Study On The Effect Of Gandou Ningshen Decoction On Rich-Club Attribute In Wilson’s Disease Patients With Mild Cognitive Impairment Of Mixed Phlegm And Blood Stasis

1.Objective(1)Based on diffusion tensor imaging(DTI)brain network graph theory analysis technology,to explore the Rich-Club organization of brain networks in Wilson’s disease patients with mild cognitive impairment(WD-MCI)and the changes of the connectivity strength between brain networks.(2)By obtaining the neuropsychological scale and DTI data before and after the intervention of Gandou Ningshen Decoction in patients with WD-MCI of mixed phlegm and blood stasis,we investigated the changes of Rich-Club attributes of WD-MCI patients and explored the intervention effect of Gandou Ningshen Decoction in patients with WD-MCI of mixed phlegm and blood stasis.2.Methods(1)We collected 40 WD patients who meet the inclusion and exclusion criteria and 20 healthy controls(HC)with similar age and sex,divided all WD patients into non-cognitive impairment group(WD-nMCI)and mild cognitive impairment group(WD-MCI).Magnetic resonance scans were performed on all subjects,as well as a neurological examination and a series of neuropsychological tests,using MATLAB,PANDA GRETNA,SPSS 23.0 and other software to conduct DTI brain network graph analysis on the collected data.(2)20 cases of WD-MCI patients of mixed phlegm and blood stasis were randomly divided into observation group(conventional copper treatment + Gantou Ningshen Decoction)and control group(conventional copper treatment).They were intervened for 4 courses of treatment(one course of treatment was 8 days).The DTI data and cognitive domain scales were collected before and after treatment in the two groups,and the data were processed and analyzed.3.Results(1)Rich-club nodes in HC group were mainly distributed in PCUN,DCG,SOG,CUN,MOG.L,PUT.L,SFGdor.R,ACG.R and CAL.R.Rich-club nodes in WD-nMCI group were mainly distributed in PCUN,PUT,DCG,MOG.L,SOG,CUN.R,ORBsup.R,SFGdor.R and ACG.Rich-club nodes in WD-MCI group were mainly distributed in PCUN,PUT,DCG,MOG.L,SOG,CUN,ANG.R and SFGdor.R.(2)Compared with the HC group,the Rich-Club connection strength was decreased in all patients,and when mild cognitive impairment occurred,the Rich-Club connection strength was increased in the WD-MCI group compared with the WD-nMCI group.The Feeder connection strength of WD-MCI group was lower than that of HC and WD-nMCI group,but there was no difference between HC and WD-nMCI group.The strength of Local connections in the patient group decreased significantly compared with the HC group regardless of mild cognitive impairment.(3)Compared with before treatment,the score of memory specific cognitive domain in the observation group increased after treatment.Compared with the control group,the score of memory specific cognitive domain in the observation group increased significantly after treatment.(4)There was no significant difference between the observation group and the control group in connection analysis before treatment.In the observation group,there were 7edges with significant differences between the groups after treatment and before treatment.After treatment,compared with before treatment,the control group had 2edges with significant differences between groups.Compared with the control group after treatment,there were 33 connecting edges in the observation group after treatment with significant differences between groups.The connection strength of these different edges is mostly increased.4.Conclusion(1)Rich-club organization is disrupted in patients with WD-nMCI and WD-MCI.Rich-club node with high value is stable when it is attacked by disease,while Rich-club node with low value is prone to transfer reorganization phenomenon when it is attacked by external disease.(2)In WD-nMCI patients,the strength of Rich-Club connection and Local connection was mainly impaired,while in WD-MCI patients,the strength of Rich-Club,Local and Feeder connections all decreased.(3)The temporary increase of Rich-club connection strength in WD-MCI patients(compared with WD-nMCI group)indicates that the damage of brain network is more serious in patients with mild cognitive impairment.The brain strengthens the connection between core and peripheral regions by the compensatory increase of Rich-club connection strength.This is an optimization of the efficiency of the damaged brain network.(4)After treatment,the memory of WD-MCI patients of mixed phlegm and blood stasis improved.The connection strength of the different edges of the patients mostly increased,indicating that the treatment was effective,and the efficacy of conventional copper displacement therapy combined with Gandou Ningshen Decoction was superior to that of western medicine alone.