Association between early serum uric acid levels and diffusion tensor imaging analysis along the perivascular space with cognitive function

Serum uric acid (SUA) demonstrates dual roles as both an antioxidant and a pro-oxidant; however, its long-term effects on glymphatic function and cognitive performance remain unclear. This study included 944 participants in a longitudinal cohort to investigate the associations between the temporal progression of SUA levels and diffusion tensor imaging (DTI) analysis along the perivascular space (DTI-ALPS) with cognition. The results revealed that there were negative linear correlations between early average SUA levels and DTI-ALPS index for the left hemisphere (beta = −0.02, 95% confidence interval [CI] −0.04 to 0.00, p = 0.03), and cumulative SUA (cumSUA) levels and DTI-ALPS index for the left hemisphere (beta = −0.02, 95% CI −0.04 to −0.01, p = 0.01) and the whole brain (beta = −0.02, 95% CI −0.04 to 0.00, p = 0.03). A U-shaped relationship was observed between coefficient of variation of early SUA (CVSUA) levels and DTI-ALPS index in the left hemisphere (p = 0.01) and whole brain (p = 0.03). Higher early CVSUA levels, lower early cumSUA levels and reduced DTI-ALPS index were associated with lower MoCA scores. These findings suggest that moderately elevated SUA levels within the normal ranges, as well as stable SUA concentrations, may help mitigate future cognitive decline.