Zhongguo cuzhong zazhi (Jul 2024)
缺血性脑白质病变伴认知障碍患者脑网络改变与注意功能的相关性研究 A Study on the Correlation between Brain Network Changes and Attention Function in Patients with Ischemic White Matter Lesion and Cognitive Dysfunction
Abstract
目的 为缺血性脑白质病变（ischemic white matter lesion，IWML）患者认知障碍进展的评估提供影像依据。 方法 回顾性纳入2018年1月—2021年12月就诊于首都医科大学附属北京天坛医院的IWML患者，按照认知功能测评结果分为：非痴呆血管性认知障碍（non-dementia vascular cognitive impairment，VCIND）组、血管性痴呆（vascular dementia，VaD）组。同期入组认知功能和头颅MRI检查正常的就诊患者为正常对照（normal control，NC）组。所有患者均完善了静息态功能MRI检查及注意功能检查，包括Stroop色-词干扰测试B（Stroop color-word interference B test，Stroop B），Stroop色-词干扰测试C（Stroop color-word interference C test，Stroop C），数字连线测验A（trail making test A，TMT-A）和符号数字转换测试（symbol digit modalities test，SDMT）。使用独立成分分析选择左侧和右侧额顶叶网络、初级和次级视觉网络、背侧注意网络5个脑区，选择9个主要区域为感兴趣区，提取每个脑区Z值，作为脑区两两间的功能连接（functional connectivity，FC）值。进行VCIND、VaD和NC组FC差异分析，并进一步分析VCIND、VaD两组脑区间FC变化与注意功能评分的相关性。 结果 共纳入60例患者，其中男性29例（48.3%）。NC组24例，VCIND组19例，VaD组17例。结果提示，与NC组相比，VCIND组完成Stroop B（P＜0.01）、TMT-A（P=0.01）评分更高，SDMT评分更低（P=0.01）；VaD组完成Stroop B、Stroop C及TMT-A评分更高（均P＜0.01），SDMT评分更低（P＜0.01）。与VCIND组相比，VaD组完成Stroop B（P＜0.01）、Stroop C（P＜0.01）及TMT-A（P=0.01）评分更高，SDMT评分（P＜0.01）更低。FC分析显示，与NC组相比，VCIND组右侧背外侧前额叶皮质和左侧顶上小叶（P=0.01）、右侧背外侧前额叶皮质和楔叶（P=0.04）之间的FC值增高；与VCIND组相比，VaD组右侧背外侧前额叶皮质与楔叶（P=0.02）之间的FC值增高。右侧背外侧前额叶皮质和左侧顶上小叶之间的FC值与Stroop C用时呈负相关（r=－0.365，P=0.04），其余脑区之间的FC值与其他注意功能评分项目无显著相关性。 结论 随着认知功能下降，IWML患者执行网络与背侧注意网络、初级视觉网络间的FC值升高，部分脑区间FC的改变伴随着更差的注意功能。 Abstract: Objective To provide an imaging reference for assessing cognitive dysfunction progression in patients with ischemic white matter lesion (IWML). Methods Patients with IWML admitted to Beijing Tiantan Hospital, Capital Medical University from January 2018 to December 2021 were retrospectively included. They were divided into two groups according to the results of the cognitive function assessment: the non-dementia vascular cognitive impairment (VCIND) group and the vascular dementia (VaD) group. Patients with normal cognitive function and brain MRI results were enrolled in the normal control (NC) group at the same time. All patients underwent resting state functional MRI examination and attention function tests, including Stroop color-word interference B test (Stroop B), Stroop color-word interference C test (Stroop C), trail making test A (TMT-A), and symbol digit modalities test (SDMT). The left frontoparietal network, right frontoparietal network, primary visual network, secondary visual network, and dorsal attention network were selected by independent component analysis. Nine major regions were chosen as regions of interest, and the Z value of each brain region was extracted as the functional connectivity (FC) value of the pairwise brain interval. The differences in FC among the three groups were analyzed, and the correlation between altered FC and attention function scores in VCIND and VaD groups was further investigated. Results Among 60 eligible patients, 29 (48.3%) being male. There were 24 cases in the NC group, 19 cases in the VCIND group, and 17 cases in the VaD group. The results suggested that compared with the NC group, the VCIND group had higher scores on the Stroop B (P<0.01) and TMT-A (P=0.01), and the SDMT scores were lower (P=0.01). In the VaD group, patients had higher scores on the Stroop B, Stroop C, and TMT-A (P<0.01), and had lower scores on the SDMT (P<0.01). Compared with the VCIND group, the VaD group had higher scores on the Stroop B (P<0.01), Stroop C (P<0.01), and TMT-A (P=0.01) and had lower SDMT scores (P<0.01). The FC analysis results showed that compared with the NC group, the FC between the right dorsolateral prefrontal cortex and the left superior parietal lobule (P=0.01), and the right dorsolateral prefrontal cortex and cuneus (P=0.04) were increased in the VCIND group. Compared with the VCIND group, the FC between the right dorsolateral prefrontal cortex and cuneus (P=0.02) was increased in the VaD group. The FC between the right dorsolateral prefrontal cortex and the left superior parietal lobule was negatively correlated with the Stroop C score (r=－0.365, P=0.04), while the FC between the other brain regions was not significantly correlated with other attention function scores. Conclusions With the decline of cognitive, the FC between the executive network and the dorsal attention network, as well as the primary visual network increased in IWML patients, and the FC changes in some brain regions were associated with worse attention function.
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