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MRI markers of cerebrospinal fluid dynamics predict dementia and mediate the impact of cardiovascular risk
Hui Hong, Yutong Chen, Dan Tozer, Yeerfan Jiaerken, Peiyu Huang, Hugh Stephen Markus. Alzheimer s & Dementia, 2025-10-01
Topic: Risk, prevention and care in population studies
Lower DTI-ALPS, lower BOLD-CSF coupling, and higher CP volume predicted dementia, but PVS volume did not. DTI-ALPS and CP volume mediated the effect of white matter hyperintensities and diabetes duration on dementia. Impaired CSF dynamics may lead to dementia and partially mediate cardiovascular risk-dementia associations. HIGHLIGHTS: We developed fully automated methods for quantifying diffusion tensor image analysis along the perivascular space (DTI-ALPS) and blood oxygen level-dependent cerebrospinal fluid (BOLD-CSF) coupling. Three CSF dynamics markers-BOLD-CSF coupling, DTI-ALPS, and choroid plexus (CP) volume-were predictive of incident dementia, whereas PVS volume was not. Magnetic resonance imaging proxies of CSF dynamics markers were associated with cardiovascular injury. CP volume and DTI-ALPS mediated the associations of both white matter hyperintensities and diabetes with dementia.
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
APA 7th
Hong, H., Chen, Y., Tozer, D., Jiaerken, Y., Huang, P., & Markus, H. S. (2025). MRI markers of cerebrospinal fluid dynamics predict dementia and mediate the impact of cardiovascular risk. Alzheimer s & Dementia. https://doi.org/10.1002/alz.70699
Vancouver
Hong H, Chen Y, Tozer D, Jiaerken Y, Huang P, Markus HS. MRI markers of cerebrospinal fluid dynamics predict dementia and mediate the impact of cardiovascular risk. Alzheimer s & Dementia. 2025. doi:10.1002/alz.70699. PMID: 41128158.
BibTeX
@article{hong2025-41128158,
author = {Hong, Hui and Chen, Yutong and Tozer, Dan and Jiaerken, Yeerfan and Huang, Peiyu and Markus, Hugh Stephen},
title = {{MRI markers of cerebrospinal fluid dynamics predict dementia and mediate the impact of cardiovascular risk}},
journal = {Alzheimer s \& Dementia},
year = {2025},
doi = {10.1002/alz.70699},
pmid = {41128158},
url = {https://doi.org/10.1002/alz.70699}
}
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Key findings
- Lower DTI-ALPS, lower BOLD-CSF coupling, and higher CP volume predicted dementia, but PVS volume did not.
- DTI-ALPS and CP volume mediated the effect of white matter hyperintensities and diabetes duration on dementia.
- Impaired CSF dynamics may lead to dementia and partially mediate cardiovascular risk-dementia associations.
- HIGHLIGHTS: We developed fully automated methods for quantifying diffusion tensor image analysis along the perivascular space (DTI-ALPS) and blood oxygen level-dependent cerebrospinal fluid (BOLD-CSF) coupling.
- Three CSF dynamics markers-BOLD-CSF coupling, DTI-ALPS, and choroid plexus (CP) volume-were predictive of incident dementia, whereas PVS volume was not.
Why it matters
Lower DTI-ALPS, lower BOLD-CSF coupling, and higher choroid plexus volume predicted dementia, while perivascular space volume did not, and DTI-ALPS and choroid plexus volume mediated the effects of white matter hyperintensities and diabetes duration on dementia. This suggests impaired cerebrospinal fluid dynamics may contribute to dementia and partly explain cardiovascular risk links, but it is an observational imaging study and not a treatment.
Study details
- Evidence strengthLow
How this study scored 43/100
Published in a peer-reviewed journal. Scored zero for study design, sample size, effect reported, studied in people and randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Alzheimer s & Dementia) |
| Journal's citation record | 2 / 4 | Alzheimer s & Dementia: journal h-index 228 (OpenAlex, 2026-10-29) |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 1 / 5 | Rated “low” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 4 / 5 | 2025 — within 3 year(s) of the newest study here |
| Sample size | 0 / 4 | Participant count not stated — scores zero (not stated in the record — scored 0) |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 0 / 3 | Not stated whether this was studied in people — scores zero (not stated in the record — scored 0) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 2 / 7 | Cited 11 times (OpenAlex, 2026-10-10) |
| Citations per year | 2 / 5 | 3.7 citations a year over 3 year(s) since 2025 |
| Impact for its field and year | 3 / 6 | Cited 3.9× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 0 / 6 | No other study in this library cites it |
| Still being cited | 1 / 4 | Cited 11 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 4 / 4 | Last-listed author Hugh Stephen Markus: h-index 137 (OpenAlex, whole career) |
| Institution's track record | 2 / 3 | University of Cambridge: institution h-index 1,973 (OpenAlex) |
| Multi-centre collaboration | 1 / 3 | OpenAlex lists 2 institution(s) in 2 countries |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 41128158) |
| Free to read | 2 / 2 | Free to read |
| Total | 43 / 100 | — |
What each of these 20 components measures, and what this score is not →
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