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Impairment of paravascular clearance pathways in the aging brain
Open accessAbstract
Objective: In the brain, protein waste removal is partly performed by paravascular pathways that facilitate convective exchange of water and soluble contents between cerebrospinal fluid (CSF) and interstitial fluid (ISF). Several lines of evidence suggest that bulk flow drainage via the glymphatic system is driven by cerebrovascular pulsation, and is dependent on astroglial water channels that line paravascular CSF pathways. The objective of this study was to evaluate whether the efficiency of CSF–ISF exchange and interstitial solute clearance is impaired in the aging brain. Methods: CSF–ISF exchange was evaluated by in vivo and ex vivo fluorescence microscopy and interstitial solute clearance was evaluated by radiotracer clearance assays in young (2–3 months), middle‐aged (10–12 months), and old (18–20 months) wild‐type mice. The relationship between age‐related changes in the expression of the astrocytic water channel aquaporin‐4 (AQP4) and changes in glymphatic pathway function was evaluated by immunofluorescence. Results: Advancing age was associated with a dramatic decline in the efficiency of exchange between the subarachnoid CSF and the brain parenchyma. Relative to the young, clearance of intraparenchymally injected amyloid‐β was impaired by 40% in the old mice. A 27% reduction in the vessel wall pulsatility of intracortical arterioles and widespread loss of perivascular AQP4 polarization along the penetrating arteries accompanied the decline in CSF–ISF exchange. Interpretation: We propose that impaired glymphatic clearance contributes to cognitive decline among the elderly and may represent a novel therapeutic target for the treatment of neurodegenerative diseases associated with accumulation of misfolded protein aggregates. Ann Neurol 2014;76:845–861
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“In AD, reactive astrogliosis is upregulated corresponds to the severity of astroglial activation and high levels of proinflammatory cytokines and the hypertrophic processes make aberrant contacts with nearby cerebral vessels and neurons, leading to neurovascular uncoupling.[ 42 ]”
From Multifunctional Nanostructure RAP‐RL Rescues Alzheimer's Cognitive Deficits through Remodeling the Neurovascular Unit (2021) · cites this paper as [42]
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“Impaired glymphatic function has been suggested to be instrumental in a range of brain diseases; this has been illustrated most in Alzheimer's dementia (7, 19, 20) but has also been shown to be relevant in posttraumatic encephalopathy (21), ageing (22), sleep (23, 24), depression (20), and exercise (25).”
From Brain-wide glymphatic enhancement and clearance in humans assessed with MRI. (2018) · cites this paper as [22]
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In the citing paper
“and paravascular clearance has been shown to be impaired with ageing (22).”
From Brain-wide glymphatic enhancement and clearance in humans assessed with MRI. (2018) · cites this paper as [22]
In the citing paper
“Yet the glymphatic system degrades with age, suggesting a causal relationship between sleep disturbance and symptomatic progression in the neurodegenerative dementias.”
From Glymphatic failure as a final common pathway to dementia (2020) · cites this paper as [52]
In the citing paper
“Aging is also associated with a steep fall in glymphatic flow in the brains of both rodents and humans.”
From Glymphatic failure as a final common pathway to dementia (2020) · cites this paper as [52]
In the citing paper
“CSF inflow of larger tracers are reduced by up to 85% in aged wild-type mice”
From Glymphatic failure as a final common pathway to dementia (2020) · cites this paper as [52]
In the citing paper
“The decrease in glymphatic flow in old mice is in part mediated by mislocation of AQP4 water channels away from the vascular wall (52) and possible by atrophy of meningeal lymphatic vessel (42).”
From Glymphatic failure as a final common pathway to dementia (2020) · cites this paper as [52]
In the citing paper
“while contrast clearance in human brain tissue was inversely correlated to age in all subjects studied (50, 52–54).”
From Glymphatic failure as a final common pathway to dementia (2020) · cites this paper as [52]
In the citing paper
“As individuals age, there is a decline in the efficiency of these transport mechanisms in eliminating waste products such as Aβ.156,157”
From Antiageing strategy for neurodegenerative diseases: from mechanisms to clinical advances (2025) · cites this paper as [157]
In the citing paper
“both the brain glymphatic and meningeal lymphatic systems deteriorate with age”
From Living on the Edge of the CNS: Meninges Cell Diversity in Health and Disease (2021) · cites this paper as Kress et al., 2014
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Iliff, J. J., Wang, M., Liao, Y., Plogg, B. A., Peng, W., Gundersen, G. A., Benveniste, H., Vates, G. E., Deane, R., Goldman, S. A., et al. (2012) · Science Translational Medicine · doi:10.1126/scitranslmed.3003748 · Cited by 5,824 · cited 10×
“nel and measuring the thresholded area as a percentage of the overall region area, as described previously.(4) The fluorescence area”
BackgroundMethodInfluentialSelf-citationSleep Drives Metabolite Clearance from the Adult Brain
Xie, L., Kang, H., Xu, Q., Chen, M. J., Liao, Y., Thiyagarajan, M., O’Donnell, J., Christensen, D. J., Nicholson, C., Iliff, J. J., et al. (2013) · Science · doi:10.1126/science.1241224 · Cited by 5,411 · cited 10×
