| Objective:Vascular congnitive impairment no dementia is the early stage of vascular dementia.Early diagnosis and effective treatment of VCIND are of great significance to reduce the occurrence of dementia.In this study,structural and functional multimodal magnetic resonance imaging technique combined with a multidimensional cognitive neuropsych-ological assessment scale was used to investigate the imaging mechanism of VCIND treated by the Xingnao Kaiqiao acupuncture method.It provides a theoretical basis for clinical diagnosiss,treatment and evaluation of the disease.Methods:1.Structural and functional multimodal MRI technology with multidi-mensi onal neuropsychological scale tests(MMSE,Mo CA,MES)were performed in 21 patients with VCIND who met the inclusion criteria as well as in 25 healthy controls.Intergroup comparisons of demographic and neurop-sychological rating scales were completed using SPSS V25 software.Imaging data were pretreatment and statistical analyzed using the DPARSF and SPM12 based on MATLAB platform,gender,age,years of education and whole brain volume were used as covariables for regression.Independent sample T test was used for comparison between the two groups,tructural and functional indicators GMV,ALFF and FC(FC values were selected as seed points based on GMV and ALFF differential brain regions)were obtained.The statistical thresholds of multiple comparison correction was P=0.001 for voxel level(uncorrected),and Cluster level P<0.05 for FWEc correction,and results were presented using xj View,MRIcron and Brain Net Viewer software.2.21 patients in the VCIND group were treated with Xingnao Kaiqiao acupuncture for 6 consecutive days followed by 1 day of rest for a total of 4weeks.The treated VCIND patients were evaluated by MMSE,Mo CA,and MES,followed by structural and functional multimodal MRI scans.The neuropsychological scale scores as well as imaging indices(GMV,ALFF,FC)of VCIND patients before and after acupuncture were statistically analyzed,as above.3.Local brain network analysis was done between the six selected seed points to obtain the differences in brain network between HC group,VCIND group before and after acupuncture treatment,and VCIND group before and after acupuncture treatment compared with HC group,using a correction using FDR,P<0.05.4.Pearson’s correlation analysis of GMV,ALFF,and FC values with clinical neuropsychologicalscales for brain regions with significant differences,P<0.05.Results:1.Differences in clinical scale scores and imaging indexes between the VCIND and HC groups before acupuncture(1)Comparison of neuropsychological scale scores:There was no statistically significant difference between the two groups of subjects in terms of age,gender,years of education,and whole brain volume P>0.05;However,there were statistically significant differences between the two groups in MMSE scores,Mo CA scores scores.The two groups had statistically significant P<0.05 in each item score of the Memory and Executive Screening Scale(MES),except for fluency.(2)Brain gray matter volume(GMV)value changed:Compared with the HC group,the brain regions with reduced GMV in patients in the VCIND group before acupuncture were the right cingulate gyrus,right parahippocampal gyrus,left cingulate gyrus,left lingual gyrus,right lingual gyrus,dorsolateral superior frontal gyrus,right thalamus,right hippocampus,left hippocampus,left deltoid superior frontal gyrus,left precentral gyrus,and left postcentral gyrus.(3)Low frequency amplitude(ALFF)value changed:Compared with the HC group,patients in the VCIND group had increased ALFF values in the following brain regions: left middle occipital gyrus,left superior temporal gyrus,right precentral gyrus,and right superior frontal gyrus;Decreased brain regions: left precuneus,right precuneus,posterior cingulate gyrus,and left caudate nucleus.(4)Function Connection(FC)value changed:Based on the differences in GMV and ALFF values between the two groups,six seed points(seed points)were selected for functional connectivity with the whole brain: left cingulate gyrus(seed1),left lingual gyrus(seed2),right lingual gyrus(seed3),left deltoid superior frontal gyrus(seed4),left postcentral gyrus(seed5),and left middle frontal gyrus(seed6).The results were that seed1 had reduced functional connectivity with the left lingual gyrus,left syrinx,right inferior occipital gyrus,right syrinx,and left superior temporal gyrus;seed2 had reduced functional connectivity with the left superior temporal gyrus,right superior temporal gyrus,right intraparietal superior frontal gyrus,right middle occipital gyrus,right inferior temporal gyrus,and right middle frontal gyrus,and seed3 had reduced functional connectivity with the right inferior temporal gyrus,left supraorbital frontal gyrus,right transverse temporal gyrus,and with right angular gyrus and enhanced functional connectivity(Table 6-1,Figure 5);seed4 has reduced functional connectivity with the right inferior triangular frontal gyrus,right inferior orbital frontal gyrus,and left inferior triangular frontal gyrus,and enhanced functional connectivity with the right cingulate gyrus;seed5 has reduced functional connectivity with the right inferior box frontal gyrus and left superior temporal gyrus,and enhanced functional connectivity with the left middle frontal gyrus and right precuneus;seed6 has reduced functional connectivity with the left superior occipital gyrus,right doublestar nucleus,the seed6 had reduced functional connectivity with the left supraoccipital gyrus,right caudate nucleus,and right superior frontal gyrus.2.Differences in clinical scale scores and imaging indexes between the VCIND group before and after acupuncture treatment(1)Comparison of neuropsychological scale scores:The two groups were statistically significant in MMSE,Mo CA and each subitem of MES immediate memory,short delayed memory,long delayed memory,snap finger experiment,executive ability,MES-E,MES-M and MES-T scores,P﹤ 0.05;MES subitem fluency was not statistically significa-nt P﹥ 0.05.