{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,8]],"date-time":"2026-11-08T03:23:34Z","timestamp":1794108214896,"version":"4.8.0"},"reference-count":74,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,10,18]],"date-time":"2024-10-18T00:00:00Z","timestamp":1729209600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Aging Neurosci."],"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>To explore the relationship between glymphatic dysfunction and cognitive impairment in unilateral temporal lobe epilepsy (TLE).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This study retrospectively included 38 patients with unilateral TLE and 26 age- and gender-matched healthy controls (HCs). The diffusion tensor image analysis along the perivascular space (DTI-ALPS) index, choroid plexus volume (CPV), and cognitive assessment were obtained for each participant. Neuropsychological test batteries included Montreal Cognitive Assessment (MoCA), Minimum Mental State Examination, Arithmetic Test (AT), Digit Symbol Substitution Test (DSST), Digit Span Test (DST), Boston Naming Test, Block design, Phonological Fluency Test (PFT), and Semantic Verbal Fluency (SVF).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Compared to HCs, TLE patients had lower scores of MoCA, AT, DSST, DST, Block design, PFT and SVF (all <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.05) and lower values of mean DTI-ALPS index (1.491\u2009\u00b1\u20090.142 vs. 1.642\u2009\u00b1\u20090.123, <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.001). Significantly lower DTI-ALPS index values were observed in the ipsilateral hemisphere than in the contralateral hemisphere (1.466\u2009\u00b1\u20090.129 vs. 1.517\u2009\u00b1\u20090.175, <jats:italic>p<\/jats:italic>\u2009=\u20090.013) for patients with unilateral TLE. Correlation analyses found that SVF performance was significantly or borderline significantly associated with glymphatic function (<jats:italic>FDR-corrected p<\/jats:italic>\u2009&amp;lt;\u20090.05 for all DTI-ALPS index and <jats:italic>FDR-corrected p<\/jats:italic>\u2009=\u20090.057 for CPV) in TLE patients. Linear regression analyses showed that increased CPV and decreased DTI-ALPS index were independent risk factors for semantic fluency impairment (all <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.05). Furthermore, mediation analyses found the mediator role of the mean DTI-ALPS index in the relationship between choroid plexus enlargement and semantic fluency impairment (indirect effect: <jats:italic>\u03b2<\/jats:italic>\u2009=\u2009\u22120.182, <jats:italic>95%CI<\/jats:italic>\u2009=\u2009\u22120.486 to \u22120.037).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>These findings reveal the important role of the DTI-ALPS index and CPV in SVF performance in unilateral TLE. Decreased DTI-ALPS index and increased CPV are the independent risk factors for semantic fluency impairment. The DTI-ALPS index may fully mediate the relationship between CP enlargement and SVF performance. These insights provide a radiological foundation for further investigations into the mechanism of the glymphatic system in TLE pathophysiology.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fnagi.2024.1459580","type":"journal-article","created":{"date-parts":[[2024,10,18]],"date-time":"2024-10-18T04:45:06Z","timestamp":1729226706000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":23,"title":["Association of glymphatic system dysfunction with cognitive impairment in temporal lobe epilepsy"],"prefix":"10.3389","volume":"16","author":[{"given":"Jiajia","family":"Wang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaona","family":"Xia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bin","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaotian","family":"Ma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Feng","family":"Shi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying","family":"Wei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ling","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiangshui","family":"Meng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2024,10,18]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"431","DOI":"10.1002\/jmri.28759","article-title":"Current