“In a prior study, we observed that dynamic changes in the brain extracellular volume fraction are key regulators of glymphatic pathway function during the sleep– wake cycle, greater extracellular volume fraction during sleep facilitating the exchange of paravascular CSF with ISF.(6) The decline in glymphatic pathway a…”
BackgroundMethodInfluentialSelf-citationProtein aggregation and neurodegenerative disease
Ross, C. A., & Poirier, M. A. (2004) · Nature Medicine · doi:10.1038/nm1066 · Cited by 3,454 · cited 1×
“A central histopathological hallmark of each of these diseases is the presence of misaggregated proteins, including senile plaques comprised of amyloid-b (Ab) in AD, neurofibrillary tangles comprised of hyperphosphorylated tau in AD and CTE, Pick bodies comprised of hyperphosphorylated tau in frontotemporal dementia,…”
BackgroundJUNCTIONS BETWEEN INTIMATELY APPOSED CELL MEMBRANES IN THE VERTEBRATE BRAIN
Brightman, M., & Reese, T. S. (1969) · The Journal of Cell Biology · doi:10.1083/jcb.40.3.648 · Cited by 2,457
Decreased Clearance of CNS β-Amyloid in Alzheimer’s Disease
Mawuenyega, K. G., Sigurdson, W., Ovod, V., Munsell, L., Kasten, T., Morris, J. C., Yarasheski, K. E., & Bateman, R. J. (2010) · Science · doi:10.1126/science.1197623 · Cited by 2,078
Diffusion in Brain Extracellular Space
Syková, E., & Nicholson, C. (2008) · Physiological Reviews · doi:10.1152/physrev.00027.2007 · Cited by 1,481
Nielsen, S. M., Nagelhus, E. A., Amiry-Moghaddam, M. R., Bourque, C. W., Agre, P. C., & Ottersen, O. P. (1997) · Journal of Neuroscience · doi:10.1523/jneurosci.17-01-00171.1997 · Cited by 1,440 · cited 1×
“Perivascular AQP4 Polarization Is Impaired in the Aging Brain AQP4, an astroglial water channel, is localized in a highly polarized manner to endfoot processes surrounding the cerebral vasculature in addition to the glial limitans externa, which abuts the pia mater and bounds the subarachnoid CSF compartment.(19,20) T…”
BackgroundShibata, M., Yamada, S., Kumar, S. R., Calero, M., Bading, J., Frangione, B., Holtzman, D. M., Miller, C. A., Strickland, D. K., Ghiso, J., et al. (2000) · Journal of Clinical Investigation · doi:10.1172/jci10498 · Cited by 1,413 · cited 1×
“In addition to paravascular pathways of Ab clearance, the clearance of Ab by BBB transporters such as low-density lipoprotein receptor–related protein 1 are major contributors to Ab efflux from the brain.(15) We surmise that these are likely overlapping processes.”
BackgroundCerebral Arterial Pulsation Drives Paravascular CSF–Interstitial Fluid Exchange in the Murine Brain
Iliff, J. J., Wang, M., Zeppenfeld, D. M., Venkataraman, A., Plog, B. A., Liao, Y., Deane, R., & Nedergaard, M. (2013) · The Journal of Neuroscience · doi:10.1523/jneurosci.1592-13.2013 · Cited by 1,319 · cited 4×
“Impairment of glymphatic pathway function was accompanied by a 27% reduction in cerebral arterial wall pulsatility, which is an important contributor to paravascular flux along the glymphatic pathway.(7,17,26) In addition, we show that impairment of paravascular CSF–ISF exchange is similarly associated with loss of pe…”
BackgroundMethodResultInfluentialSelf-citationLindsay, J. (2002) · American Journal of Epidemiology · doi:10.1093/aje/kwf074 · Cited by 1,261 · cited 1×
“In the case of AD, incidence increases from approximately 12% in the 70s to >50% in the 80s.(1) A central histopathological hallmark of each of these diseases is the presence of misaggregated proteins, including senile plaques comprised of amyloid-b (Ab) in AD, neurofibrillary tangles comprised of hyperphosphorylated…”
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Braun, M., Simon, M. J., Jang, J., Sanderson, K., Swierz, J., Sevao, M., Pincus, A. B., Schaser, A. J., Elliott, J. E., Lim, M. M., et al. (2024) · bioRxiv (Cold Spring Harbor Laboratory) · doi:10.1101/2024.08.14.607971 · Cited by 12
Self-citationPerivascular cerebrospinal fluid inflow matches interstitial fluid efflux in anesthetized rats
Mortensen, K. N., Lilius, T. O., Rosenholm, M., Sigurðsson, B., Kelley, D. H., & Nedergaard, M. (2025) · iScience · doi:10.1016/j.isci.2025.112323 · Cited by 11
Self-citationThe link between gut microbiota and multiple sclerosis from the perspective of barrier function
Ren, J., Niu, Z., Wang, J., Guo, J., Hao, H.-J., Gao, F., Liu, R., & Wang, Z. (2025) · Frontiers in Immunology · doi:10.3389/fimmu.2025.1652796 · Cited by 13
“The CSF exchanges with ISF through the PVS of the penetrating arteries and is ultimately drained by arachnoid granulations and MLVs, aiding nutrient delivery and metabolic waste clearance within the brain parenchyma (77, 78).”
Zhang, X., Hatoum, L., Ying, J., & Huang, C. (2025) · Psychoradiology · doi:10.1093/psyrad/kkaf031 · Cited by 11
“Aging (Kress et al. , 2014 ), neuroinflammation (Fukuda and Badaut, 2012 ), and metabolic stress (Wei et al. , 2019 ) can alter AQP4 localization and reduce transport efficiency.”
Volonté, C., Hu, G., Shaw, C. A., Claudio, V. J., dos Santos, J. A., Vaz, S. H., Sebastião, A. M., Balcar, V. J., Mozley, P. D., Verde, F., et al. (2026) · Exploration of Neuroprotective Therapy · doi:10.37349/ent.2026.1004136 · Cited by 12
Choi, H. J., Han, M., Jung, B., Hong, Y.-R., Shin, S., Lim, S., Lee, E., Kim, Y. K., & Park, J. (2022) · Biomedicines · doi:10.3390/biomedicines10123191 · Cited by 12
“There is increasing evidence to support the theory that in an age-related decrease, paravascular recirculation clearance is responsible for the accumulation of Aβ plaques in the brain parenchyma [5,6].”
