Brain Network Study On Non-dementia Vascular Cognitive Impairment Based On Structural And Functional MRI

Objective:Non-dementia vascular cognitive impairment(VCIND)is the pre-clinical stage of vascular dementia.Early recognition and intervention have great significance for the prevention and treatment of dementia.In this study,we used structural and functional magnetic resonance multimodal imaging techniques,combined with multidimensional cognitive neuropsychological assessment,through the analysis method of graph theory,discuss the effect of central neutral system caused by the brain structure and functional network damage mode of VCIND patients.At the same time,taking Sanyinjiao as the entry point,explain the impact of the immediate effect of acupuncture on the brain function network of VCIND patients and the working relationship in cognitive collaboration,and look for imaging predictors related to the recovery and remodeling of the cognitive network of VCIND patients,so as to provide an objective theoretical basis for clinical acupuncture treatment.Methods:1.For 42 subjects(21 in VCIND group)who met the inclusion criteria,HC group of 21)performed structural and functional multimodal magnetic resonance imaging scans.structural and functional connectivity networks were constructed with diffusion tensor imaging(DTI)and resting-state functional magnetic resonance imaging(fMRI)signal correlations.Using the analysis method of graph theory and using the GRETNA software package,the topological properties and local topological properties of the whole brain network of the two groups of subjects were calculated.Two independent sample T tests were used,including age,gender,years of education,and degree of cerebrovascular disease were used as covariates to compare the differences in imaging indicators between groups.2.With the multi-dimensional neuropsychological scale score,Pearson partial correlation analysis(controlling age,sex,years of education,degree of cerebrovascular disease)was used to evaluate the correlation between imaging indicators with significant differences between VCIND patients and the field of cognitive impairment.3.Acupuncture the Sanyinjiao points of the two groups of subjects,and compare the changes in the brain BOLD signal of the acupuncture state and the global topological properties of the acupuncture state network between the VCIND group and the HC group.The brain regions with significant differences based on the immediate effects of acupuncture are used as seeds to analyze the connection patterns of the local brain function network between the acupuncture state and the resting state of VCIND patients.Paired sample T test was used for intra-group comparison,and two independent sample T test was used for comparison between groups.Use xjView and BrainNet Viewer software to present the results.Results:1.General clinical dataThere was no significant difference in age,sex,years of education,degree of cerebrovascular disease between the VCIND group and the HC group,and there had statistical difference in MMSE score and MoCA score,P<0.05.VCIND group had different changes in memory and execution screening scale(MES)scores,except for fluency test,in immediate memory,short delayed memory,long delayed recall,finger deduction test,execution ability,execution factor score(MSE-E),memory factor score(MES-M),MES total score,P<0.05.2.VCIND group and HC group structure network topology attribute results(1)Small world attributes and global attributes:Based on diffusion tensor imaging(DTI)deterministic fiber tracing method,In the range of sparsity 0.21--0.41 step size 0.01,VCIND group and HC group structure network all accord with "small world attribute".The characteristic path length(Lp),normalized clustering coefficient(y)and global network efficiency(Eg)between the two groups have significant differences,P<0.05,FDR correction.(2)Node attributes of the local network:Compared to HC group,VCIND group significantly reduced the efficiency of the left dorsal lateral frontal gyrus(SFGdor.L),left lateral margin superior gyrus(SMG.L),left lenticular nucleus(PUT.L),right right paracentral lobule(PCL.R)nodes P<0.001,Bonferroni correction;the efficiency of local nodes in the left supplementary motor area(SMA.L)and right inferior temporal gyrus(ITG.R)was significantly reduced,P<0.001,Bonferroni correction.(3)Edge connection properties of the local network:VCIND group had significantly decreased white matter fiber connectivity in the left subfrontal gyrus and left dorsal exfrontal gyrus,left medial exfrontal gyrus and left orbital exfrontal gyrus,left lenticular nucleus and left thalamus,left paracentral lobule and right supplementary motor region,bilateral medial and paracuneus gyrus,P<0.05,NBS correction,5000 iterations.