Du Jing, Zhu Hong, Zhou Jie, Lu Peiwen, Qiu Yage, Yu Ling, Cao Wenwei, Zhi Nan, Yang Jie, Xu Qun, Sun Junfeng, Zhou Yan
Renji-UNSW CHeBA Neurocognitive Center, Renji Hospital, Medical School of Shanghai Jiao Tong University, Shanghai 200127, China; Department of Neurology, Renji Hospital, Medical School of Shanghai Jiao Tong University, Shanghai 200127, China; Department of Health Management Center, Renji Hospital, Medical School of Shanghai Jiao Tong University, Shanghai 200127, China.
Shanghai Med-X Engineering Research Center, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200030, China.
Neuroscience. 2020 Nov 21;449:99-115. doi: 10.1016/j.neuroscience.2020.08.037. Epub 2020 Sep 4.
Cerebral small vessel disease (CSVD) is a common disease among elderly individuals and recognized as a major cause of vascular cognitive impairment. Recent studies demonstrated that CSVD is a disconnection syndrome. However, due to the covert neurological symptoms and subtle changes in clinical performance, the connection alterations during the stage of preclinical cognitive impairment (PCI) and mild cognitive impairment (MCI) are usually neglected and still largely unknown. Using diffusion tensor imaging (DTI), we investigated the early structural network changes in PCI and MCI patients. The PCI group demonstrated well preserved rich-club organization, less nodal strength loss, and disruption of connections centered in the feeder and local connections. Nevertheless, the MCI group manifested a disruption in the rich-club organization, a worse nodal strength loss especially in hub nodes, and an overall disturbance in rich-club, feeder and local connections. Moreover, in all CSVD patients, the strength of the rich-club, feeder and local connections was significantly correlated with multiple cognitive scores, especially in attention, executive, and memory domains; while in MCI patients, only the strength of the rich-club connections was significantly correlated with cognition. Furthermore, based on the network-based statistic analysis, we also identified distinct network component disruption pattern between the PCI group and the MCI group, validating the results described above. These results suggest a disruption pattern from peripheral to central connections with the change of cognitive status, shedding light on the early identification and the underlying disruption of CSVD.
脑小血管病（CSVD）是老年人中的常见疾病，被认为是血管性认知障碍的主要原因。最近的研究表明，CSVD是一种脱节综合征。然而，由于隐匿的神经症状和临床表现的细微变化，临床前认知障碍（PCI）和轻度认知障碍（MCI）阶段的连接改变通常被忽视，并且在很大程度上仍然未知。我们使用扩散张量成像（DTI）研究了PCI和MCI患者早期的结构网络变化。PCI组显示出丰富俱乐部组织保存良好，节点强度损失较少，以及以馈线和局部连接为中心的连接中断。然而，MCI组表现出丰富俱乐部组织的破坏，尤其是枢纽节点处更严重的节点强度损失，以及丰富俱乐部、馈线和局部连接的整体紊乱。此外，在所有CSVD患者中，丰富俱乐部、馈线和局部连接的强度与多个认知评分显著相关，尤其是在注意力、执行和记忆领域；而在MCI患者中，只有丰富俱乐部连接的强度与认知显著相关。此外，基于基于网络的统计分析，我们还确定了PCI组和MCI组之间不同的网络组件破坏模式，验证了上述结果。这些结果表明，随着认知状态的变化，从外周到中枢连接存在破坏模式，为CSVD的早期识别和潜在破坏提供了线索。