BackgroundDeregulation of the Glymphatic System in Alzheimer’s Disease: Genetic and Non-Genetic Factors
Hu, Y., Su, T., Wu, L., Wu, J., Liu, D., Zhu, L., & Yuan, M. (2024) · Aging and Disease · doi:10.14336/ad.2023.1229 · Cited by 15
Enlarged perivascular spaces in alcohol-related brain damage induced by dyslipidemia
Liu, H., Lin, M., Wang, J., Qin, C., Feng, R., Chen, Y., Chen, P., Zhu, Q., Ma, M., Teng, J., et al. (2024) · Journal of Cerebral Blood Flow & Metabolism · doi:10.1177/0271678x241251570 · Cited by 11
“…region was measured by a uniform threshold in each fluorescence channel and defined the thresholded area as % of the overall region area, as described by Benjamin T et al. 36 The average fluorescence intensity of the 8 brain sections was used to define the CSF tracer distribution for each mouse.”
Arendash, G. W., Lin, X., & Cao, C. (2024) · Journal of Alzheimer s Disease · doi:10.3233/jad-240600 · Cited by 12
“6 , 49 For example, MRI studies revealed age-related lymphatic output and waste removal were reduced in older human subjects compared with younger subjects.”
BackgroundInfluencing factors of glymphatic system during perioperative period
Dong, R., Liu, W., Han, Y., Wang, Z., Jiang, L., Wang, L., & Gu, X. (2024) · Frontiers in Neuroscience · doi:10.3389/fnins.2024.1428085 · Cited by 11
“Aging contributes to the dysfunction of the glymphatic system, resulting in the accumulation of A β and ultimately developing AD (Kress et al., 2014).”
BackgroundInfluentialLin, R., Luo, R., Yu, X., Zou, J., Huang, X., & Guo, Y. (2024) · Journal of Translational Medicine · doi:10.1186/s12967-024-05912-2 · Cited by 11
“AQP4 polarization was defined as the ratio between the AQP4 intensity along the PVS area and global parenchymal domains [23, 24].”
Hasegawa, S., Yoshimaru, D., Hayashi, N., Shibukawa, S., Takagi, M., & Murai, H. (2024) · Journal of Neurology · doi:10.1007/s00415-024-12850-y · Cited by 11
Ma, Y., & Han, Y. (2024) · Neural Regeneration Research · doi:10.4103/nrr.nrr-d-24-00821 · Cited by 12
“Dysfunction of the glymphatic system has been shown to be associated with cerebrovascular risk factors, such as aging, hypertension, and diabetes (Kress et al., 2014; Jiang et al., 2017; Da Mesquita et al., 2018b; Mestre et al., 2018; Mortensen et al., 2019).”
Cerebral small vessel disease: The impact of glymphopathy and sleep disorders
Hein, Z. M., Nassir, C. M. N. C. M., Ramli, M. D. C., Jaffer, U., Mehat, M. Z., Mustapha, M., & Hamid, H. A. (2025) · Journal of Cerebral Blood Flow & Metabolism · doi:10.1177/0271678x251333933 · Cited by 12
Approaches for Increasing Cerebral Efflux of Amyloid-β in Experimental Systems
Loeffler, D. A. (2024) · Journal of Alzheimer s Disease · doi:10.3233/jad-240212 · Cited by 12
Janssen, L., Keppens, C., Deyn, P. P. D., & Dam, D. V. (2015) · Biochimica et Biophysica Acta (BBA) - Molecular Basis of Disease · doi:10.1016/j.bbadis.2015.10.027 · Cited by 11
Blood-brain barrier at the interface of air pollution-associated neurotoxicity and neuroinflammation
Young, T. L., Zychowski, K. E., Denson, J. L., & Campen, M. J. (2018) · Advances in neurotoxicology · doi:10.1016/bs.ant.2018.10.010 · Cited by 11
Han, F., Liu, X., Yang, Y., & Liu, X. (2023) · bioRxiv (Cold Spring Harbor Laboratory) · doi:10.1101/2023.04.02.535258 · Cited by 11
Meningeal lymphatics as a therapeutic target for neurodegenerative disorders
Feng, Y., Wang, S., Xia, H., Jiang, X., Wu, M., Pan, S., & Song, W. (2025) · Translational Neurodegeneration · doi:10.1186/s40035-025-00528-y · Cited by 11
“Aging, the strongest risk factor for AD [103, 131–134], is also associated with impaired functions of multiple clearance systems, exacerbating cognitive decline and Aβ pathology [125, 135].”
Glymphatic transport and ocular diseases
Wang, X., Delle, C., Nedergaard, M., & Wostyn, P. (2025) · Progress in Retinal and Eye Research · doi:10.1016/j.preteyeres.2025.101433 · Cited by 10
Self-citationPetitclerc, L., Hirschler, L., Örzsik, B., Asllani, I., & van Osch, M. J. P. (2022) · NMR in Biomedicine · doi:10.1002/nbm.4852 · Cited by 9
Narrative review of roles of astrocytes in subarachnoid hemorrhage
Luo, Y., Chen, J., Huang, H. Y., Lam, E. S. Y., & Wong, G. K.-C. (2023) · Annals of Translational Medicine · doi:10.21037/atm-22-5486 · Cited by 9
“Impaired glymphatic system is associated with AQP4 polarization loss, and leads to impaired brain macromolecular substances elimination (72,73).”
Song, J. G., Li, Z., Xue, X., Meng, J., Zhu, W., Hu, S., Xu, G., & Wang, L. (2024) · CNS Neuroscience & Therapeutics · doi:10.1111/cns.14587 · Cited by 11
Wang, Y., Liu, W.-C., Zhang, J., Geng, P., & Jin, X. (2024) · Brain Hemorrhages · doi:10.1016/j.hest.2024.02.002 · Cited by 12
Mouse brain elastography changes with sleep/wake cycles, aging, and Alzheimer's disease
Ge, G. R., Song, W., Giannetto, M. J., Rolland, J. P., Nedergaard, M., & Parker, K. J. (2024) · NeuroImage · doi:10.1016/j.neuroimage.2024.120662 · Cited by 11
“Furthermore, waste clearance and glymphatic influx were found to be reduced, indicating glymphatic impairment in both aging and AD-related pathologies (Kress et al., 2014; Ma et al., 2017; Reeves et al., 2020).”