(4)Node centrality and core nodes of the local network:The nodal centrality of the left paracentral lobule(PCL.L)in the VCIND group decreased significantly,P<0.001,and was Bonferroni correction.VCIND group compared with the HC group,the centrality of all core nodes and the layout of core nodes changed,but the difference between groups was not statistically significant,P>0.05.(5)The relevance of structural network topology and cognition:No significant correlation was found between the global network attribute index of VCIND group structure and MMSE score and MoCA score,P>0.05.The total score of MES in the VCIND group was significantly negatively correlated with the global network efficiency(Eg)of the patient,P<0.05;it was significantly positively correlated with the characteristic path length(Lp),P<0.05.The scores of each sub-item of the MES scale in the VCIND group(such as immediate memory,short-delayed memory,finger deduction test,etc.)and left paracentral lobule(PCL.L),left upper marginal gyrus(SMG.L),left bean-shaped The nodal topological changes of putamen(PUT.L),right inferior temporal gyrus(ITG.R),and left supplementary motor area(SMA.L)were significantly correlated,P<0.05.This study did not find a statistically significant correlation between the changes in the fiber connection strength between nodes and the cognitive score scale,P>0.05.3.VCIND group and HC group functional network topology attribute results(1)Small world attributes and global attributes:Based on the temporal correlation between resting-state functional magnetic resonance imaging(fMRI)blood oxygen level-dependent signals,in the sparsity range of 0.21-0.41 step size 0.01,the functional networks of VCIND and HC groups were consistent with the "small world attribute".There were significant differences in clustering coefficient(Cp),characteristic path length(Lp),normalized clustering coefficient(y)、network global efficiency(Eg),local efficiency(Eloc)between the two groups,P<0.05,FDR correction.(2)Node attributes of the local network:Compared to HC group,VCIND group significantly reduced nodal efficiency in the right supplementary motor region(SMA.R),right cuneus(CUN.R),bilateral superior occipital gyrus(SOG.L/R),left central occipital gyrus(MOG.L),bilateral fusiform gyrus(FFG.L/R),left anterior cuneus(PCUN.L),bilateral superior temporal gyrus(STG.L/R),right temporal pole,superior temporal gyrus(TPOsup.R),P<0.001,Bonferroni correction;The local efficiency of bilateral supplementary motor region(SMA.L/R),bilateral insula(INS.L/R),left medial and paraspinal cingulate gyrus(DCG.L)and right lateral margin superior gyrus(SMG.R)were significantly decreased,P<0.001,Bonferroni correction.(3)Edge connection properties of the local network:Compared to HC group,left cuneate(CUN.L)and right central groove cover(ROL.R),right supplementary motor area(SMA.R),Left superior occipital gyrus(SOG.L)and right central furrow cover(ROL.R),bilateral supplementary motor area(SMA.L/R),Left middle occipital gyrus(MOG.L)and right supplementary motor region(SMA.R),right upper margin gyrus(SMG.R)and right amygdala(AMYG.R),left middle occipital gyrus(MOG.L),There was a significant decrease in the intensity of functional connectivity between the left anterior cingulate and the lateral cingulate gyrus(ACG.L)and the right lateral temporal gyrus(HES.R),P<0.05,NBS correction.The number of iterations is 5000.(4)Node centrality and core nodes of the local network:Compared to HC group,in the VCIND group,the right supplementary motor area(SMA.R),left middle occipital gyrus(MOG.L),left superior temporal gyrus(STG.L),right temporal pole,superior temporal gyrus(TPOsup.R)node centrality decreased significantly,P<0.001,Bonferroni correction.Compared with the HC group,the centrality of all core nodes in the VCIND group decreased,and the layout of the core nodes changed,but the difference between the groups was not statistically significant,P>0.05.(5)The correlation between functional network topology and cognition:The MMSE score of the VCIND group was significantly negatively correlated with the clustering coefficient(Cp)of the functional network of patients,P<0.05.The total score of the MES scale in the VCIND group and the scores of each sub-item(such as short-latency memory,execution factor,etc.)and left middle occipital gyrus(MOG.L),right supplementary motor area(SMA.R),right fusiform gyrus(FFG.R),right superior marginal gyrus(SMG.R),bilateral insula(INS.L/R),bilateral cuneiform lobes(CUN.L/R),left medial and lateral cingulate gyrus(DCG.L),the left paracentral lobule(PCL.L),and the right superior temporal gyrus(STG.R)have significant correlations