Multimodal MRI Insights into Glymphatic Clearance and Blood-Brain Barrier Integrity in Healthy Aging

Aging is associated with impaired CSF clearance in preclinical models, but its impact on blood-brain barrier (BBB) health and glymphatic function in humans remains unclear. We aimed to compare healthy younger and older adults using multimodal MRI to assess age-related changes in BBB permeability and glymphatic clearance, and to examine the relationships between these measures. Thirty participants were recruited (12 younger, 26 ± 3 years; 18 older, 75 ± 7 years). Diffusion-prepared arterial spin labeling measured the water exchange rate (Kw) across the BBB; free water (FW) imaging quantified extracellular free water in white matter; and diffusion tensor imaging along perivascular spaces (DTI-ALPS) assessed glymphatic function. Older individuals showed reduced whole-brain Kw (p=0.021), increased white matter FW (p=0.002), and reduced DTI-ALPS (p<0.001) compared to younger adults. Kw associated with both DTI-ALPS (β=0.402×10 ⁻² , p=0.022) and FW (β=-0.676×10 ⁻³ , p=0.008). Reduced Kw may reflect impaired BBB function, while reduced DTI-ALPS and increased FW indicate impaired glymphatic clearance. FW partially mediated the relationship between Kw and DTI-ALPS, suggesting a potential mechanistic link. Overall, this study provides novel multimodal MRI insights into BBB and glymphatic alterations in healthy aging and may inform the development of MRI biomarkers to preserve cognitive health.