BackgroundSelf-citationNouman, M., Khoo, S., Mahmud, M. A. P., & Kouzani, A. Z. (2024) · Journal of Ambient Intelligence and Humanized Computing · doi:10.1007/s12652-024-04827-6 · Cited by 10
“Because the pro - duction of proteins and protein waste removal in the aging brain is impaired (Kress et al. 2014 ).”
Macura, I. J., Milanović, D., Tešić, V., Major, T., Perović, M., Adžić, M., & Ivković, S. (2024) · International Journal of Molecular Sciences · doi:10.3390/ijms25179400 · Cited by 10
Different Glymphatic Kinetics in Spontaneous Intracranial Hypotension
Urbach, H., Duman, İ. E., Zander, C., Becker, L. E., Kellner, E., Reisert, M., Rahal, A. E., Volz, F., Wolf, K., Beck, J., et al. (2024) · American Journal of Neuroradiology · doi:10.3174/ajnr.a8365 · Cited by 11
A brain-wide solute transport model of the glymphatic system
Quirk, K., Stevens, K. A., Tithof, J., & Kelley, D. H. (2024) · Journal of The Royal Society Interface · doi:10.1098/rsif.2024.0369 · Cited by 10
“Studies of solute transport are essential because neurodegenerative disorders are often caused by accumulation of toxic solutes [32–34].”
BackgroundToscano, J. D., Wu, C., Ladrón-de-Guevara, A., Du, T., Nedergaard, M., Kelley, D. H., Karniadakis, G. E., & Stevens, K. A. (2024) · Interface Focus · doi:10.1098/rsfs.2024.0030 · Cited by 13
“This system of solute transport is often referred to as the glymphatic system and has been shown to be altered with ageing in mice and humans [3,4].”
Self-citationXiong, C., Yu, Z., Yin, Y., Zhu, Q., Ba, R., Shen, Y., Li, H., Wei, Z., Lin, Z., & Wu, D. (2025) · NeuroImage · doi:10.1016/j.neuroimage.2025.121141 · Cited by 10
“(Kress et al., 2014) Through visual inspection, we found that AQP4 was largely reduced at the astrocytic endfeet particularly around larger vessels, i.e. depolarized, in the hippocampus of AD mouse brains (Fig 5B), showing consistency with the finding in other AD mouse models (Harrison et al.,…”
The Meninges as CNS Interfaces and the Roles of Meningeal Macrophages
Hiraki, C., & Tsuruta, F. (2025) · Biomolecules · doi:10.3390/biom15040497 · Cited by 12
The pulsing brain: state of the art and an interdisciplinary perspective
Lecchini‐Visintini, A., Zwanenburg, J. J. M., Wen, Q., Nicholls, J. K., Desmidt, T., Catheline, S., Minhas, J. S., Robba, C., Dvoriashyna, M., Vallet, A., et al. (2025) · Interface Focus · doi:10.1098/rsfs.2024.0058 · Cited by 13
“In animal models, solutes stagnate when these pulsations are reduced, either through artificial vascular ligation [33] or in conditions such as ageing [34] and acute hypertension [35].”
Baek, S., Tae, W., Park, J., & Kim, B. (2025) · Frontiers in Aging Neuroscience · doi:10.3389/fnagi.2025.1570327 · Cited by 11
Frey, M. M., Zohoorian, N., Skauli, N., Ottersen, O. P., & Amiry-Moghaddam, M. R. (2025) · Fluids and Barriers of the CNS · doi:10.1186/s12987-025-00676-3 · Cited by 11
“This hypothesis has spurred interest in the circadian regulation of AQP4, especially as disrupted circadian rhythms—common in aging and neurodegenerative conditions—are linked to impaired glymphatic clearance [17].”
Wang, Y., Yang, M., Zeng, X., Wang, S., Zhang, W., Wang, W., Du, Y., Ding, J., & Ding, X. (2025) · Frontiers in Neurology · doi:10.3389/fneur.2025.1605889 · Cited by 11
Focused Ultrasound Enhances Glymphatic Transport Robustly Across Anesthesia Levels
Xiao, H., Sreejith, A., Howson, I., Cruz, A. A., Key, T., Iliff, J. J., & Aryal, M. (2025) · Ultrasound in Medicine & Biology · doi:10.1016/j.ultrasmedbio.2025.06.009 · Cited by 10
Self-citationImpact of Sleep Apnea on Perivascular Diffusivity and Cognition: A 4-Year Prospective Cohort Study
Lee, M., Lee, W., Lee, S. K., Kim, S., Siddiquee, A. T., Hwang, Y. H., Paik, S., Park, H. J., Kim, J. R., THOMAS, R. J., et al. (2025) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.202411-2221oc · Cited by 10
Mengr, A., Hrubá, L., Exnerová, A., Holubová, M., Popelová, A., Železná, B., Kuneš, J., & Maletı́nská, L. (2021) · Current Alzheimer Research · doi:10.2174/1567205018666210922110652 · Cited by 10
SARS-CoV-2 Morbidity in the CNS and the Aged Brain Specific Vulnerability
Casoli, T. (2022) · International Journal of Molecular Sciences · doi:10.3390/ijms23073782 · Cited by 10
Rotaru-Zăvăleanu, A. D., Neacșu, A. I., Neacsu, A., Pirici, D. N., Osiac, E., Cătălin, B., & Gheonea, D. I. (2022) · Current Issues in Molecular Biology · doi:10.3390/cimb44090262 · Cited by 12
“e know that AQP4 distribution around arteries (Sma+ vessels) can change in aging [26,27] or when the BBB is altered [28].”
