Physicians frequently manage cardiovascular risk factors in ageing populations. Therefore, a new cross-sectional study offers crucial insights into the neurological consequences of poorly controlled vascular health. This research confirms a strong link between multiple vascular risk factors and choroid plexus enlargement (CPV) in older adults. The choroid plexus (CP) is a vital brain structure; it produces cerebrospinal fluid (CSF). Significantly, changes in its volume indicate potential glymphatic system dysfunction and neurodegenerative risk.
Investigators included 2,137 participants with a median age of 70 years. All subjects underwent 3-T MRI and comprehensive vascular risk factor assessment. Factors examined included systolic blood pressure (SBP), body mass index (BMI), total cholesterol, and hemoglobin A1c (HbA1c). Multiple regression analysis controlled for factors like age, gender, medication use, and total intracranial volume (TIV).
Key Vascular Risk Factors Driving Choroid Plexus Enlargement
The study found a highly significant correlation between CP volume and advancing age. In addition, several modifiable vascular risk factors were independently associated with larger CPV. Higher SBP, elevated total cholesterol, increased BMI, and poor glycemic control (higher HbA1c) showed a robust link to CP volume. Interestingly, the study did not find a significant relationship between CP enlargement and current smoking or physical activity. This suggests a primary role for chronic metabolic and blood pressure dysregulation.
Furthermore, CP enlargement acts as a valuable precursor of cerebral small vessel disease. Other research suggests this enlargement links to increased ventricular volume and white matter hyperintensity (WMH) volume. Both are markers of small vessel damage. Consequently, aggressively managing hypertension, diabetes, and dyslipidemia is even more critical. This prevents poor brain health in the elderly population.
Choroid Plexus Volume, Aging, and Glymphatic Health
The CP plays a central role in regulating brain fluid homeostasis, largely through CSF production. Consequently, CP volume changes often reflect alterations in CSF dynamics. Existing literature supports the finding that CP volume increases with age. This increase is attributed to dystrophic changes in the tissue. Moreover, research confirms that CPV enlargement is a significant risk factor for glymphatic dysfunction. Since the glymphatic system is the brain’s waste clearance pathway, impaired function is strongly implicated in neurodegenerative conditions.
Collectively, the evidence points to a mechanism where chronic vascular risk leads to structural changes in the CP. These changes compromise CSF production and waste clearance via the glymphatic system. Ultimately, this contributes to cerebral small vessel disease and potential cognitive decline. Therefore, clinicians should view CP enlargement as an imaging biomarker of compromised neurovascular health.
Frequently Asked Questions
Q1: What is the choroid plexus (CP) and why is its enlargement significant?
The CP is a brain structure that produces most of the cerebrospinal fluid (CSF). Enlargement of the CP, known as choroid plexus enlargement (CPV), is considered a marker of potential glymphatic system dysfunction and is associated with cerebral small vessel disease markers like white matter hyperintensities.
Q2: Which specific vascular risk factors were linked to larger CP volume?
The study found that higher systolic blood pressure (SBP), elevated total cholesterol, increased body mass index (BMI), and poor glycemic control (measured by HbA1c) were all independently and significantly associated with larger CP volume in the elderly cohort.
Q3: Does physical activity or smoking affect choroid plexus volume?
In this particular cross-sectional study, neither current smoking status (quantified by the Brinkman Index) nor the level of physical activity (measured by the International Physical Activity Questionnaire) showed a significant, independent association with CP volume enlargement.
References
- Watanabe K et al. The influence of vascular risk factors and aging on choroid plexus enlargement. Eur Radiol. 2025 Dec 05. doi: 10.1007/s00330-025-12196-7. PMID: 41348213.
- Alisch JSR, Kiely M, Triebswetter C, et al. Characterization of Age-Related Differences in the Human Choroid Plexus Volume, Microstructural Integrity, and Blood Perfusion Using Multiparameter Magnetic Resonance Imaging. Front Aging Neurosci. 2021.
- Cai S, Lei H, Wu H, et al. Choroid Plexus Volume in Rural Chinese Older Adults: Distribution and Association With Cardiovascular Risk Factors and Cerebral Small Vessel Disease. J Am Heart Assoc. 2024.
- Li X, et al. Exploring cerebral small vessel disease, choroid plexus, demographics and vascular risk factors that affect glymphatic function. BMC Neurol. 2025.