{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T08:11:22Z","timestamp":1789459882455,"version":"build-2803163510"},"reference-count":56,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T00:00:00Z","timestamp":1789171200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T00:00:00Z","timestamp":1789171200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/501100003196","name":"Ministero della Salute","doi-asserted-by":"publisher","award":["Ricerca corrente"],"award-info":[{"award-number":["Ricerca corrente"]}],"id":[{"id":"10.13039\/501100003196","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Alzheimer\u2019s Disease"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      The choroid plexus (CP) is involved in cerebrospinal fluid production, immune surveillance, and brain fluid homeostasis. CP enlargement has been linked to neuroinflammation, glymphatic dysfunction, and white matter lesion (WML) burden, but the mechanisms underlying these associations remain uncertain\n                      <jats:bold>.<\/jats:bold>\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To investigate the relationships among CP volume, glymphatic function estimated using diffusion tensor imaging along the perivascular space (DTI-ALPS), WML burden, and global cognitive performance in individuals with suspected neurodegenerative conditions, and to assess whether DTI-ALPS mediates the association between CP enlargement and white matter damage.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively analyzed 104 participants, including 63 individuals with neurodegenerative conditions and 41 without neurodegeneration, who underwent multimodal MRI with 3D-T1-weighted, 3D-FLAIR, and diffusion-weighted sequences. CP volume was segmented using ASCHOPLEX and normalized to total intracranial volume. DTI-ALPS indices were derived from diffusion imaging, WML burden was quantified by automated segmentation, and global cognition was assessed using the Mini-Mental State Examination. Associations were tested using linear and quantile regression models. Mediation analysis evaluated indirect effects through DTI-ALPS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Greater CP volume was associated with lower DTI-ALPS values and higher WML burden. DTI-ALPS partially mediated the relationship between CP volume and WML burden, although the magnitude of mediation was modest. No significant mediation effect was observed for global cognitive performance. DTI-ALPS also showed strong associations with white matter integrity metrics, suggesting possible sensitivity to non-glymphatic microstructural changes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>CP enlargement is associated with reduced DTI-ALPS and greater WML burden, but the contribution of glymphatic impairment remains uncertain. Alternative mechanisms, including neuroinflammation, blood\u2013brain barrier dysfunction, and white matter microstructural damage, may contribute to these findings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/13872877261467934","type":"journal-article","created":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T17:17:56Z","timestamp":1789233476000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Assessing glymphatic role in the association between choroid plexus enlargement and white matter lesions load: The uncertain path through diffusion tensor imaging along the perivascular space (DTI-ALPS)"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3929-9009","authenticated-orcid":false,"given":"Luca","family":"Sacchi","sequence":"first","affiliation":[{"name":"University of Milan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valentina","family":"Veronesi","sequence":"additional","affiliation":[{"name":"University of Milan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giorgio","family":"Bocca","sequence":"additional","affiliation":[{"name":"University of Milan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lia","family":"Schmid","sequence":"additional","affiliation":[{"name":"University of Heidelberg"},{"name":"University of Milan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federico","family":"D'Agata","sequence":"additional","affiliation":[{"name":"University of Turin"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Corrado","family":"Campisi","sequence":"additional","affiliation":[{"name":"University of Turin"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-1371-7652","authenticated-orcid":false,"given":"Bal\u00e1zs","family":"\u00d6rzsik","sequence":"additional","affiliation":[{"name":"Leiden University Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3821-0682","authenticated-orcid":false,"given":"Marina","family":"Arcaro","sequence":"additional","affiliation":[{"name":"Fondazione IRCCS Ca\u2019 Granda, Ospedale Maggiore