'Brain Cleaning System' Damage Increases Parkinson's Disease Risk

Bundang Seoul National University Hospital Multidisciplinary Research Team
First in the World to Identify Link Between Glymphatic System Damage and Parkinson's Disease
Published in Prestigious International Journal

A study has found that damage to the brain's waste removal system during sleep, known as the 'Glymphatic System,' increases the risk of developing Parkinson's disease. This is the first time a connection between the brain glymphatic system and Parkinson's disease onset has been confirmed.

Professor Jongmin Kim (left), Department of Neurology, Seoul National University Bundang Hospital, and Professor Yoonjung Bae, Department of Radiology.

A multidisciplinary research team from Seoul National University Bundang Hospital, consisting of Neurology Professor Kim Jong-min, Radiology Professor Bae Yoon-jung, Psychiatry Professor Yoon In-young, and Nuclear Medicine Professor Song Yo-sung, announced on the 27th that they confirmed a higher risk of Parkinson's disease in patients with REM sleep behavior disorder whose brain glymphatic system is impaired.

Recently, the discovery of the 'brain glymphatic system,' which removes waste accumulated in the brain during deep sleep through perivascular glymphatic pathways, has drawn medical attention to its potential link with Parkinson's disease. Since Parkinson's disease is known to result from the inadequate clearance of the pathological protein alpha-synuclein, it was predicted that impairment of the glymphatic system could lead to the accumulation of pathological proteins in the brain.

The research team conducted MRI scans, including Diffusion Tensor Imaging (DTI), on 20 patients with REM sleep behavior disorder, 20 patients with Parkinson's disease, and 20 control subjects, analyzing and comparing the diffusion index of the perivascular space reflecting brain glymphatic flow (ALPS index).

As a result, the ALPS index was 1.72 in the control group, while it was lower at 1.53 in the REM sleep behavior disorder group and 1.49 in the Parkinson's disease group. A lower ALPS index indicates greater damage to the brain glymphatic system. This means that individuals with REM sleep behavior disorder have a higher degree of impairment in the brain's waste removal system compared to those without the disorder. Furthermore, it was confirmed that the lower the ALPS index, the higher the risk of conversion to Parkinson's disease.

A schematic diagram illustrating the principle related to the diffusion index of the perivascular space reflecting the glymphatic flow around blood vessels in the brain. [Source: Bundang Seoul National University Hospital]

Professor Bae Yoon-jung stated, "We revealed that among patients with REM sleep behavior disorder, known as a prodromal condition of Parkinson's disease, those with damage to the brain glymphatic system have a higher risk of developing Parkinson's disease. This is significant as it proves that impairment of the brain glymphatic system substantially contributes to this degenerative brain disorder." Professor Kim Jong-min added, "It is clinically meaningful that we demonstrated the ability to assess actual brain glymphatic function in humans non-invasively using only MRI, without invasive procedures such as contrast agent injection. This advancement allows us to predict the risk of Parkinson's disease onset in patients with REM sleep behavior disorder."

This study was published in the latest issue of 'Radiology,' the leading journal in the field of radiology, and has attracted academic attention with a special editorial explaining the significance and importance of the research findings.

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