Alpha-synucleinopathy is postulated to be central to both idiopathic rapid eye movement sleep behaviour disorder (iRBD) and Parkinson’s disease (PD). Growing evidence suggests an association between the diminished clearance of α-synuclein and glymphatic system dysfunction. However, evidence accumulating primarily based on clinical data to support glymphatic system dysfunction in patients with iRBD and PD is currently insufficient. This study aimed to use diffusion tensor image analysis along the perivascular space (DTI-ALPS) to evaluate glymphatic system activity and its relationship to clinical scores of disease severity in patients with possible iRBD (piRBDs) and those with PD. Further, we validated the correlation between the ALPS index and the prognosis of PD longitudinally. Overall, 168 patients with PD, 119 piRBDs, and 129 healthy controls were enroled. Among them, 50 patients with PD had been longitudinally reexamined. Patients with PD exhibited a lower ALPS index than those with piRBDs (P = 0.036), and both patient groups showed a lower ALPS index than healthy controls (P < 0.001 and P = 0.001). The ALPS index and elevated disease severity were negatively correlated in the piRBD and PD subgroups. Moreover, the ALPS index was correlated with cognitive decline in patients with PD in the longitudinal analyses. In conclusion, DTI-ALPS provided neuroimaging evidence of glymphatic system dysfunction in piRBDs and patients with PD; however, the potential of assessing the pathological progress of α-synucleinopathies as an indicator is worth verifying. Further development of imaging methods for glymphatic system function is also warranted.

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Introduction: China has the most people with Parkinson disease (PD) in the world, and is estimated to have over half of the worldwide PD population. The objective of this study is to analyze the corresponding burden of PD in China for the past decades. Method: Data on disease burden related to PD in China were retrieved from the Global Burden of Disease (GBD) 2019 study. The estimated annual percentage changes (EAPCs) were calculated to assess temporal trends, and the ratio of years lived with disability (YLDs) to disability-adjusted life-years (DALYs) was used as an index to evaluate the healthcare system. Result: Nationally, the burden of PD increased from 1990 to 2019. Although the age-standardized incidence rate (ASIR) increased, the age-standardized death rate (ASDR) and age-standardized DALY rate both decreased. Age-standardized rates of PD in males remained higher than those in females, but trends in ASDR and age-standardized DALY rate for females showed a pronounced decrease. The most remarkable increase in the ASIR was in individuals aged 45 to 49 years, with an EAPC of 1.74 (95% confidence interval, 1.26 to 2.21). The YLDs : DALYs ratio continuously increased compared with global figures and even with countries with high sociodemographic index (SDI). Conclusion: Although ASDR and age-standardized DALY rates for PD have been declining, the burden of PD still needs attention, as the total numbers have increased over the period. Generally, the greater burden from PD was in males. A sound health system with services tailored to PD continues to be required in the future.