understanding of the anatomy, physiology, and magnetic resonance imaging of Neurofluids: update from the 2022 \"ISMRM imaging Neurofluids study group\" workshop in Rome","volume":"59","author":"Agarwal","year":"2024","journal-title":"J. Magn. Reson. Imaging"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"591","DOI":"10.1177\/1094428121999096","article-title":"A robust bootstrap test for mediation analysis","volume":"25","author":"Alfons","year":"2022","journal-title":"Organ. Res. Methods"},{"key":"ref3","author":"Bao","year":"2023"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"185","DOI":"10.1159\/000503831","article-title":"The epidemiology of epilepsy","volume":"54","author":"Beghi","year":"2020","journal-title":"Neuroepidemiology"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"559","DOI":"10.2214\/ajr.151.3.559","article-title":"Brain MR: pathologic correlation with gross and histopathology. 2. Hyperintense white-matter foci in the elderly","volume":"151","author":"Braffman","year":"1988","journal-title":"AJR Am. J. Roentgenol."},{"key":"ref6","doi-asserted-by":"publisher","first-page":"2462","DOI":"10.1212\/WNL.0000000000004740","article-title":"Epilepsy in multiple sclerosis: a nationwide population-based register study","volume":"89","author":"Burman","year":"2017","journal-title":"Neurology"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"4034509","DOI":"10.1155\/2021\/4034509","article-title":"Associations among cognitive functions, plasma DNA, and diffusion tensor image along the perivascular space (DTI-ALPS) in patients with Parkinson's disease","volume":"2021","author":"Chen","year":"2021","journal-title":"Oxidative Med. Cell. Longev."},{"key":"ref8","doi-asserted-by":"publisher","first-page":"635","DOI":"10.1148\/radiol.212400","article-title":"Choroid plexus volume and permeability at brain MRI within the Alzheimer disease clinical Spectrum","volume":"304","author":"Choi","year":"2022","journal-title":"Radiology"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"1163","DOI":"10.1177\/0271678X221082786","article-title":"Choroid plexus function in neurological homeostasis and disorders: the awakening of the circadian clocks and orexins","volume":"42","author":"Christensen","year":"2022","journal-title":"J. Cereb. Blood Flow Metab."},{"key":"ref10","doi-asserted-by":"publisher","first-page":"2058460115609635","DOI":"10.1177\/2058460115609635","article-title":"MRI with intrathecal MRI gadolinium contrast medium administration: a possible method to assess glymphatic function in human brain","volume":"4","author":"Eide","year":"2015","journal-title":"Acta Radiol. Open"},{"key":"ref11","author":"Ge","year":"2022"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"1482","DOI":"10.1016\/j.neuropsychologia.2004.12.010","article-title":"Semantic memory in partial epilepsy: verbal and non-verbal deficits and neuroanatomical relationships","volume":"43","author":"Giovagnoli","year":"2005","journal-title":"Neuropsychologia"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1016\/j.yebeh.2015.04.047","article-title":"Status epilepticus, blood-brain barrier disruption, inflammation, and epileptogenesis","volume":"49","author":"Gorter","year":"2015","journal-title":"Epilepsy Behav."},{"key":"ref14","doi-asserted-by":"publisher","first-page":"353","DOI":"10.1037\/\/0894-4105.14.3.353","article-title":"A comparison of rCBF patterns during letter and semantic fluency","volume":"14","author":"Gourovitch","year":"2000","journal-title":"Neuropsychology"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"2690","DOI":"10.1093\/cercor\/bhp023","article-title":"Structural correlates of semantic and phonemic fluency ability in first and second languages","volume":"19","author":"Grogan","year":"2009","journal-title":"Cereb. Cortex"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"576","DOI":"10.4065\/71.6.576","article-title":"Descriptive epidemiology of epilepsy: contributions of population-based studies from Rochester, Minnesota","volume":"71","author":"Hauser","year":"1996","journal-title":"Mayo Clin. Proc."