BackgroundGlycation‐mediated tissue‐level remodeling of brain meningeal membrane by aging
Kim, H. M., Kim, S., Sim, J., Ma, B. S., Yong, I., Jo, Y., Kim, T., Chang, J., Park, S., Jeong, Y., et al. (2023) · Aging Cell · doi:10.1111/acel.13805 · Cited by 9
“Intracisternal CSF tracer influx through the paravascular space was reduced in aged mice, showing similar to previous observations of reduced peripheral lymphatic transport in aged mice (Kress et al., 2014).”
ResultHayden, M. R. (2024) · Biomedicines · doi:10.3390/biomedicines12010096 · Cited by 13
Lee, W. J., Jung, K., Park, H.-M., Sohn, C., Lee, S., Park, K., Chu, K., Jung, K.-Y., Kim, M., Lee, S. K., et al. (2019) · Scientific Reports · doi:10.1038/s41598-019-52029-4 · Cited by 10
Research on the Glial–Lymphatic System and Its Relationship With Alzheimer’s Disease
Ding, D., Wang, X., Li, Q., Li, L., & Wu, J. W. (2021) · Frontiers in Neuroscience · doi:10.3389/fnins.2021.605586 · Cited by 11
Sato, T., Niijima, A., Arai, A., Maku, T., Motegi, H., Takahashi, M., Takatsu, H., Tanabe, M., Komatsu, T., Sakuta, K., et al. (2022) · Journal of Stroke and Cerebrovascular Diseases · doi:10.1016/j.jstrokecerebrovasdis.2021.106296 · Cited by 10
Taniguchi, D., Shimura, H., Watanabe, M., Hattori, N., & Urabe, T. (2017) · BMC Neurology · doi:10.1186/s12883-017-0997-9 · Cited by 10
Schob, S., Weiß, A., Surov, A., Dieckow, J., Richter, C., Pirlich, M., Horvath-Rizea, D., Härtig, W., Hoffmann, K., Krause, M., et al. (2017) · Molecular Neurobiology · doi:10.1007/s12035-017-0835-5 · Cited by 10
Mechanics of Lymphatic Pumping and Lymphatic FunctionPreprint
Razavi, M. S., Munn, L. L., & Padera, T. P. (2024) · Cold Spring Harbor Perspectives in Medicine · doi:10.1101/cshperspect.a041171 · Cited by 11
Novel therapeutic modulators of astrocytes for hydrocephalus
Yang, Y., Wang, C., Chen, R., Wang, Y.-C., Tan, C., Liu, J., Zhang, Q., & Xiao, G. (2022) · Frontiers in Molecular Neuroscience · doi:10.3389/fnmol.2022.932955 · Cited by 10
“Therefore, AQP4 depolarization occurs in the mouse model of iNPH (Kress et al., 2014).”
BackgroundImaging of brain clearance pathways via MRI assessment of the glymphatic system
He, Y., Guan, J., Lai, L., Zhang, X., Chen, B., Wang, X., & Wu, R. (2023) · Aging · doi:10.18632/aging.205322 · Cited by 9
“The glymphatic system is influenced by vascular pulsation [10], sleep [11, 12], age [4, 13] and other factors, and a decline in its function may be associated with ageing, AD and other neurodegenerative pathologies [5, 14–16].”
BackgroundUsing Neuroimaging to Study Cerebral Amyloid Angiopathy and Its Relationship to Alzheimer’s Disease
Wheeler, K. V., Andrei Irimia, A., & Braskie, M. N. (2024) · Journal of Alzheimer s Disease · doi:10.3233/jad-230553 · Cited by 9
Shao, Z., Gao, X., Cen, S., Tang, X., Gong, J., & Ding, W. (2024) · Journal of Affective Disorders · doi:10.1016/j.jad.2024.08.094 · Cited by 9
“The poor performance of this system raises the possibility that decreased glycolytic clearance contributes to the susceptibility of the aging brain to aberrant protein accumulation (Kress et al., 2014).”
Caron, N. S., Byrne, L. M., Lemarié, F. L., Bone, J. N., Aly, A. E.-E., Ko, S., Anderson, C., Casal, L. L., Hill, A. M., Hawellek, D. J., et al. (2024) · Translational Neurodegeneration · doi:10.1186/s40035-024-00443-8 · Cited by 10
“This is further supported by reports showing that the glymphatic function is impaired in neurodegenerative diseases (reviewed in [100]) and in the aging brain [101, 102].”
BackgroundKoundal, S., Chen, X., Gursky, Z. H., Lee, H., Xu, K., Liang, F., Xie, Z., Xu, F., Lin, H., Nostrand, W. E. V., et al. (2024) · iScience · doi:10.1016/j.isci.2024.111463 · Cited by 11
“Finally, we assessed the regional transport in the brain tissue of the WT and TgSD-AD rats using the traditional Gd-DOTA uptake measures 8,13,19,38,39 which confirmed that there were no statistically significant differences in glymphatic transport in the preselected ROIs including in the ventral…”
InfluentialFunctional abnormalities of the glymphatic system in cognitive disorders
Shentu, W., Kong, Q., Zhang, Y., Li, W., Chen, Q., Yan, S., Wang, J., Lai, Q., Qi, X., & Qiao, S. (2025) · Neural Regeneration Research · doi:10.4103/nrr.nrr-d-24-01049 · Cited by 9
“Compared with young mice, a significant loss of AQP4 polarization has been shown in aged mouse models (Kress et al., 2014).”
