Neural Mechanism Of Baduanjin Intervention For Cognitive Frailty Based On Triple Brain Network Model

Objectives:1.To evaluate the effects of 24 weeks Baduanjin exercise on the cognitive function and physical function in community CF patients.2.To explore the possible neural mechanism based on triple brain network model of Baduanjin exercise in improving the cognitive function and physical function of CF patients.Methods:Part 1:A total of 102 eligible CF elderly patients were randomly allocated into Baduanjin group or control group.The control group was only given diet guidance and health education related to cognitive and frailty,and participants in Baduanjin group were required to do Baduanjin exercise for 24 weeks based on the given diet guidance and health education intervention.The Montreal Cognitive Assessment Scale（MoCA）,the trail making test（TMT）,the Rey Osterrieth complex figure test（ROCF）to assess the cognitive dimensions of the subjects,such as the global cognitive function,executive function and visual spatial function;and the Edmonton frail scale（EFS）,grip,fatigue scale-14,body composition were used to evaluate the physical function of the subjects.These outcomes were detected and analyzed statistically before intervention,in the middle of intervention（12 weeks）,and after intervention.Part 2:Based on the experimental design of part 1,part of the subjects were selected for fMRI scanning before and after the intervention following the principle of voluntariness.DPABI software was used to preprocess MRI image,using the method of area of interest（ROI）based functional connection analysis.According to the previous literature,selected bilateral fronto-insular cortex and anterior cingulate cortex as salience network seeds,dorsolateral prefrontal cortex and bilateral posterior parietal portex as the central executive network seeds,ventromedial prefrontal cortex and posterior cingulate cortex as the default mode network seeds.The functional connection between single network and whole brain,internal network and triple brain network were analyzed respectively.Finally,the partial correlation between the networks functional connection and the results of cognitive function and physical function were analyzed.Results:Before the intervention,there was no significant difference in gender,years of education,BMI,Global Deterioration Scale and Beck Depression Scale score among the groups（P>0.05）,but the age of Baduanjin group was significantly higher than control group（P=0.021）.In the baseline evaluation of cognitive function,the score of MoCA visual space test in Baduanjin group was significantly higher than control group（P=0.019）,the error number of TMT-B was significantly lower than control group（P=0.002）,and there was no significant difference in other outcomes（P>0.05）;in terms of physical function,there was no statistical difference in all outcomes in baseline（P>0.05）.After 12 weeks of intervention,the total score of MoCA,visual space,language,abstract,delayed memory,TMT-B error number and ROCF recall score of Baduanjin group were significantly better than control group（P<0.05）;the EFS score of Baduanjin group was significantly lower than control group（P=0.014）in terms of physical function,and no significant statistical difference was found in other outcomes（P>0.05）.After 24 weeks of intervention,the total score of MoCA,language and delayed memory test,ROCF recall score of Baduanjin group were significantly better than control group in terms of cognitive function（P<0.05）;EFS score and grip strength of Baduanjin group were significantly better than that of control group in terms of physical function（P<0.05）,the body fat rate was significantly lower than control group（P=0.043）,and no significant difference was found in other outcomes（P>0.05）.The results of mixed linear model show that MoCA total score,visual space,language,abstract,delayed memory,EFS score and ROCF recall score had significant group effect（P<0.05）;MoCA total score,language,delayed memory,EFS score,fatigue scale score,grip,TMT-A time,TMT-B error number,ROCF recall score,and edema index had significant time effect;MoCA total score,delayed memory,fatigue scale score,grip strength,ROCF memory score,body fat rate,muscle mass,and basic metabolism had significant interaction effect with group and time（P<0.05）,Baduanjin group was significantly better than control group.2.Based on the first part,a total of 50 participants completed MRI before and after the intervention in the second part.Before the intervention,there was no significant difference between the two groups in gender,age,years of education,Global Deterioration Scale and Beck Depression Scale score and other basic conditions（P>0.05）;except that the TMT-B error number in control group was significantly greater than Baduanjin group（P=0.005）,there was no significant difference in the baseline