},{"key":"ref17","doi-asserted-by":"publisher","first-page":"60","DOI":"10.1002\/epi4.12877","article-title":"Role of the glymphatic system and perivascular spaces as a potential biomarker for post-stroke epilepsy","volume":"9","author":"Hlauschek","year":"2024","journal-title":"Epilepsia Open"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"1004","DOI":"10.1016\/S1474-4422(07)70266-1","article-title":"Semantic dementia: a unique clinicopathological syndrome","volume":"6","author":"Hodges","year":"2007","journal-title":"Lancet Neurol."},{"key":"ref19","doi-asserted-by":"publisher","first-page":"164","DOI":"10.1002\/ana.26516","article-title":"Magnetic resonance images implicate that glymphatic alterations mediate cognitive dysfunction in Alzheimer disease","volume":"93","author":"Hsu","year":"2023","journal-title":"Ann. Neurol."},{"key":"ref20","doi-asserted-by":"publisher","first-page":"147ra111","DOI":"10.1126\/scitranslmed.3003748","article-title":"A paravascular pathway facilitates CSF flow through the brain parenchyma and the clearance of interstitial solutes, including amyloid beta","volume":"4","author":"Iliff","year":"2012","journal-title":"Sci. Transl. Med."},{"key":"ref21","doi-asserted-by":"publisher","first-page":"2825","DOI":"10.1161\/STROKEAHA.120.029388","article-title":"Neuropathologic and cognitive correlates of enlarged perivascular spaces in a community-based cohort of older adults","volume":"51","author":"Javierre-Petit","year":"2020","journal-title":"Stroke"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"1047","DOI":"10.1136\/jnnp-2023-331170","article-title":"Association of choroid plexus volume with motor symptoms and dopaminergic degeneration in Parkinson's disease","volume":"94","author":"Jeong","year":"2023","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"209","DOI":"10.1002\/ana.26806","article-title":"Correction: regional glymphatic abnormality in behavioral variant frontotemporal dementia","volume":"95","author":"Jiang","year":"","journal-title":"Ann. Neurol."},{"key":"ref24","doi-asserted-by":"publisher","first-page":"442","DOI":"10.1002\/ana.26710","article-title":"Regional glymphatic abnormality in behavioral variant frontotemporal dementia","volume":"94","author":"Jiang","year":"","journal-title":"Ann. Neurol."},{"key":"ref25","doi-asserted-by":"publisher","first-page":"149","DOI":"10.1186\/s13195-024-01520-w","article-title":"Choroid plexus volume as a novel candidate neuroimaging marker of the Alzheimer's continuum","volume":"16","author":"Jiang","year":"2024","journal-title":"Alzheimers Res. Ther."},{"key":"ref26","doi-asserted-by":"publisher","first-page":"176","DOI":"10.5603\/pjnns.97714","article-title":"Predicting clinical progression and cognitive decline in patients with relapsing-remitting multiple sclerosis: a 6-year follow-up study","volume":"58","author":"Kania","year":"2024","journal-title":"Neurol. Neurochir. Pol."},{"key":"ref27","doi-asserted-by":"publisher","first-page":"52","DOI":"10.1186\/s13195-016-0219-5","article-title":"An update on semantic dementia: genetics, imaging, and pathology","volume":"8","author":"Landin-Romero","year":"2016","journal-title":"Alzheimers Res. Ther."},{"key":"ref28","doi-asserted-by":"publisher","first-page":"16144","DOI":"10.1038\/s41598-020-73151-8","article-title":"Improvement of glymphatic-lymphatic drainage of beta-amyloid by focused ultrasound in Alzheimer's disease model","volume":"10","author":"Lee","year":"2020","journal-title":"Sci. Rep."},{"key":"ref29","doi-asserted-by":"publisher","first-page":"2133","DOI":"10.1007\/s00415-021-10799-w","article-title":"Glymphatic system dysfunction in patients with juvenile myoclonic epilepsy","volume":"269","author":"Lee","year":"2022","journal-title":"J. Neurol."},{"key":"ref30","doi-asserted-by":"publisher","first-page":"306","DOI":"10.1002\/epi4.12594","article-title":"Glymphatic system dysfunction in temporal lobe epilepsy patients with hippocampal sclerosis","volume":"7","author":"Lee","year":"2022","journal-title":"Epilepsia Open"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"17553","DOI":"10.1523\/JNEUROSCI.3258-13.2013","article-title":"The choroid plexus and cerebrospinal fluid: emerging roles in development, disease, and therapy","volume":"33","author":"Lehtinen","year":"2013","journal-title":"J. Neurosci."