Policlinico, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiara","family":"Fenoglio","sequence":"additional","affiliation":[{"name":"University of Milan"},{"name":"Fondazione IRCCS Ca\u2019 Granda, Ospedale Maggiore Policlinico, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tiziana","family":"Carandini","sequence":"additional","affiliation":[{"name":"Fondazione IRCCS Ca\u2019 Granda, Ospedale Maggiore Policlinico, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manuela","family":"Pintus","sequence":"additional","affiliation":[{"name":"Fondazione IRCCS Ca\u2019 Granda, Ospedale Maggiore Policlinico, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna Margherita","family":"Pietroboni","sequence":"additional","affiliation":[{"name":"Fondazione IRCCS Ca\u2019 Granda, Ospedale Maggiore Policlinico, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8180-9730","authenticated-orcid":false,"given":"Laura","family":"Ghezzi","sequence":"additional","affiliation":[{"name":"University of Milan"},{"name":"Fondazione IRCCS Ca\u2019 Granda, Ospedale Maggiore Policlinico, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6102-7272","authenticated-orcid":false,"given":"Julia","family":"Schubert","sequence":"additional","affiliation":[{"name":"Institute of Psychiatry, Psychology & Neuroscience, King's College London"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giorgio","family":"Conte","sequence":"additional","affiliation":[{"name":"Fondazione IRCCS Ca\u2019 Granda, Ospedale Maggiore Policlinico, Milan, Italy"},{"name":"University of Milan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marta","family":"Rigoni","sequence":"additional","affiliation":[{"name":"University of Milan"},{"name":"IRCCS MultiMedica, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raffaella","family":"Lanzarotti","sequence":"additional","affiliation":[{"name":"University of Milan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3060-4097","authenticated-orcid":false,"given":"Claudia","family":"Dolci","sequence":"additional","affiliation":[{"name":"University of Milan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabio","family":"Triulzi","sequence":"additional","affiliation":[{"name":"Fondazione IRCCS Ca\u2019 Granda, Ospedale Maggiore Policlinico, Milan, Italy"},{"name":"University of Milan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3766-3815","authenticated-orcid":false,"given":"Federico","family":"Turkheimer","sequence":"additional","affiliation":[{"name":"Institute of Psychiatry, Psychology & Neuroscience, King's College London"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9284-5953","authenticated-orcid":false,"given":"Daniela","family":"Galimberti","sequence":"additional","affiliation":[{"name":"University of Milan"},{"name":"Fondazione IRCCS Ca\u2019 Granda, Ospedale Maggiore Policlinico, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4550-2456","authenticated-orcid":false,"given":"Mara","family":"Cercignani","sequence":"additional","affiliation":[{"name":"Brain Research Imaging Centre, Cardiff University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Bozzali","sequence":"additional","affiliation":[{"name":"University of Turin"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2865-3970","authenticated-orcid":false,"given":"Andrea","family":"Arighi","sequence":"additional","affiliation":[{"name":"Fondazione IRCCS Ca\u2019 Granda, Ospedale Maggiore Policlinico, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,9,12]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.3389\/fnmol.2022.949231"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12987-022-00382-4"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1152\/physrev.00031.2020"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1002\/nbm.5159"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/awx191"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.neuroimage.2021.118257"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1002\/ana.25670"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00330-023-09796-6"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1111\/ejn.15974"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11604-017-0617-z"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.2463\/mrms.rev.2023-0175"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1002\/jmri.29203"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00234-023-03270-2"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1002\/alz.12970"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1126\/science.abb8739"},{"key":"e_1_3_3_17_2","first-page":"2230","article-title":"Association of plasma markers of Alzheimer\u2019s disease, neurodegeneration, and neuroinflammation with the choroid plexus integrity in aging","volume":"15","author":"Bouhrara