Yoon, J., Ji, M., Hwang, I., Lee, W., Yu, S., Kim, J., Lee, C., Lee, H., Koh, B., Bae, H., et al. (2025) · Journal of Cerebral Blood Flow & Metabolism · doi:10.1177/0271678x251353142 · Cited by 10
Li, J., Gao, Y., Xu, Y., Dai, W., Hu, Y., Feng, X., Wu, D., & Zhao, L. (2025) · NeuroImage · doi:10.1016/j.neuroimage.2025.121392 · Cited by 9
“It may reflect a compensatory mechanism to support the functioning of the glymphatic system, as glymphatic clearance efficiency decreases with age (Ma et al., 2017; Kress et al., 2014).”
Tian, J., Zhang, Y., Liu, L., Li, C., & Hao, X. (2025) · Frontiers in Neuroscience · doi:10.3389/fnins.2025.1566957 · Cited by 9
“…brain parenchyma, cerebrospinal fluid is mixed with interstitial fluid, flowing to the perivenous space via global convection (Iliff et al., 2012; Kress et al., 2014), and is finally excreted out of the brain through meningeal lymphatic vessels and arachnoid granules (Holter et al., 2017; Smith…”
Berberich, C., Müller, L., Zott, B., Nuttal, R., Schneider, G. H., Zimmer, C., Sorg, C., Hedderich, D. M., & Zimmermann, J. (2025) · NeuroImage · doi:10.1016/j.neuroimage.2025.121420 · Cited by 12
“Further studies also reported impaired glymphatic function, e.g., reduced CSF flow, with increasing age in the animal model (Kress et al., 2014; Ma et al., 2017; Nedergaard & Goldman, 2020).”
Agomelatine Targets Aquaporin-4 Polarization to Rescue Glymphatic Dysfunction in Parkinson’s Disease
Wang, S., Wu, D., Chen, G., Yuan, J., Zheng, L., Huang, X., Liu, X., Kang, Z., Feng, Y., Zhang, J., et al. (2025) · Neuroscience Bulletin · doi:10.1007/s12264-025-01543-9 · Cited by 9
“One pattern, based on 4’,6-diamidino-2-phenylindole (DAPI), glial fibrillary acidic protein (GFAP), and AQP4 immunostaining as reported [23–26], defines blood vessels as voids encircled by DAPI-and GFAP-rich zones.”
When sleep fails, brain clearance suffers: the role of glymphatic impairment in clinical neurology
la Herrán-Arita, A. K. D. (2025) · Acta Neurologica Belgica · doi:10.1007/s13760-025-02959-w · Cited by 11
“This waste-laden fluid then collects in the perivenous spaces surrounding draining veins and exits the brain to be cleared by meningeal and cervical lymphatic vessels [ 6 , 7].”
Deep cervical lymphaticovenous anastomosis for Alzheimer's disease: A narrative review
Chen, Q., Wen, Q., Zhong, T. P., Liu, J., & Gao, H. (2025) · Alzheimer s & Dementia · doi:10.1002/alz.71038 · Cited by 9
Li, T., Zhang, J., Song, H., Zhang, R., Fan, F., Huang, Z., Zeng, M., Peng, B., & Zhang, J. (2025) · Journal of Neuroinflammation · doi:10.1186/s12974-025-03631-z · Cited by 11
“Impaired glymphatic clearance is believed to be associated with cognitive decline [134].”
Qarin, S., Howlett, S., Jones, J., & Barker, R. A. (2021) · Neuronal Signaling · doi:10.1042/ns20200083 · Cited by 9
“been found to be mislocalised with age in mouse brains [37, 38] and this coupled to age related arterial stiffening and reduced arterial pulsatility could all further adversely impact on D ow naded rom http://pndpress.”
BackgroundThe Implication of Glial Metabotropic Glutamate Receptors in Alzheimer’s Disease
de Lima, I. B. Q., & Ribeiro, F. M. (2021) · Current Neuropharmacology · doi:10.2174/1570159x20666211223140303 · Cited by 9
“During ageing, the density of AQP4 is reduced, which might impair the removal of toxic proteins such as Aβ, whose turnover partially relies on this clearance mechanism [165, 166].”
Can meditation-based approaches improve the cleansing power of the glymphatic system?
Wostyn, P., & Goddaer, P. (2022) · Exploration of Neuroprotective Therapy · doi:10.37349/ent.2022.00022 · Cited by 10
“Glymphatic pathway function has been reported to be dramatically diminished in the aging brain [11].”
BackgroundThe Glymphatic Response to the Development of Type 2 Diabetes
Boyd, E., Zhang, L., Ding, G., Li, L., Lü, M., Li, Q., Huang, R., Kaur, J., Hu, J., Chopp, M., et al. (2024) · Biomedicines · doi:10.3390/biomedicines12020401 · Cited by 11
“The glymphatic transport of waste solutes, including A β , was significantly reduced in AQP4 − / − mice when compared to controls [3,5,55,60].”
BackgroundCognitive functions and jugular venous reflux in severe mitral regurgitation: A pilot study
Sung, S., Lee, C., Wang, P., Lee, H., Chen, C.-H., & Chung, C. (2019) · PLoS ONE · doi:10.1371/journal.pone.0207832 · Cited by 9
Tanner, J. J., Amin, M., Hardcastle, C., Parvataneni, H. K., Vaillancourt, D. E., Mareci, T. H., & Price, C. C. (2019) · Frontiers in Aging Neuroscience · doi:10.3389/fnagi.2019.00117 · Cited by 9
Frontera, J. A. (2020) · The Journal of Heart and Lung Transplantation · doi:10.1016/j.healun.2020.01.1337 · Cited by 10
Association of autosomal dominant polycystic kidney disease with cerebral small vessel disease
Lee, W.-J., Jung, K.-H., Ryu, H., Oh, K.-H., Kim, J.-M., Lee, S.-T., Park, K.-I., Chu, K., Jung, K.-Y., Kim, M., et al. (2021) · Journal of Cerebral Blood Flow & Metabolism · doi:10.1177/0271678x211037869 · Cited by 9
“However, given that the glymphatic system feeds and drains the brain via CSF transmission, factors involved in the regulation of the CSF circulation might provide a non-microvascular pathomechanistic contribution to the SVD progression.(6,12,13,15) Additionally, given that ePVS represents the fluid accumulation within…”
Aquaporins and Neuropathic Pain
Wang, F., Xu, W.-M., Xu, C.-L., Li, J., & Lin, J. (2023) · Frontiers in Bioscience-Landmark · doi:10.31083/j.fbl2802035 · Cited by 9
“It is reported that many diseases are associated with the impaired glymphatic system, such as Alzheimer’s disease, traumatic brain injury, and cognitive deficiency associated with diabetes [ 157–159].”
