{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T14:02:31Z","timestamp":1789480951412,"version":"build-2803163510"},"reference-count":40,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T00:00:00Z","timestamp":1785715200000},"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. Neurol."],"abstract":"<jats:sec>\n                    <jats:title>Inroduction<\/jats:title>\n                    <jats:p>Cerebral small vessel disease contributes substantially to cognitive decline in older adults, but conventional structural magnetic resonance imaging markers mainly reflect accumulated lesion burden and do not directly characterize diffusion-derived alterations in brain fluid homeostasis. We investigated whether combining diffusion imaging along the perivascular space and white matter free-water imaging improves identification of Montreal Cognitive Assessment (MoCA)-defined cognitive impairment in elderly patients with cerebral small vessel disease.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This prospective study included 100 patients with cerebral small vessel disease and 50 healthy controls. According to MoCA scores, patients were classified as cognitively normal (\n                      <jats:italic>n<\/jats:italic>\n                      = 42) or cognitively impaired (\n                      <jats:italic>n<\/jats:italic>\n                      = 58). All participants underwent 3.0-T magnetic resonance imaging, including conventional structural imaging and diffusion tensor imaging. Conventional structural magnetic resonance imaging markers were evaluated on anatomical imaging, whereas diffusion-derived metrics were used to assess perivascular diffusion and free-water burden. Group comparisons, correlation analyses, multivariate logistic regression, and receiver operating characteristic analyses were performed.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Analysis along the perivascular space decreased progressively from healthy controls to cognitively normal patients and cognitively impaired patients, whereas white matter free water increased in the opposite direction (all\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.001). Lower ALPS-Index values and higher white matter free-water values were both associated with lower MoCA scores. The clinical information model showed moderate discrimination for MoCA-defined cognitive impairment (area under the curve = 0.764, 95% confidence interval: 0.669\u20130.859). After incorporating age, sex, education, hypertension, and diabetes as covariates, the traditional cerebral small vessel disease marker model achieved an area under the curve of 0.819 (95% confidence interval: 0.731\u20130.908), whereas the glymphatic-edema signature combining ALPS-Index and white matter free water achieved better discriminative performance (area under the curve = 0.928, 95% confidence interval: 0.875\u20130.981). The combined imaging model incorporating conventional structural markers, ALPS-Index, and white matter free water achieved the highest discriminative performance (area under the curve = 0.950, 95% confidence interval: 0.906\u20130.993).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Perivascular diffusion imaging and white matter free water capture complementary aspects of altered perivascular diffusion and extracellular free-water accumulation in cerebral small vessel disease and improve identification of MoCA-defined cognitive impairment beyond conventional structural magnetic resonance imaging markers.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fneur.2026.1879894","type":"journal-article","created":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T04:26:07Z","timestamp":1785731167000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Perivascular diffusion and white matter free water improve identification of cognitive impairment in cerebral small vessel disease"],"prefix":"10.3389","volume":"17","author":[{"given":"Chunhong","family":"Yang","sequence":"first","affiliation":[{"name":"Department of Radiology, Punan Branch of Renji Hospital, Shanghai Jiaotong University School of Medicine (Punan Hospital in Pudong New District, Shanghai)","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sunmei","family":"Cai","sequence":"additional","affiliation":[{"name":"Department of Radiology, Punan Branch of Renji Hospital, Shanghai Jiaotong University School of Medicine (Punan Hospital in Pudong New District, Shanghai)","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bing","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Radiology, Punan Branch of Renji Hospital, Shanghai Jiaotong University School of Medicine (Punan Hospital in Pudong New District, Shanghai)","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jie","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Radiology, Punan Branch of Renji Hospital, Shanghai Jiaotong University School of Medicine (Punan Hospital in Pudong New District, Shanghai)","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dongmei","family":"Wu","sequence":"additional","affiliation":[{"name":"Shanghai Key Laboratory of Magnetic Resonance, School of Physics, Institute of Magnetic Resonance and Molecular Imaging in Medicine, East China Normal 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China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaiyue","family":"Peng","sequence":"additional","affiliation":[{"name":"Department of Radiology, Punan Branch of Renji Hospital, Shanghai Jiaotong University School of Medicine (Punan Hospital in Pudong New District, Shanghai)","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, The First Affiliated Hospital of Soochow University","place":["Suzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenquan","family":"Gu","sequence":"additional","affiliation":[{"name":"Department of Radiology, Punan Branch of Renji Hospital, Shanghai Jiaotong University School of Medicine (Punan Hospital in Pudong New District, Shanghai)","place":["Shanghai, 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