(2)Low frequency amplitude(ALFF)value changed:Compared with before acupuncture,the brain areas with increased ALFF values in the VCIND group after acupuncture treatment: left superior parietal gyrus,right middle frontal gyrus,right superior frontal gyrus,left superior frontal gyrus,left superior frontal gyrus,left middle frontal gyrus;brain areas with decreased values: left middle temporal gyrus,left middle temporal gyrus,left precentral gyrus(2)Function Connection(FC)value changed:Based on the differences in GMV and ALFF values between the two groups of subjects,six seed points(seed points)were selected: left cingulate gyrus(seed1),left lingual gyrus(seed2),right lingual gyrus(seed3),left deltoid superior frontal gyrus(seed4),left postcentral gyrus(seed5),and left middle frontal gyrus(seed6),which were correlated with whole brain voxels.seed1 had enhanced functional connectivity with the right parahippocampal gyrus,right syrinx,right inferior occipital gyrus,left lingual gyrus,left syrinx,and left superior temporal gyrus,and no brain regions with reduced functional connectivity;seed2 had enhanced functional connectivity with the right inferior temporal gyrus,left superior temporal gyrus,and right middle frontal gyrus;seed3 had reduced functional connectivity with the left middle temporal gyrus and left superior temporal gyrus,and increased functional connectivity with the right inferior temporal gyrus and right boxed superior frontal gyrus.seed4 had increased functional connectivity with the left cingulate gyrus,right inferior frontal gyrus,and left postcentral gyrus,and no reduced functional connectivity was observed;seed5 had increased functional connectivity with the right inferior frontal gyrus,left inferior frontal gyrus,left middle frontal gyrus,right precuneus,and right postcentral gyrus,and no reduced functional connectivity was observed;seed6 had increased functional connectivity with the left parahippocampal gyrus,right cingulate gyrus,and left inferior parietal marginal gyrus,and reduced functional connectivity with the right superior frontal The functional connectivity between seed6 and the left parahippocampal gyrus,right spinoid gyrus,and left inferior parietal marginal gyrus was increased,while the functional connectivity with the right superior frontal gyrus was decreased.3.Change of functional network connection between seed pointsThere were functional network connections among the 6 seed points in HC group.The network connections between left middle frontal gyrus,left fusiform gyrus and left posterior central gyrus decreased before acupuncture treatment.After acupuncture treatment,the brain network connection partially recovered and was close to the healthy group.Compared with HC group,there were many functional connections between left middle frontal gyrus,left fusiform gyrus,left triangular superior frontal gyrus,left lingual gyrus and right lingual gyrus in VCIND group before acupuncture treatment.After acupuncture treatment,the functional connection brain area of VCIND group decreased significantly.4.Correlation analysis of imaging indexes and clinical scoresIn the present study,we could find some brain regions with significant differences,and these brain regions were used as imaging markers,and their imaging data were extracted separately for correlation analysis with clinical scale scores.It was found that GMV values in the left hippocampus of the pre-needle VCIND group were significantly and positively correlated with executive function(MES-E)scores(r=0.476,P=0.029),and the left deltoid superior frontal gyrus GMV values were significantly and positively correlated with memory function(MES-M)scores(r=0.528,P=0.014).The right middle frontal gyrus ALFF values after needling were significantly and positively correlated with long delayed memory scores(r=0.493,P=0.023);FC values between the left cingulate gyrus and the right cingulate gyrus were positively correlated with Simple Mental State Examination(MMSE)scores(r=0.557,P=0.009);FC values between the left cingulate gyrus and the left lingual gyrus were positively correlated with Montreal Cognitive Assessment Scale((r=0.54,P=0.012);FC values between the left lingual gyrus and the left superior temporal gyrus were significantly and positively correlated with short delayed memory scores(r=0.498,P=0.022);FC values between the left postcentral gyrus and the right inferior frontal gyrus were significantly and positively correlated with immediate memory scores(r=0.502,P=0.02),No significant correlation was found between other differential brain regions and each clinical rating scale.Conclusion:1.VCIND patients had reduced GMV,ALFF,and FC values in several brain regions,indicating that VCIND patients have impaired structural and functional connectivity in several brain regions,which is the central mechanism leading to their clinical symptoms,and that elevated imaging indices in some brain regions may be their compensatory effect.2.After acupuncture treatment,unctional indexes of relatively specific brain areas in VCIND patients,ALFF values of right superior frontal gyrus,FC values of left fusiform gyrus and left superior temporal gyrus,left inferior occipital gyrus,left lingual gyrus and right inferior temporal gyrus,left triangular superior frontal gyrus and right inferior frontal gyrus and clinical scale scores increased,which proves the effect of Xingnao Kaiqiao acupuncture on the improvement of cognitive function in patients with VCIND.3.The function of memory-related brain areas in VCIND patients can be adjusted by Xingnao Kaiqiao acupuncture,ameliorates cognitive impairment by rebuilding functional brain network connection.It indicates that acupuncture can reshape and integrate brain work,and reveal the central effect mechanism of acupuncture on VCIND from the perspective of imaging.4.It was found that there were significant correlations between the brain GMV values of the left hippocampus,the left triangular superior frontal gyrus,the ALFF values of the right superior frontal gyrus,the FC values between the left syrinx and the right syrinx,between the left syrinx and the left lingual gyrus,between the left lingual gyrus and the left superior temporal gyrus,and between the left postcentral gyrus and the right boxed inferior frontal gyrus and partial clinical score scale and these indicators can be used as predictive of the efficacy of VCIND imaging markers of VCIND. |
PDF Full Text Request