},{"key":"ref32","volume-title":"Neuropsychological assessment","author":"Lezak","year":"2012"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"182","DOI":"10.1002\/ana.26648","article-title":"Choroid plexus enlargement exacerbates white matter hyperintensity growth through glymphatic impairment","volume":"94","author":"Li","year":"2023","journal-title":"Ann. Neurol."},{"key":"ref34","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1016\/0304-3940(78)90051-4","article-title":"Peptidergic (VIP) nerves in the mammalian choroid plexus","volume":"9","author":"Lindvall","year":"1978","journal-title":"Neurosci. Lett."},{"key":"ref35","doi-asserted-by":"publisher","first-page":"245","DOI":"10.1038\/jcbfm.1981.30","article-title":"Autonomic nerves in the mammalian choroid plexus and their influence on the formation of cerebrospinal fluid","volume":"1","author":"Lindvall","year":"1981","journal-title":"J. Cereb. Blood Flow Metab."},{"key":"ref36","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1016\/j.seizure.2020.02.015","article-title":"Quantification of visible Virchow-Robin spaces for detecting the functional status of the glymphatic system in children with newly diagnosed idiopathic generalized epilepsy","volume":"78","author":"Liu","year":"2020","journal-title":"Seizure"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1016\/j.eplepsyres.2011.06.016","article-title":"A study of word finding difficulties in Spanish speakers with temporal lobe epilepsy","volume":"97","author":"Lomlomdjian","year":"2011","journal-title":"Epilepsy Res."},{"key":"ref38","doi-asserted-by":"publisher","first-page":"528","DOI":"10.1016\/j.cortex.2012.02.004","article-title":"A longitudinal study of semantic memory impairment in patients with Alzheimer's disease","volume":"49","author":"Mardh","year":"2013","journal-title":"Cortex"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"58","DOI":"10.1007\/s11910-020-01077-9","article-title":"The regulation of cerebral spinal fluid flow and its relevance to the glymphatic system","volume":"20","author":"McKnight","year":"2020","journal-title":"Curr. Neurol. Neurosci. Rep."},{"key":"ref40","doi-asserted-by":"publisher","first-page":"98","DOI":"10.1016\/j.parkreldis.2021.06.004","article-title":"Diffusion along perivascular spaces reveals evidence supportive of glymphatic function impairment in Parkinson disease","volume":"89","author":"McKnight","year":"2021","journal-title":"Parkinsonism Relat. Disord."},{"key":"ref41","doi-asserted-by":"publisher","first-page":"313","DOI":"10.1016\/j.seizure.2008.11.010","article-title":"Neuropsychological predictors of quality of life in focal epilepsy","volume":"18","author":"Meneses","year":"2009","journal-title":"Seizure"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"311","DOI":"10.1016\/j.yebeh.2007.10.014","article-title":"Semantic memory impairment in temporal lobe epilepsy associated with hippocampal sclerosis","volume":"12","author":"Messas","year":"2008","journal-title":"Epilepsy Behav."},{"key":"ref43","doi-asserted-by":"publisher","first-page":"590","DOI":"10.1016\/0006-8993(79)90410-4","article-title":"Raphe origin of serotonin-containing neurons within choroid plexus of the rat","volume":"169","author":"Moskowitz","year":"1979","journal-title":"Brain Res."},{"key":"ref44","doi-asserted-by":"publisher","first-page":"1179069518783762","DOI":"10.1177\/1179069518783762","article-title":"Strong circadian rhythms in the choroid plexus: implications for sleep-independent brain metabolite clearance","volume":"12","author":"Myung","year":"2018","journal-title":"J. Exp. Neurosci."},{"key":"ref45","doi-asserted-by":"publisher","first-page":"458","DOI":"10.1002\/eat.23849","article-title":"The role of emotion regulation in the relationship between mindfulness and risk factors for disordered eating: a longitudinal mediation analysis","volume":"56","author":"Osborne","year":"2023","journal-title":"Int. J. Eat. Disord."