Correlation Between Brain Microstructural Changes And Functional Network Abnormalities And Cognitive Impairment In Patients With End-stage Renal Disease Undergoing Maintenance Dialysis

PART? Evaluation of cognitive impairment in maintenance dialysis patients with end-stage renal disease based on MRI intravoxel incoherent motionObjective:To evaluate the objective imaging markers of cognitive impairment in patients with end-stage renal diseaseby MRI intravoxel incoherent motion.Methods:A total of 40 patients with ESRD from the Department of Nephrology,Changzhou second Hospital affiliated to Nanjing Medical University from January 2019 to August 2020,and 24 healthy controls were prospectively enrolled.All subjects were performed with MR scan,and the slow apparent diffusion coefficient(ADC_SLOW)of the corresponding brain regions were obtained.The cognitive function was evaluated by using the Montreal Cognitive Assessment scale(Mo CA).Two-sample t test was used to analyze the difference of ADC_SLOWand cognitive score between two groups.Pearson correlation analysis was performed among the cognitive function score of end-stage renal disease and ADC_SLOWvalue.Results:(1)The scores of the intelligence test scale in the ESRD group(23.30±1.76)were significantly lower than those of the healthy control group(27.92±1.00)(P<0.01).The ADC_SLOWvalues of bilateral frontal lobe,hippocampus,and insula brain areas(respectively(0.648±0.035),(0.633±0.043),(0.762±0.043),(0.756±0.042),(0.792±0.048),(0.776±0.054))in the ESRD group was significantly higher than those in the healthy control group((0.600±0.039),(0.610±0.037),(0.725±0.059),(0.711±0.054),(0.740±0.063),(0.716±0.051))(P<0.01).(2)Pearson correlation analysis showed that the ADC_SLOWvalue of bilateral insula and right hippocampus in the ESRD group was negatively correlated with the intelligence test scale score(P<0.05).Conclusion:ADC_SLOWvalue in IVIM can better reflect the changes of cognitive function impairment in ESRD patients.PART ? The research of default brain network topology properities and cognitive impairment in in maintenance dialysis patients with end-stage renal diseaseObjective: To investigate the relationship between the changes of default network topology of brain function and cognitive function in patients with end-stage renal disease(ESRD).Methods: A total of 31 patients with ESRD were prospectively enrolled in the Department of Nephrology,Changzhou second Hospital affiliated to Nanjing Medical University from January 2019 to December 2020,and 18 healthy persons were included in the same period as the control group.The cognitive function was evaluated with the Montreal Cognitive Assessment scale(Montreal Cognitive Assessment scale,Mo CA),and then the subjects were examined by resting functional magnetic resonance imaging(rs-f MRI).After preprocessing,the brain functional network is constructed and the topological attribute parameters of the network are calculated.Results:(1)The score of Mo CA in the ESRD group was significantly lower than that in the healthy control group(P < 0.01).(2)The levels of Eglobal,Elocal,Cp and Si gma in ESRD group((0.129 ±0.025),(0.150 ±0.040),(0.188 ±0.046),(1.593 ±0.650))w ere significantly lower than those in healthy control group((0.160 ±0.040),(0.212 ±0.024),(0.276 ±0.049),(2.004 ±0.864))(P < 0.01).The Lp value of the ESRD group(8.131±1.905)was significantly higher than that of the control group(6.777±2.150)(P < 0.05).The node efficiency values of bilateral dorsolateral superior frontal gyrus,left middle fro ntal gyrus,bilateral posterior cingulate gyrus,right hippocampus,left superior marginal gyrus,bilateral angular gyrus and bilateral cuneate anterior lobe in ESRD group((0.133±0.071),(0.201 ±0.047),(0.211 ±0.106),(0.175 ±0.066),(0.276 ±0.113),(0.12±0.146),(0.042±0.075),(0.171±0.027),(0.154±0.078),(0.240±0.095),(0.161±0.056))were lowe r than those in the healthy control group((0.312±0.075),(0.289±0.091),(0.277±0.132),(0.284±0.053),(0.368±0.063),(0.231±0.227),(0.120±0.162),(0.296±0.064),(0.310±0.186),(0.318±0.066),(0.286±0.103))(P<0.01).(3)Pearson correlation analysis showed th at the node efficiency values of bilateral posterior cingulate gyrus and right hippocampu s in ESRD group were positively correlated with the score of Mo CA scale(P < 0.05).Conclusion:The topological structure of brain functional network is abnormal in ESRD patients,which can affect the cognitive function of patients.