Cannabis, psychosis, and violence: case reports and comprehensive evidence review.

Neurodegenerative disorders such as Alzheimer’s disease (AD) are increasingly understood to involve disturbances in brain homeostatic systems that regulate cerebrospinal fluid (CSF) production, circulation, and clearance (; ; ). While the accumulation of amyloid- and tau proteins remains a defining feature of AD pathology, growing evidence suggests that impaired brain fluid dynamics may contribute to the development and progression of cognitive decline (; ). Inefficient clearance of metabolic waste can lead to the accumulation of neurotoxic proteins in brain tissue (), potentially accelerating neuronal dysfunction. Two systems play central roles in maintaining this fluid balance. The choroid plexus (CP) is the primary site of CSF production and forms the blood-CSF barrier, regulating molecular exchange between the circulation and the central nervous system (). In parallel, the glymphatic system supports the clearance of interstitial solutes through perivascular pathways, enabling the removal of metabolic by-products from the brain (). Experimental and clinical studies suggest that dysfunction in either system may contribute to neurodegenerative processes (; ; ), but their potential interaction remains poorly understood. Recent neuroimaging developments allow these processes to be investigated . The diffusion tensor imaging analysis along the perivascular space (DTI-ALPS) index has been proposed as a non-invasive surrogate of glymphatic transport efficiency, with lower ALPS values interpreted as reflecting reduced diffusion along perivascular pathways (). Several studies have reported lower ALPS indices in neurodegenerative disorders and associations with cognitive impairment (; ; ). At the same time, structural alterations of the CP have emerged as a potential imaging marker of brain pathology. Enlargement of the CP has been observed in individuals across the AD continuum and has been linked to neuroinflammatory processes and altered CSF dynamics ().