},{"key":"ref46","doi-asserted-by":"publisher","first-page":"5598","DOI":"10.1007\/s00415-024-12525-8","article-title":"Glymphatic function from diffusion-tensor MRI to predict conversion from mild cognitive impairment to dementia in Parkinson's disease","volume":"271","author":"Pang","year":"2024","journal-title":"J. Neurol."},{"key":"ref47","doi-asserted-by":"publisher","first-page":"1221667","DOI":"10.3389\/fnagi.2023.1221667","article-title":"Evaluation of glymphatic system activity using diffusion tensor image analysis along the perivascular space and amyloid PET in older adults with objectively normal cognition: a preliminary study","volume":"15","author":"Park","year":"2023","journal-title":"Front. Aging Neurosci."},{"key":"ref48","doi-asserted-by":"publisher","first-page":"976","DOI":"10.1038\/nrn2277","article-title":"Where do you know what you know? The representation of semantic knowledge in the human brain","volume":"8","author":"Patterson","year":"2007","journal-title":"Nat. Rev. Neurosci."},{"key":"ref49","doi-asserted-by":"publisher","first-page":"355","DOI":"10.1212\/WNL.0000000000206874","article-title":"Reader response: association of sleep, neuropsychological performance, and gray matter volume with glymphatic function in community-dwelling older adults","volume":"100","author":"Piantino","year":"2023","journal-title":"Neurology"},{"key":"ref50","doi-asserted-by":"publisher","first-page":"1312676","DOI":"10.3389\/fnins.2023.1312676","article-title":"Dysfunction of the glymphatic system in childhood absence epilepsy","volume":"17","author":"Pu","year":"2023","journal-title":"Front. Neurosci."},{"key":"ref51","doi-asserted-by":"publisher","first-page":"157","DOI":"10.1007\/s00234-023-03270-2","article-title":"Glymphatic imaging: a critical look at the DTI-ALPS index","volume":"66","author":"Ringstad","year":"2024","journal-title":"Neuroradiology"},{"key":"ref52","doi-asserted-by":"publisher","first-page":"371","DOI":"10.1097\/WCO.0000000000000568","article-title":"Neuroimaging in epilepsy","volume":"31","author":"Sidhu","year":"2018","journal-title":"Curr. Opin. Neurol."},{"key":"ref53","doi-asserted-by":"publisher","first-page":"e1887","DOI":"10.1212\/WNL.0000000000207087","article-title":"Bilingualism and structural network organization in temporal lobe epilepsy: resilience in neurologic disease","volume":"100","author":"Stasenko","year":"2023","journal-title":"Neurology"},{"key":"ref54","doi-asserted-by":"publisher","first-page":"268","DOI":"10.2463\/mrms.rev.2023-0175","article-title":"Diffusion tensor image analysis ALong the perivascular space (DTI-ALPS): revisiting the meaning and significance of the method","volume":"23","author":"Taoka","year":"2024","journal-title":"Magn. Reson. Med. Sci."},{"key":"ref55","doi-asserted-by":"publisher","first-page":"172","DOI":"10.1007\/s11604-017-0617-z","article-title":"Evaluation of glymphatic system activity with the diffusion MR technique: diffusion tensor image analysis along the perivascular space (DTI-ALPS) in Alzheimer's disease cases","volume":"35","author":"Taoka","year":"2017","journal-title":"Jpn. J. Radiol."},{"key":"ref56","doi-asserted-by":"publisher","first-page":"118830","DOI":"10.1016\/j.neuroimage.2021.118830","article-title":"What's new and what's next in diffusion MRI preprocessing","volume":"249","author":"Tax","year":"2022","journal-title":"NeuroImage"},{"key":"ref57","doi-asserted-by":"publisher","first-page":"689","DOI":"10.1016\/S0140-6736(18)32596-0","article-title":"Epilepsy in adults","volume":"393","author":"Thijs","year":"2019","journal-title":"Lancet"},{"key":"ref58","doi-asserted-by":"publisher","first-page":"38","DOI":"10.18637\/jss.v059.i05","article-title":"Mediation: R package for causal mediation analysis","volume":"59","author":"Tingley","year":"2014","journal-title":"J. Stat. Softw."