| Objective: Chronic partial sleep deprivation can lead to cognitive dysfunction,resulting in decreased capacity of learning and memory,decreased alertness and attention with increased negative emotions.In this study,“Adjusting Zang-fu and Arousing Spirit”electro-acupuncture therapy was used as the clinical intervention,and resting-state functional MRI and MR spectroscopy techniques were performed to collect and statistically analyze the brain imaging data of patients with CPSD who are with cognitive impairment to explore the correlation between the clinical manifestations and the changes of the brain functional network of patients with CPSD with cognitive impairment.We investigated the interrelationship between the clinical manifestations and the changes of functional network in patients with CPSD with cognitive impairment,and then revealed the central pathogenesis and the central effect mechanism of “Adjusting Zang-fu and Arousing Spirit”electro-acupuncture therapy to improve the corresponding symptoms in patients with CPSD with cognitive impairment.Methods: 1.27 healthy subjects(HC group)and 26 patients with chronic partial sleep deprivation and cognitive impairment(CPSD group)were included.The sleep quality of subjects was assessed by the Montreal Cognitive Assessment Scale(Mo CA),the Pittsburgh Sleep Quality Index(PSQI),the Stanford Sleepiness Scale(SSS),the Wechsler Memory Scale(WMS),the Hamilton Anxiety Scale(HAMA),the Hamilton Depression Scale(HAMD),and the Cognitive Conflict Task(Stroop),the Psychomotor Awareness Task(PVT),the 2-back test task,and the Emotional Assessment Test Evaluate cognitive function and emotional status.Resting state functional magnetic resonance imaging(rs-MRI)and magnetic resonance spectroscopy(MRS)techniques,hippocampus and hippocampal subarea were selected as regions of interest for resting state functional connectivity,and magnetic resonance spectroscopy(MRS)was used to detect the basal ganglia of the brain.The changes in brain functional network connectivity and brain metabolites in the two groups of subjects were comprehensively analyzed,and correlation analysis was conducted with clinical cognitive function evaluation indicators.To intervene in the CPSD group with the electroacupuncture method of“Adjust Zang-fu and Arouse Spirit”,Feishu(both),Pishu(both),and Shenshu(both)points were selected on the back,Baihui and Shenting points on the head,and Zusanli(both),Sanyinjiao(both),Hegu(both),and Taichong(both)points on the limbs".After obtaining qi by acupuncture,Baihui～Shenting and Pishu～Shenshu,Zusanli～Sanyinjiao points were taken as electroacupuncture connection points.The waveform was set as a density wave,and the intervention for 5 times is a course of treatment.During the course of treatment,a rest of 2days should be taken,with a total of 4 consecutive courses of intervention.After the intervention,the subjects were subjected to sleep and cognitive related scales and behavioral tests again to assess the improvement of clinical performance of patients with cognitive impairment in CPSD.The hippocampus and subarea of hippocampus were used as regions of interest for resting functional connectivity,and the basal ganglia region was used as the detection brain region for magnetic resonance spectroscopy.Through statistical analysis of the collected image data,it was clear about the changes in the brain functional network and brain metabolites in patients with cognitive impairment in CPSD after the treatment of“Adjusting Zang-fu and Arousing Spirit” with electroacupuncture,and correlation analysis was conducted with clinical cognitive function evaluation indicators.Results:The comparison of general information,cognitive evaluation indicators,brain function,and brain metabolites between the HC group and the CPSD group shows that:(1)General information:There was no significant difference between the two groups in general data such as age,gender,height,weight,blood pressure,and educational degree(P>0.05).(2)Cognitive Indicator Results:Compared with HC group,the scores of Mo CA and WMS in CPSD group were significantly decreased,while the scores of PSQI,HAMA,and HAMD were significantly increased.The ability to complete experimental paradigms such as Stroop,2-back,and PVT in the CPSD group showed a significant decrease,with a statistically significant difference(P<0.05,P<0.001).(3)Rs-f MRI test results:Compared with the HC group,the volume of bilateral hippocampus,right amygdala,and overall gray matter in the brain of patients with CPSD decreased significantly,with a statistically significant difference(P<0.05).There was a significant positive correlation between the volume of the right amygdala and the 2-back accuracy(r=0.477,P=0.019).Comparative results of resting functional connectivity using hippocampus as ROI:compared with HC group,functional connectivity between left hippocampus and right anterior central gyrus in CPSD group decreased;Comparative results of resting functional connectivity using hippocampal sub regions as ROI: compared with HC group,the functional connectivity of left central hippocampus and right anterior central gyrus in CPSD group was enhanced.Correlation analysis showed that there was a significant positive correlation between the functional connectivity values of the left central hippocampus and the right anterior central gyrus in patients with CPSD and the PSQI score(r=0.442,P=0.031).