Glymphatic system alterations in schizophrenia evaluated by the DTI-ALPS index: A systematic review and meta-analysis.
Jiahua Chen, Fuzhe Zhang, Ruoxuan Zhang et al.
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In 30 seconds
This systematic review and random-effects meta-analysis assessed glymphatic-system function in schizophrenia using the DTI-ALPS index, a surrogate marker, across eight studies comparing patients with healthy controls. The pooled index was lower in schizophrenia (SMD = -2.42, 95% CI: -4.06 to -0.79), consistent with possible glymphatic dysfunction. Subgroup analyses found that disease stage was associated with differences in DTI-ALPS indices. The findings suggest an imaging correlate of schizophrenia-related pathology, but do not establish that glymphatic alterations cause the disorder.
Key findings
- Across eight studies, DTI-ALPS was lower in schizophrenia than in healthy controls (SMD = -2.42, 95% CI: -4.06 to -0.79).
- Subgroup analyses indicated that disease stage significantly influenced DTI-ALPS indices.
- Sensitivity analysis supported the robustness of the pooled finding; no publication bias was detected.
Why it matters
The pooled difference supports further investigation of glymphatic-system alterations as a potential neurobiological correlate in schizophrenia. Because DTI-ALPS is a surrogate marker and disease stage was associated with index differences, interpretation should account for stage and should not equate the imaging result with direct measurement of waste clearance or a causal mechanism.
What to keep in mind
The analysis included eight studies and relied on DTI-ALPS as a surrogate marker of glymphatic function; the findings do not establish causality.