M","year":"2024","unstructured":"Bouhrara M, Walker KA, Alisch JSR, et al. Association of plasma markers of Alzheimer\u2019s disease, neurodegeneration, and neuroinflammation with the choroid plexus integrity in aging. Aging Dis 2024; 15: 2230\u20132240.","journal-title":"Aging Dis"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1002\/ana.26710"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13195-024-01520-w"},{"key":"e_1_3_3_20_2","first-page":"552","article-title":"Choroid plexus volume, amyloid burden, and cognition in the Alzheimer\u2019s disease continuum","volume":"16","author":"Jeong SH","year":"2024","unstructured":"Jeong SH, Park CJ, Cha J, et al. Choroid plexus volume, amyloid burden, and cognition in the Alzheimer\u2019s disease continuum. Aging Dis 2024; 16: 552\u2013564.","journal-title":"Aging Dis"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13195-024-01407-w"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2023.1039239"},{"key":"e_1_3_3_23_2","doi-asserted-by":"publisher","DOI":"10.1111\/ene.15999"},{"key":"e_1_3_3_24_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000207600"},{"key":"e_1_3_3_25_2","doi-asserted-by":"publisher","DOI":"10.1038\/s43587-023-00550-7"},{"key":"e_1_3_3_26_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(18)30318-1"},{"key":"e_1_3_3_27_2","doi-asserted-by":"publisher","DOI":"10.1002\/alz.13789"},{"key":"e_1_3_3_28_2","doi-asserted-by":"publisher","DOI":"10.1002\/ana.26516"},{"key":"e_1_3_3_29_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000201300"},{"key":"e_1_3_3_30_2","doi-asserted-by":"publisher","DOI":"10.1002\/hbm.26805"},{"key":"e_1_3_3_31_2","doi-asserted-by":"publisher","DOI":"10.1002\/alz.13659"},{"key":"e_1_3_3_32_2","doi-asserted-by":"publisher","DOI":"10.1002\/ana.26729"},{"key":"e_1_3_3_33_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.parkreldis.2024.106950"},{"key":"e_1_3_3_34_2","doi-asserted-by":"publisher","DOI":"10.1159\/000530075"},{"key":"e_1_3_3_35_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.neulet.2024.137995"},{"key":"e_1_3_3_36_2","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/awad274"},{"key":"e_1_3_3_37_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11604-023-01454-7"},{"key":"e_1_3_3_38_2","doi-asserted-by":"publisher","DOI":"10.1002\/ana.26648"},{"key":"e_1_3_3_39_2","doi-asserted-by":"publisher","DOI":"10.1093\/cercor\/bhae265"},{"key":"e_1_3_3_40_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.msard.2024.105550"},{"key":"e_1_3_3_41_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00234-023-03240-8"},{"key":"e_1_3_3_42_2","doi-asserted-by":"publisher","DOI":"10.3389\/fnagi.2024.1459580"},{"key":"e_1_3_3_43_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2024.3770"},{"key":"e_1_3_3_44_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0b013e31827f0fd1"},{"key":"e_1_3_3_45_2","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/awr179"},{"key":"e_1_3_3_46_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000004058"},{"key":"e_1_3_3_47_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.compbiomed.2024.109164"},{"key":"e_1_3_3_48_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.neuroimage.2006.01.015"},{"key":"e_1_3_3_49_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.neuroimage.2015.10.019"},{"key":"e_1_3_3_50_2","doi-asserted-by":"publisher","DOI":"10.4135\/9781412985550"},{"key":"e_1_3_3_51_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbankfin.2012.10.015"},{"key":"e_1_3_3_52_2","doi-asserted-by":"publisher","DOI":"10.1201\/9781315120256"},{"key":"e_1_3_3_53_2","doi-asserted-by":"publisher","DOI":"10.18637\/jss.v048.i02"},{"key":"e_1_3_3_54_2","doi-asserted-by":"publisher","DOI":"10.3233\/ADR-230143"},{"key":"e_1_3_3_55_2","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.212400"},{"key":"e_1_3_3_56_2","doi-asserted-by":"publisher","DOI":"10.3389\/fnins.2021.799576"},{"key":"e_1_3_3_57_2","doi-asserted-by":"publisher","DOI":"10.3233\/JAD-131829"}],"container-title":["Journal of Alzheimer\u2019s Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/13872877261467934","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/13872877261467934","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/13872877261467934","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T07:48:27Z","timestamp":1789458507000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/13872877261467934"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,12]]},"references-count":56,"alternative-id":["10.1177\/13872877261467934"],"URL":"https:\/\/doi.org\/10.1177\/13872877261467934","relation":{},"ISSN":["1387-2877","1875-8908"],"issn-type":[{"value":"1387-2877","type":"print"},{"value":"1875-8908","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,12]]},"article-number":"13872877261467934"}}