Choroid plexus alterations correlate with cognitive impairment in multiple system atrophy.

BACKGROUND

Emerging evidence suggests that the choroid plexus (CP) contributes to cognitive dysfunction through its role in cerebrospinal fluid regulation and barrier function. However, its imaging profile in multiple system atrophy (MSA) remains unexplored. This study aimed to investigate CP structural and microstructural alterations in MSA patients and to examine their associations with cognitive performance.

METHODS

Eighty-six patients with MSA (46 with mild cognitive impairment [MSA-MCI], 40 with normal cognition [MSA-NC]) and 40 age-matched healthy controls (HC) underwent T1-weighted and multi-shell diffusion MRI, along with cognitive assessments (Montreal Cognitive Assessment [MoCA], Mini-Mental State Examination [MMSE]). Bilateral CPs were segmented using a Gaussian Mixture Model algorithm. CP volume and free water fraction (FWf) were compared across groups, and associations with global cognitive scores were assessed using partial correlations adjusting for age, sex, intracranial volume, and disease duration.

RESULTS

Both MSA groups showed significantly higher CP volume compared with HC (MSA-NC:956.98 ± 193.40 mm3; MSA-MCI: 1327.67 ± 374.47 mm3; HC: 723.53 ± 152.14 mm3; P < 0.001). Besides, MSA-MCI exhibited significantly greater CP volume (1327.67 ± 374.47 mm3) and FWf (0.82 ± 0.03) than MSA-NC (volume: 956.98 ± 193.40 mm3; FWf: 0.77 ± 0.06; P < 0.001). Higher CP volume and FWf were negatively correlated with MoCA (r = -0.32 and -0.40) and MMSE (r = -0.41 and -0.49) scores after covariate adjustment (P < 0.05).

CONCLUSION

CP enlargement and increased FWf may suggest glymphatic dysfunction in MSA and are associated with cognitive impairment.