| Objective:(1)Screening of WD patients with cognitive dysfunction,collecting scores of cognitive domain assessment scales,combined with the neuro-imaging,research the brain gray matter structure change of WD patients with cognitive dysfunction in based on the method of VBM,completing correlation analysis of brain structure changes and cognitive dysfunction;(2)Based on rs-f MRI technique,functional connectivity analysis was used to explore the effect of GDL Tablet on the brain default network in WD patients with cognitive impairment.Combined with cognitive domain detection,it was found that there were differences in brain regions or possible related loops through technical analysis to complete the correlation analysis of the functional connectivity of the brain and cognitive behavior.Methods:(1)To collected the neuroimaging data of 22 patients with standard WD patients as experimental group and 22 cases of the healthy control group with similar age,gender,level of education,collected regular 3D-T1 and rs-f MRI data by using the same magnetic resonance instrument and scanning parameters,compare the strength of the neuronal spontaneous activity index of experimental group and control group with Voxel-Based Method to local and discover the significant difference structure of the two groups of patients with brain gray matter related brain areas.(2)Conducting clinical research,divided the first nuclear magnetic scanning patients into treatment group and control group,treatment group will given the based treatment of protected liver and excreted copper with proprietary Chinese medicine GDL spirit,the control group only given the based treatment of protected liver and excreted copper with a total of four cycles intervention(a course of 8 days).Collecting the MoCA scores and six cognitive domain scores data before and after treatment in both groups.Based on the analysis method of functional connectivity to analysis the brain default network differences of before and after treatment of the resting state subjectors and explore the improvement loop of GDL tablet to promote cognitive.Results:(1)The study of general information of all the subjects showed that there was no significant difference in the gender,age and education years between the WD test group and the normal control group(P> 0.05).The score of cognitive domain in Mo CA was statistically significant(P <0.01).Indicating that WD test group has obvious cognitive impairment;(2)In the special cognitive domain assessment,the WD test group had statistically significant differences in all items(P <0.01),indicating that cognitive impairment in WD patients was present in all cognitive domains;(3)Through the imaging analysis,compared with the control group,the gray matter volume of the experimental group decreased,there was a statistically significant difference(P <0.05),indicating a certain degree of cerebral atrophy in the test group;(4)Based on the morphological analysis of VBM,we found that compared with the control group after false discovery rate,the gray matter volume of the experimental group increased in those areas including the right superior temporal gyrus,the right temporal gyrus,the right inferior temporal gyrus,the right Fusiform gyrus,right inferior occipital gyrus,right supraorbital frontal gyrus,right amygdala,right anterior cingulate and parathyroidism,whereas areas of gray matter volume reduction include bilateral lentiform nucleus,bilateral caudate nucleus,both globus pallidus;(5)Correlation analysis of covariates between age,gender,education years and gray matter volume data of all subjects showed no significant correlation between these covariates and gray matter volume changes;(6)There was a significant statistical significance(P <0.05)between the scores of cognitive domain of Mo CA in two groups of TCM-WM combined test group and western medicine control group,indicating that the use of GDL tablet in cognition of WD patients function has an improvement effect;(7)The treatment effect was evaluated on the 16 th day and the 32 nd day respectively,and found that on the 16 th day of treatment,the total effective rate was 70% in the TCM-WM combined test group and 50% in the western medicine control group,(P <0.05).On the 32 nd day of treatment,the curative effect was evaluated again.The results showed that the total effective rate of the TCM-WM treatment group was 90%,while the Western medicine control group's total effective rate was 75%.There was obvious statistical difference between the two groups difference(P <0.05)shows that the combination of TCM-WM treatment group than the western medicine group early effect was significant;(8)Compared with western medicine control group,we can find that there is significant difference in evaluation of special cognitive domain between TCM-WM treatment group and western medicine treatment group,so we can see that western medicine combined with GDL for cognitive function improvement of WD patients with cognitive impairment better than western medicine treatment alone;(9)Functional connectivity analysis of the cingulate cortex(PCC),the medial prefrontal cortex(m PFC)and the hippocampus(Hippocampus)showed that compared with the western medicine group,In the brain of the patients in the experimental group,the posterior cingulate gyrus and right wedge anterior lobe,the right hippocampus increased functional connectivity,and the left central anterior connection reduced;medial prefrontal cortex and the right frontal gyrus,right frontal back connection Lower frontal gyrus,left upper edge of the back connection to reduce;left hippocampus and left lower cerebellar increased connection with the right central front back,right inferior frontal gyrus,the right central ditch lid connection reduced;the right Hippocampus and the left central back,the lower left edge of the lower edge of the back connection function to reduce.Conclusion: 1,The cognitive impairment of WD patients with cognitive dysfunction is reflected in all cognitive domains.And the improvement of cognitive function in WD patients is reflected in all cognitive domains with the use of GDL.2,The gray matter atrophy area of WD patients with cognitive dysfunction includes bilateral lenticular nucleus,bilateral caudate nucleus and bilateral globus pallidus.It suggests that the damage of multiple cognitive domains in WD patients with cognitive dysfunction is closely related to the volume atrophy of basal ganglia gray matter.3,WD patients with cognitive dysfunction in the right part of the temporal lobe,right fusiform gyrus,right occipital gyrus,right orbital frontal gyrus,the right amygdala,primary auditory cortex and the auditory association cortex of gray matter volume increased,suggesting that WD with cognitive neural compensatory mechanism dysfunction,this compensatory mechanism to strengthen the effect of frontal and parietal lobe amygdala function loop.4,It's found after intervention of GDL with WD DMN network node cognitive dysfunction in patients with existing connection strength reduced areas,including the precentral gyrus,left superior frontal gyrus,left supramarginal gyrus,left postcentral gyrus,suggesting that the mechanism of brain network of cognitive impairment in patients with WD and between cortical parietal lobe and hippocampus loop brain functional network connection strength decreased;at the same time there are the right superior frontal gyrus,right middle frontal gyrus and right precuneus functional connectivity,suggesting that gandouling tablets with WD intervention in patients with cognitive impairment in language,attention,executive function,visual spatial ability mainly lies in improving the fronto parietal-DMN loop coordination,reduced the connection of long range and increasd connection performance. |
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