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中风后认知障碍:基于先进神经影像学分析技术对脑失连接组的病理生理学见解

Post-Stroke Cognitive Impairment: Pathophysiological Insights into Brain Disconnectome from Advanced Neuroimaging Analysis Techniques.

作者信息

Lim Jae-Sung, Lee Jae-Joong, Woo Choong-Wan

机构信息

Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Department of Biomedical Engineering, Sungkyunkwan University, Suwon, Korea.

出版信息

J Stroke. 2021 Sep;23(3):297-311. doi: 10.5853/jos.2021.02376. Epub 2021 Sep 30.

Abstract

The neurological symptoms of stroke have traditionally provided the foundation for functional mapping of the brain. However, there are many unresolved aspects in our understanding of cerebral activity, especially regarding high-level cognitive functions. This review provides a comprehensive look at the pathophysiology of post-stroke cognitive impairment in light of recent findings from advanced imaging techniques. Combining network neuroscience and clinical neurology, our research focuses on how changes in brain networks correlate with post-stroke cognitive prognosis. More specifically, we first discuss the general consequences of stroke lesions due to damage of canonical resting-state large-scale networks or changes in the composition of the entire brain. We also review emerging methods, such as lesion-network mapping and gradient analysis, used to study the aforementioned events caused by stroke lesions. Lastly, we examine other patient vulnerabilities, such as superimposed amyloid pathology and blood-brain barrier leakage, which potentially lead to different outcomes for the brain network compositions even in the presence of similar stroke lesions. This knowledge will allow a better understanding of the pathophysiology of post-stroke cognitive impairment and provide a theoretical basis for the development of new treatments, such as neuromodulation.

摘要

传统上,中风的神经症状为大脑功能图谱的绘制奠定了基础。然而,在我们对大脑活动的理解中,仍有许多未解决的方面,尤其是关于高级认知功能。鉴于先进成像技术的最新发现,本综述全面审视了中风后认知障碍的病理生理学。结合网络神经科学和临床神经学,我们的研究重点在于大脑网络的变化如何与中风后的认知预后相关联。更具体地说,我们首先讨论由于典型静息态大规模网络受损或整个大脑组成变化而导致的中风病变的一般后果。我们还回顾了用于研究中风病变引起的上述事件的新兴方法,如病变网络映射和梯度分析。最后,我们研究了其他患者易损因素,如叠加的淀粉样蛋白病变和血脑屏障渗漏,即使在存在相似中风病变的情况下,这些因素也可能导致大脑网络组成出现不同的结果。这些知识将有助于更好地理解中风后认知障碍的病理生理学,并为神经调节等新治疗方法的开发提供理论基础。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/645f/8521255/2f2e9470b482/jos-2021-02376f1.jpg

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