with node topology changes,P<0.05.In the VCIND group,the functional connection strength of the right superior marginal gyrus(SMG.R)and the right amygdala(AMYG.R)was significantly negatively correlated with the memory factor(MES-M)and finger deduction test,P<0.05;right The functional connection strength changes of the superior lateral marginal gyrus(SMG.R)and the left middle occipital gyrus(MOG.L)were significantly negatively correlated with executive function,P<0.05;the left anterior cingulate and lateral cingulate gyrus(ACG.L)The change in the functional connection strength with the right transverse temporal gyrus(HES.R)has a significant negative correlation with the finger deduction test,P<0.05.4.Results of acupuncture task in VCIND group and HC group(1)Small world attributes and global attributes:In the acupuncture functional network,the global network topology attributes of the VCIND group and the HC group changed,and they did not have the small-world attribute,but the difference between the topology attribute groups was not statistically significant,P>0.05.(2)Sanyinjiao acupuncture task state BOLD signal changes brain areas:Compared with the HC group,the BOLD signal of the right insular lobe(INS.R)and left superior temporal gyrus(STG.L)in the Sanyinjiao acupuncture VCIND group was significantly weaker,P<0.05,corrected by FWE;right anterior buckle The BOLD signal brought back(ACG.R)was significantly enhanced,P<0.05,corrected by FWE.(3)Functional connection between seed points:Compared with the functional connection based on seed points in the acupuncture state VCIND group and the HC group,between seed 1-right insular lobe(INS.R)and seed 2-left superior temporal gyrus(STG.L)The functional connection of the seed was significantly reduced,P<0.05;the functional connection between seed 1-right insular lobe(INS.R)and seed 3-right anterior cingulate gyrus(ACG.R)did not change significantly,P>0.05;There was no significant change in the functional connection between seed 2-left superior temporal gyrus(STG.L)and seed 3-right anterior cingulate gyrus(ACG.R),P>0.05.(4)The functional connection between the seed point and the whole brain:the three-yin-jiao acupuncture state of the VCIND group compared with the resting state of the VCIND group:①seed 1-right insula(INS.R)and right superior marginal gyrus(SMG.R),right central posterior The connection of the gyrus(PoCG.R)is significantly enhanced,P<0.05,FDR corrected;②seed 2-left superior temporal gyrus(STG.L)and right middle temporal gyrus(MTG.R),right cuneiform lobe(CUN.R),the left medial and lateral cingulate gyrus(DCG.L),and the left precuneus(PCUN.L)have significantly enhanced connections,P<0.05,FDR corrected;③seed 3-right Anterior cingulate gyrus(ACG.R)and left caudate nucleus(CAU.L),left middle frontal gyrus(MFG.L),right medial superior frontal gyrus(SFGmed),right supplementary motor area(SMA.R))Connection is significantly enhanced,P<0.05,FDR correction.Conclusions:1.The brain structure network and resting state functional network of VCIND patients have small-world attributes.However,due to the damage of the white matter fiber microstructure,the remote connection strength of the network can be reduced,which increased the degree of grouping in the local network of VCIND patients,and the tendency of separation of global functions..2.VCIND patients have brain white texture fiber microstructure damage in the prefrontal cortex,parietal cortex,and outer temporal cortex,causing damage to the corresponding cognitive domains in the functional network.This cognitive impairment model is mainly related to the adaptation of cognitive control Sexual regulation is related.3.Changes in the local topology indicators of the brain structure network and functional network,such as node centrality,node efficiency,edge connection,etc.,can reflect the impairment of the cognitive domain and cognitive dimension of VCIND patients to a certain extent,and can be used as the specific imaging of VCIND.The indicators provide an objective basis for early clinical diagnosis of the disease,dynamic observation of the course of the disease,and prognostic evaluation.4.Acupuncture at acupoints can change the pathological state of the small world network of VCIND patients.The immediate effect of acupuncture is centered on the insular lobe,anterior cingulate cortex,and superior temporal gyrus of VCIND patients,establishing a locally enhanced functional connection mode,and transforming the pathological network modules of VCIND patients to the normal expected resting state metabolic mode.The specific imaging indicators obtained can be used as reference indicators for dynamic observation of the course of acupuncture treatment of VCIND patients.