(4)MRS test results:Compared with the HC group,the values of GABA and GABA/Cr in the left basal ganglia of patients with CPSD were significantly higher,with a statistically significant difference(P<0.05),while the left MI value was significantly lower,with a statistically significant difference(P<0.05).There was a significant negative correlation between the value of GABA/Cr in the left basal ganglia of patients with CPSD and the accuracy of Stroop conflict conditions(r=-0.412,P=0.045).2.Comparison of cognitive evaluation indicators,brain functional connectivity,and brain metabolites in the CPSD group before and after the intervention of“Adjusting Zang-fu and Arousing Spirit” electroacupuncture(1)Results of cognitive indicators: After the acupuncture intervention of “Adjusting Zang-fu and Arousing Spirit”,the scores of Mo CA and WMS in patients with CPSD were significantly improved,while the scores of PSQI,HAMA,and HAMD were significantly decreased.The completion ability of the experimental paradigms such as Stroop,N-back,and PVT in the CPSD group was significantly improved in comparation with the one before the intervention,with a statistically significant difference(P <0.05,P<0.001).(2)Rs-f MRI detection results showed that: After the“Adjusting Zang-fu and Arousing Spirit” electroacupuncture intervention,the resting functional connection of the whole hippocampus as ROI was compared.The difference results showed that the functional connection between the right hippocampus and the left posterior central gyrus in the CPSD group was enhanced,while the functional connection between the left hippocampus and the left cerebellum was weakened.Comparative differences in resting functional connectivity using hippocampal subareas as ROI showed that among patients with CPSD,functional connectivity between the right anterior hippocampus and the left posterior central gyrus increased,while functional connectivity between the bilateral posterior hippocampus and its opposite anterior cuneiform lobe decreased.The correlation analysis showed that after the electroacupuncture intervention of “Adjusting Zang-fu and Arousing Spirit”,the functional connectivity values of both the right hippocampus and the left posterior central gyrus were significantly positively correlated with the WMS score(r=0.664,P=0.005).(3)MRS test results: After the intervention of “Adjusting Zang-fu and Arousing Spirit” electroacupuncture,the values of NAA/Cr on the right side,Cho and Cho/Cr on the left side of the cerebral basal ganglia in patients with CPSD were significantly increased compared to before the intervention,while the values of GABA and GABA/Cr on the left side significantly decreased compared to the ones before the treatment,with a statistically significant difference(P<0.05).There was a significant negative correlation between the right NAA/Cr value and HAMA(r=-0.533,P=0.034),and a significantly negative correlation between the left Cho/Cr value and the 2-back reaction time(r=-0.701,P=0.002).Conclusion:1.The overall cognitive function of patients with CPSD was decreased,manifested by poor sleep quality,decreased alertness,attention,learning and memory abilities,and increased negative emotions.Patients with CPSD have abnormal connectivity of cognitive functional networks in the brain,specifically manifested by abnormal functional connectivity between the left hippocampus and the right anterior central gyrus.Among them,the enhanced functional connectivity between the left central hippocampus and the right anterior central gyrus may be a potential central mechanism for the pathogenesis of cognitive dysfunction in patients with CPSD.A significant increase in the GABA/Cr ratio in the left basal ganglia may be associated with cognitive decline in patients with CPSD.“Adjusting Zang-fu and Arousing Spirit” electroacupuncture was able to improve the sleep quality of patients with cognitive impairment in CPSD and improve their overall cognitive function,and have a certain improvement effect on the decline of alertness,attention,learning and memory,as well as negative emotions.It may also take effect by regulating the abnormal functional connections between the hippocampus subarea,the posterior central gyrus,and the anterior cuneiform lobe,as well as the abnormal number or function of neurons in the basal ganglia.Among of which,the enhancement of functional connectivity between the right anterior hippocampus and the left posterior central gyrus,the increase of the right NAA/Cr value and the left Cho/Cr value in the basal ganglia region,and the decrease of the left GABA/Cr may be the potential mechanism of “Adjusting Zang-fu and Arousing Spirit” electroacupuncture for improving cognitive function in patients with CPSD. |
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