Radiological Sciences, Division of Clinical Neuroscience, School of Medicine, Queen's Medical Centre, University of Nottingham, Nottingham, UK.
Sir Peter Mansfield Imaging Centre, School of Medicine, University of Nottingham, Nottingham, UK.
Eur J Neurol. 2020 Feb;27(2):352-359. doi: 10.1111/ene.14084. Epub 2019 Oct 25.
The interrelation of cognitive performance, cerebrovascular damage and brain functional connectivity (FC) in advanced arteriosclerosis remains unclear. Our aim was to investigate the associations between FC, white matter damage and cognitive impairment in carotid artery disease.
Seventy-one participants with a recent cerebrovascular event and with written informed consent underwent resting-state functional magnetic resonance imaging and the Addenbrooke's Cognitive Examination - Revised (ACE-R). Network and inter-hemispheric FC metrics were compared between cognitively normal and impaired subjects, and interrelated with cognition. In order to explore the nature of FC changes, their associations with microstructural damage of related white matter tracts and cognitive performance were investigated, followed by mediation analysis.
Participants with global cognitive impairment showed reduced FC compared to the cognitively intact subjects within the central executive network (CEN), and between hemispheres. Patients with executive dysfunction had decreased CEN FC whilst patients with memory loss demonstrated low FC in both the CEN and the default mode network (DMN). Global performance correlated with connectivity metrics of the CEN hub with DMN nodes, and between hemispheres. Cingulum mean diffusivity (MD) was negatively correlated with ACE-R and CEN-DMN FC. The cingulum MD-cognition association was partially mediated by CEN-DMN FC.
Long-range functional disconnection of the CEN with DMN nodes is the main feature of cognitive impairment in elderly subjects with symptomatic carotid artery disease. Our findings provide further support for the connectional diaschisis concept of vascular cognitive disorder, and highlight a mediation role of functional disconnection to explain associations between microstructural white matter tract damage and cognitive impairment.
认知表现、脑血管损伤和大脑功能连接（FC）之间的相互关系在动脉粥样硬化晚期仍不清楚。我们的目的是研究颈动脉疾病患者 FC、白质损伤与认知障碍之间的相关性。
71 名近期发生过脑血管事件且签署了书面知情同意书的参与者接受了静息态功能磁共振成像和 Addenbrooke's 认知评估修订版（ACE-R）检查。比较认知正常和受损受试者之间的网络和半球间 FC 指标，并与认知相关联。为了探索 FC 变化的性质，我们还研究了它们与相关白质束的微观结构损伤和认知表现的相关性，并进行了中介分析。
与认知完整的受试者相比，整体认知障碍的参与者在中央执行网络（CEN）内以及半球间的 FC 降低。执行功能障碍的患者 CEN FC 降低，而记忆丧失的患者 CEN 和默认模式网络（DMN）的 FC 均较低。整体表现与 CEN 与 DMN 节点之间的 CEN 枢纽连接度量相关，与半球间的连接度量也相关。胼胝体平均弥散度（MD）与 ACE-R 和 CEN-DMN FC 呈负相关。胼胝体 MD 与认知的相关性部分由 CEN-DMN FC 介导。
CEN 与 DMN 节点之间的长程功能连接中断是有症状颈动脉疾病老年患者认知障碍的主要特征。我们的研究结果进一步支持了血管性认知障碍的连接性失活概念，并强调了功能连接中断在解释白质微观结构束损伤与认知障碍之间关系中的中介作用。
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