BackgroundMarchesi, V. T. (2015) · The FASEB Journal · doi:10.1096/fj.15-282285 · Cited by 9
The prevalence of cardiovascular disease in non-communicating hydrocephalus
Eide, P. K., & Pripp, A. H. (2016) · Clinical Neurology and Neurosurgery · doi:10.1016/j.clineuro.2016.07.024 · Cited by 9
Zheng, X., Peng, J., Zhao, Q., Li, L., Gao, J., Zhou, K., Tan, B., Deng, L., & Zhang, Y. (2024) · Frontiers in Neuroscience · doi:10.3389/fnins.2023.1321365 · Cited by 8
“…that include inadequate competence in dealing with overloaded waste, turbulent convective flux through the interstitium along the central nervous system vasculature, and aquaporin-4 depolarization in damaged astrocytic endfeet (Kress et al., 2014; Jessen et al., 2015; Radford et al., 2015).”
BackgroundYong, Y., Cai, Y., Lin, J., Ma, L., Han, H., & Li, F. (2024) · Med-X · doi:10.1007/s44258-024-00021-7 · Cited by 10
“Glymphatic clearance was reduced by 40% in aged mice relative to young ones, suggesting impairment of glymphatic pathway in aging [94, 296].”
The impact of aging on HIV-1-related neurocognitive impairment
Ostermann, P. N., & Evering, T. H. (2024) · Ageing Research Reviews · doi:10.1016/j.arr.2024.102513 · Cited by 9
Impaired glymphatic clearance is an important cause of Alzheimer’s disease
Hazzard, I., Batiste, M., Luo, T., Cheung, C., & Lui, F. (2024) · Exploration of Neuroprotective Therapy · doi:10.37349/ent.2024.00091 · Cited by 9
The glymphatic system: A new insight into the understanding of neurological diseases
Liao, J., An, Z., Cheng, Q., Liu, Y., Chen, Y., Su, Z., Usman, A. M., Tang, Z., & Xiao, G. (2024) · Brain‐X · doi:10.1002/brx2.70011 · Cited by 9
NOTCH3 Mutation Causes Glymphatic Impairment and Promotes Brain Senescence in CADASIL
Li, C., Li, H., Men, X., Wang, Y., Kang, X., Hu, M., Su, X., Wang, S., Lu, D., Shen, S., et al. (2025) · CNS Neuroscience & Therapeutics · doi:10.1111/cns.70140 · Cited by 8
“Inhibition of glymphatic function could lead to accumulation of metabolic waste in the brain [57].”
Llach, C.-D., Le, G. H., Shah, H., Marcato, L. M., Brietzke, E. M., Gill, H., Tabassum, A., Badulescu, S., Rosenblat, J. D., McIntyre, R. S., et al. (2025) · Journal of Neuroimmunology · doi:10.1016/j.jneuroim.2025.578587 · Cited by 8
Tian, B., Jiang, X., Luo, X., & Zhang, W. (2025) · BMC Neurology · doi:10.1186/s12883-025-04166-9 · Cited by 8
“The negative age correlation commonly observed in adults older than 40 years might be attributed to a reduction in AQP4 channels in astrocytic end-feet and decreased CSF production due to lessened arterial pulsations [5, 30].”
Impaired Flow: Glymphatic Dysfunction in Ischemic Stroke and the Influence of Sex
Mathias, K., da Costa, M. D. A., de Rezende, V. L., Maragno, V. D. A., Felipe, C. M. K., dos Reis, L. D. R., Gonçalves, C. L., & Petronilho, F. C. (2025) · Journal of Molecular Neuroscience · doi:10.1007/s12031-025-02377-w · Cited by 8
“These advantages are estrogen-dependent, as noted in hormone-deprivation models (Kress et al. 2014; Goulay et al. 2020; Nikolenko et al. 2020).”
Dik, D., Halliday, G. M., Sytnyk, V., & Shepherd, C. E. (2025) · Brain · doi:10.1093/brain/awaf305 · Cited by 9
Deep cervical lymph node analysis in central nervous system inflammatory disease
Giff, A., Clark, M. W., Bhattacharyya, S., Sage, P. T., Madore, B., Guenette, J. P., & Miyawaki, E. K. (2026) · Frontiers in Immunology · doi:10.3389/fimmu.2026.1747114 · Cited by 9
Sorond, F. A., Gorelick, P. B., Bae, H., Carmichael, S. T., Greenberg, S. M., Hinman, J. D., Iadecola, C., Iruela‐Arispe, M. L., LEONARD, A., Valdes, E., et al. (2026) · Stroke · doi:10.1161/str.0000000000000524 · Cited by 14
High pulse pressure impairs cerebral artery endothelial function in young, but not old, mice
Winder, N. R., Reeve, E. H., Kronquist, E. K., Khurana, A., Lee, B., Nguyen, T. D., Henson, G. D., & Walker, A. E. (2023) · Experimental Gerontology · doi:10.1016/j.exger.2023.112101 · Cited by 9
“For example, old mice have less distension of cortical arterioles and an impaired clearance of parenchymal amyloid-β (Kress et al. 2014).”
