Executive Functions In Patients With Functional Dyspepsia

Objective:Abnormal brain gut axis interaction is an important pathophysiological mechanism of functional dyspepsia（FD）,and cognitive abnormality is an important manifestation of brain gut axis dysfunction.Eating behavior,irregular eating patterns and abnormal mental state are significantly correlated with FD,which may be affected by cognitive factors.Cognitive factors play an important role in the occurrence and development of FD.Executive functions（EFs）is an advanced cognitive function,which refers to a series of top-down psychological processes in which individuals maintain concentration,resist "temptation",deal with challenges,"think before you act" and its core parts are inhibitory control,working memory and cognitive flexibility.Some brain regions of FD patients have structural and functional abnormalities,and some of these brain regions are involved in EFs.However,it is unclear whether FD patients have abnormal EFs.Therefore,this study uses the classical experimental paradigm to test the EFs of the two groups to explore whether there is abnormal EFs in FD patients and its influencing factors.Methods:According to Rome IV diagnostic criteria,43 FD patients and 43 healthy controls were included in this study.Hamilton Anxiety and depression scale was used to evaluate the degree of anxiety and depression.Dyspepsia symptom severity questionnaire was used to evaluate the severity of dyspepsia symptoms in FD patients.The EFs of the subjects were evaluated by Stroop Color Word Test（SCWT）,Digit Span Test,（DST）and Wisconsin Card Sorting Test（WCST）.Nepean Dyspepsia life quality index（NDLQI）was used to evaluate the quality of life of patients.Record basic data such as demographics,as well as clinical data such as course of disease and dyspepsia symptom severity.Independent sample t-test or non-parametric test were used to compare the differences of EFs between FD group and healthy control group.Pearson correlation analysis or Spearman correlation analysis was used to evaluate the correlation between EFs and demographic characteristics,clinical characteristics and NDLQI.The effect of HAMA score and HAMD score on the difference of EFs between the two groups was analyzed by analysis of covariance.Results:（1）In SCWT,FD patients had longer completion time of color-word card（CWT）and higher time interference score（TI）than healthy controls.It is suggested that the SCWT performance of FD patients was poor.（2）In DST,the forward score（DF）and backward score（DB）of FD patients were significantly lower than those of healthy controls,indicating that compared with the healthy control group,the DST performance of FD patients was worse.（3）In WCST,the total errors,the percentage of perseverative errors and the percentage of non perseverative errors in FD patients were significantly higher than those in healthy controls.FD patients performed poorly in WCST.（4）Pearson correlation analysis or Spearman correlation analysis found that DF and DB in patients with FD were significantly negatively correlated with age,while CT（the time to complete the color-card）,WT（the time to complete the word-card）,CWT,total errors and the percentage of non perseverative errors were significantly positively correlated with age.DF and DB were positively correlated with education level,while WT,CWT and total errors were negatively correlated with education level.CWT of FD patients were significantly positively correlated with disease duration and negatively correlated with the severity of postprandial fullness or early satiation.And % non-perseverative errors were negatively correlated with the severity of early satiation.NDLQI was not significantly correlated with any executive parameters.Conclusion: FD patients showed executive dysfunction.The severity of executive dysfunction was correlated with disease duration or severity of certain specific dyspepsia symptoms.