"e_1_3_3_2_1","doi-asserted-by":"crossref","unstructured":"Aboufares El Alaoui A Jackson M Fabri M de Vivo L Bellesi M. 2021. 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