Schwerin, S. C., Breehl, N., Obasa, A. A., Kim, Y., McCabe, J. T., Perl, D. P., Haight, T. J., & Juliano, S. L. (2023) · Cerebral Cortex · doi:10.1093/cercor/bhad199 · Cited by 8
Riba, M., Romera, C., Alsina, R., Alsina-Scheer, G., Pelegrí, C., Vilaplana, J., & del Valle, J. (2023) · Brain Structure and Function · doi:10.1007/s00429-023-02664-5 · Cited by 11
“The glymphatic system is disrupted in aging, sleep alterations, neurodegenerative diseases, and cardiovascular diseases, among others (Kress et al. 2014; Rasmussen et al. 2018; Hauglund et al. 2020).”
BackgroundEffects of Ischemic Stroke on Interstitial Fluid Clearance in Mouse Brain: a Bead Study
Yang, T., Sun, Y., Li, Q., Alraqmany, N., & Zhang, F. (2023) · Cellular and Molecular Neurobiology · doi:10.1007/s10571-023-01400-1 · Cited by 8
“…and hemoglobin, which may be an important cause of protein aggregation in aging, Alzheimer’s disease, Parkinson’s disease, and vascular cognitive impairment (Ueno et al. 2019; Sun et al. 2018; Kress et al. 2014; Kaur et al. 2021; Tarasoff-Conway et al. 2015; Ting et al. 2020; Tian et al. 2022).”
BackgroundДолжиков, А. А., Бобынцев, И. И., Белых, А. Е., Shevchenko, O. A., Победа, А. С., Dolzhikova, I. N., & Bibik, P. I. (2020) · Человек и его здоровье · doi:10.21626/vestnik/2020-1/06 · Cited by 7
Paris, J., Angeli, E., & Bousquet, G. (2021) · International Journal of Molecular Sciences · doi:10.3390/ijms22031281 · Cited by 10
Yang, E., Gonuguntla, V., Moon, W., Moon, Y., Kim, H.-J., Park, M., & Kim, J. (2021) · Applied Sciences · doi:10.3390/app11209398 · Cited by 8
“One possible explanation is that the number of subjects presented in the range of [0, 2] is higher than the number of subjects presented in the range of [3, 4].”
BackgroundSaleh, M. A. A., Bloemberg, J. S., Elassaiss‐Schaap, J., & de Lange, E. C. M. (2022) · Pharmaceutical Research · doi:10.1007/s11095-022-03281-3 · Cited by 8
“14C-inulin clearance in mice was reduced in senescent mice (18 months) compared to adult mice (2–3 months) by about 33% (76).”
BackgroundThe Glymphatic System: A Review
Oliveira, L. M., Figueiredo, E. G., & Peres, C. M. A. (2018) · Arquivos Brasileiros de Neurocirurgia Brazilian Neurosurgery · doi:10.1055/s-0038-1667052 · Cited by 9
Ortner, M., Hauser, C., Schmaderer, C., Muggenthaler, C., Hapfelmeier, A., Sorg, C., Diehl‐Schmid, J., Kurz, A., Förstl, H., Ikenberg, B. D., et al. (2019) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s225754 · Cited by 7
“This hypothesis is strengthened by the finding that older mice have a reduced pulsatility of intracortical arterioles and impaired amyloid clearance.(8)”
BackgroundInfluentialLiu, H., Chen, L., Zhang, C., Liu, C., Li, Y., Cheng, L., Wei, Z., Zhang, Z., Lu, H., van Zijl, P. C. M., et al. (2023) · bioRxiv (Cold Spring Harbor Laboratory) · doi:10.1101/2023.04.03.535397 · Cited by 8
“Glymphatic functioning is a highly regulated process, with changes in its activity accompanying aging as well as disease conditions (9-11).”
BackgroundSelf-citation
Metadata
- Authors
- Kress, B. T., Iliff, J. J., Xia, M., Wang, M., Wei, H. S., Zeppenfeld, D., Xie, L., Kang, H., Xu, Q., Liew, J. A., Plog, B. A., Ding, F., Deane, R., & Nedergaard, M.
- Affiliations
- University of Rochester Medicine (US)
- Oregon Health & Science University (US)
- Corresponding author
- Iliff, Jeffrey J.
- ORCID
- Venue
- Annals of Neurology
- Publisher
- Wiley
- Published
- 2014-09-26
- Volume
- 76
- Issue
- 6
- Pages
- 845-861
- ISSN
- 0364-5134 (ISSN-L)
- 1531-8249
- PMC
- PMC4245362
- OpenAlex
- W2100314515
- Cited by
- 1,521
- References
- 42
- Citations by year
- 2026: 182 · 2025: 186 · 2024: 202 · 2023: 167 · 2022: 172 · 2021: 126 · 2020: 126 · 2019: 98 · 2018: 89 · 2017: 70 · 2016: 54 · 2015: 47 · 2014: 1
- FWCI
- 26.22
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Annals of Neurology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- American Heart Association (12SDG11820014)
- National Institutes of Health (F32 NS073373)
- Oregon Partnership for Alzheimer's Research
- Topics
- Health Sciences › Medicine › Clinical Neurology › Cerebrospinal fluid and hydrocephalus
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Ion Transport and Channel Regulation
- Life Sciences › Neuroscience › Neurology › Barrier Structure and Function Studies
- Keywords
- glymphatic system, brain aging, aquaporin-4, astrocytes, amyloid-beta clearance, cognitive decline, neurodegenerative diseases
- MeSH terms
- Aging, Animals, Brain, Cerebrovascular Circulation, Female, Male, Metabolic Clearance Rate, Mice, Inbred C57BL, Neuroglia, Microscopy, Fluorescence, Multiphoton, Mice, Aquaporin 4
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