The Aging Meninges: Anatomical and Immunological Remodeling as Emerging Diagnostic Biomarkers of Cerebral Senescence-A Narrative Review.

Background/Objectives: Aging is a universal biological process characterized by progressive structural, cellular, and molecular alterations that contribute to functional decline and increased susceptibility to disease. In recent years, the cerebral meninges have emerged as an active regulatory interface between the central nervous system and peripheral tissues, with growing evidence supporting their involvement in immune surveillance, fluid homeostasis, and age-related neuropathology. Methods: This narrative review provides a comprehensive overview of the current state of knowledge regarding anatomical, immunological, and molecular remodeling of the aging meninges, with particular emphasis on features with potential diagnostic relevance for cerebral senescence. A systematic analysis of the literature was performed to summarize established and emerging meningeal biomarkers, including inflammatory mediators, immune cell population dynamics, vascular and lymphatic alterations, and extracellular matrix remodeling. Results: The available evidence indicates that age-related changes in meningeal immunity, lymphatic drainage, and fibrotic architecture are closely associated with impaired waste clearance, chronic low-grade neuroinflammation, and increased vulnerability to neurodegenerative processes. Importantly, this review highlights existing knowledge gaps and unresolved questions in the field, underscoring the need for integrated anatomical and molecular studies of meningeal aging. Conclusions: As a summary, by delineating current evidence and limitations, this work aims to provide a conceptual framework to guide future experimental and translational research focused on identifying novel diagnostic biomarkers of cerebral senescence.