},{"key":"ref59","doi-asserted-by":"publisher","first-page":"499","DOI":"10.1016\/s0028-3932(97)00152-8","article-title":"Clustering and switching on verbal fluency: the effects of focal frontal- and temporal-lobe lesions","volume":"36","author":"Troyer","year":"1998","journal-title":"Neuropsychologia"},{"key":"ref60","doi-asserted-by":"publisher","first-page":"1749","DOI":"10.1007\/s00234-023-03240-8","article-title":"Decreased DTI-ALPS and choroid plexus enlargement in fibromyalgia: a preliminary multimodal MRI study","volume":"65","author":"Tu","year":"2023","journal-title":"Neuroradiology"},{"key":"ref61","doi-asserted-by":"publisher","first-page":"e01475","DOI":"10.1002\/brb3.1475","article-title":"Factors for cognitive impairment in adult epileptic patients","volume":"10","author":"Wang","year":"2020","journal-title":"Brain Behav."},{"key":"ref62","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/afad107","article-title":"Glymphatic function plays a protective role in ageing-related cognitive decline","volume":"52","author":"Wang","year":"2023","journal-title":"Age Ageing"},{"key":"ref63","doi-asserted-by":"publisher","first-page":"822","DOI":"10.1016\/S1474-4422(13)70124-8","article-title":"Neuroimaging standards for research into small vessel disease and its contribution to ageing and neurodegeneration","volume":"12","author":"Wardlaw","year":"2013","journal-title":"Lancet Neurol."},{"key":"ref64","doi-asserted-by":"publisher","first-page":"1153784","DOI":"10.3389\/fradi.2023.1153784","article-title":"uRP: an integrated research platform for one-stop analysis of medical images","volume":"3","author":"Wu","year":"2023","journal-title":"Front Radiol"},{"key":"ref65","doi-asserted-by":"publisher","first-page":"373","DOI":"10.1126\/science.1241224","article-title":"Sleep drives metabolite clearance from the adult brain","volume":"342","author":"Xie","year":"2013","journal-title":"Science"},{"key":"ref66","doi-asserted-by":"publisher","first-page":"105550","DOI":"10.1016\/j.msard.2024.105550","article-title":"Enlarged choroid plexus in relapsing-remitting multiple sclerosis may lead to brain structural changes through the glymphatic impairment","volume":"85","author":"Xie","year":"2024","journal-title":"Mult. Scler. Relat. Disord."},{"key":"ref67","doi-asserted-by":"publisher","first-page":"855","DOI":"10.2147\/CIA.S404908","article-title":"Enlarged perivascular spaces and age-related clinical diseases","volume":"18","author":"Yang","year":"2023","journal-title":"Clin. Interv. Aging"},{"key":"ref68","doi-asserted-by":"publisher","first-page":"e80713","DOI":"10.1371\/journal.pone.0080713","article-title":"Deterministic diffusion fiber tracking improved by quantitative anisotropy","volume":"8","author":"Yeh","year":"2013","journal-title":"PLoS One"},{"key":"ref69","doi-asserted-by":"publisher","first-page":"116131","DOI":"10.1016\/j.neuroimage.2019.116131","article-title":"Differential tractography as a track-based biomarker for neuronal injury","volume":"202","author":"Yeh","year":"2019","journal-title":"NeuroImage"},{"key":"ref70","doi-asserted-by":"publisher","first-page":"1314","DOI":"10.1007\/s00330-023-10122-3","article-title":"Glymphatic system impairment in Alzheimer's disease: associations with perivascular space volume and cognitive function","volume":"34","author":"Zhang","year":"2024","journal-title":"Eur. Radiol."},{"key":"ref71","doi-asserted-by":"publisher","first-page":"6116","DOI":"10.1007\/s00330-023-09588-y","article-title":"Recovery of glymphatic system function in patients with temporal lobe epilepsy after surgery","volume":"33","author":"Zhang","year":"2023","journal-title":"Eur. Radiol."},{"key":"ref72","doi-asserted-by":"publisher","first-page":"693787","DOI":"10.3389\/fnagi.2021.693787","article-title":"The influence of demographics and vascular risk factors on glymphatic function measured by diffusion along perivascular space","volume":"13","author":"Zhang","year":"2021","journal-title":"Front. Aging Neurosci."},{"key":"ref73","doi-asserted-by":"publisher","first-page":"118257","DOI":"10.1016\/j.neuroimage.2021.118257","article-title":"Glymphatic clearance function in patients with cerebral small vessel disease","volume":"238","author":"Zhang","year":"2021","journal-title":"NeuroImage"},{"key":"ref74","article-title":"The asymmetry of glymphatic system dysfunction in patients with temporal lobe epilepsy: a DTI-ALPS study. J. 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