cognitive function（P>0.05）;in terms of physical function,the baseline fatigue degree in Baduanjin group was significantly higher than control group（P=0.016）.There was no significant difference between the baseline EFS score and grip strength（P>0.05）.After 24 weeks of intervention,in terms of cognitive function,the total score of MoCA,delayed recall score and ROCF copying score of Baduanjin group were significantly higher than those of control group（P<0.05）;in terms of physical function,the EFS score of Baduanjin group was significantly lower than control group（P=0.022）,and there was no significant statistical difference in other outcomes（P>0.05）.3.The results of functional connection between salience network and whole brain showed that,between the LFIC seed and right inferior frontal gyrus/right insula,left anterior central gyrus/left middle frontal gyrus,bilateral supplementary motor area/right anterior central gyrus in Baduanjin group were significantly less than control group（FDR correction,voxel P<0.005,cluster P<0.05）;between the ACC seed and left middle occipital gyrus,precuneus was significantly greater than control group（FDR correction,voxel P<0.005,cluster P<0.05）.In central executive network,between the DLPFC seed and the left middle frontal gyrus/inferior frontal gyrus/anterior central gyrus were significantly less than control group（FDR correction,voxel P<0.005,cluster P<0.05）;between the RPPC seed and bilateral lenticular putamen/left caudate nucleus/left anterior medial cingulate gyrus were significantly less than control group（FDR correction,voxel P<0.005,cluster P<0.05）;between the LPPC seed and the right dorsolateral superior frontal/middle frontal/central anterior/supplementary motor area were significantly less than control group（FDR correction,voxel P<0.005,cluster P<0.05）.In default mode network,between the PCC seed and medial cingulate gyrus/left anterior cingulate gyrus,bilateral supplementary motor area/dorsolateral superior frontal gyrus/left middle frontal gyrus were significantly less than that of control group（FDR correction,voxel P<0.005,cluster P<0.05）.4.Inside the salience network,the change of the functional connection intensity of the bilateral anterior insular lobes in Baduanjin group was significantly higher than control group（P=0.035）.Inside the central executive network,the change of functional connection intensity DLPFC-LPPC in Baduanjin group was significantly higher than control group（P=0.030）.Inside the default mode network,there was no significant difference in intensity of functional connection vMPFC-PCC（P>0.05）.5.The results of triple network functional connection analysis showed that,the changes of functional connection between the salience network and the central executive network were significantly lower in Baduanjin group than control group(P_LFIC-DLPFC=0.039,P_ACC-RPPC=0.044).The change of functional connection intensity between salience network and default mode network were significantly greater in Baduanjin group than control group（P=0.032）.The change of functional connection between central executive network and default mode network in Baduanjin group was significantly lower than that control group（P=0.019）.6.The results of correlation analysis between behavioral indexes and functional connection showed that,in the salience network,there was a significant positive correlation between the change of functional connection intensity of bilateral anterior insular and the difference of MoCA delayed memory in Baduanjin group（r=0.524,P=0.010）,but no significant correlation in control group（P=0.412）.Between salience network and central executive network,there was a significant positive correlation between the change of functional connection intensity of LFIC-DLPFC and the difference of MoCA abstraction in Baduanjin group（r=0.502,P=0.015）,while there was no significant correlation in control group（P=0.403）.Between the central executive network and the default mode network,there was a significant positive correlation between the change of functional connection intensity of the DLPFC-PCC and the difference of EFS scores（r=0.465,P=0.025）,but no significant correlation in control group（P=0.067）.Conclusions:1.24-week regular Baduanjin exercise could significantly improve the cognitive dimension of the global cognitive function,memory and executive function of CF,and improve their frail index,grip strength body fat rate and basic metabolism.2.After 24 weeks of Baduanjin intervention,the functional connection intensity of SN-DMN increased;the functional connection intensity of SN-CEN decreased,which was closely related to abstract ability;the functional connection intensity of CEN-DMN decreased,which was closely related to the frail degree.Baduanjin could adjust functional connection of triple brain network,which may be an important mechanism for its mind-body coherence.