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计算机化认知训练对轻度认知障碍患者多个脑网络结构-功能耦合和拓扑的影响:一项随机对照试验。

Effects of computerized cognitive training on structure‒function coupling and topology of multiple brain networks in people with mild cognitive impairment: a randomized controlled trial.

机构信息

College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China.

The Academy of Rehabilitation Industry, Fujian University of Traditional Chinese Medicine, Fuzhou, China.

出版信息

Alzheimers Res Ther. 2023 Sep 23;15(1):158. doi: 10.1186/s13195-023-01292-9.


DOI:10.1186/s13195-023-01292-9
PMID:37742005
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10517473/
Abstract

BACKGROUND: People with mild cognitive impairment (MCI) experience a loss of cognitive functions, whose mechanism is characterized by aberrant structure‒function (SC-FC) coupling and topological attributes of multiple networks. This study aimed to reveal the network-level SC-FC coupling and internal topological changes triggered by computerized cognitive training (CCT) to explain the therapeutic effects of this training in individuals with MCI. METHODS: In this randomized block experiment, we recruited 60 MCI individuals and randomly divided them into an 8-week multidomain CCT group and a health education control group. The neuropsychological outcome measures were the Montreal Cognitive Assessment (MoCA), Chinese Auditory Verbal Learning Test (CAVLT), Chinese Stroop Color-Word Test (SCWT), and Rey-Osterrieth Complex Figure Test (Rey CFT). The brain imaging outcome measures were SC-FC coupling and topological attributes using functional MRI and diffusion tensor imaging methods. We applied linear model analysis to assess the differences in the outcome measures and identify the correspondence between the changes in the brain networks and cognitive functions before and after the CCT. RESULTS: Fifty participants were included in the analyses after the exclusion of three dropouts and seven participants with low-quality MRI scans. Significant group × time effects were found on the changes in the MoCA, CAVLT, and Rey CFT recall scores. The changes in the SC-FC coupling values of the default mode network (DMN) and somatomotor network (SOM) were higher in the CCT group than in the control group (P(unc.) = 0.033, P(unc.) = 0.019), but opposite effects were found on the coupling values of the visual network (VIS) (P(unc.) = 0.039). Increasing clustering coefficients in the functional DMN and SOM and subtle changes in the nodal degree centrality and nodal efficiency of the right dorsal medial prefrontal cortex, posterior cingulate cortex, left parietal lobe, somatomotor area, and visual cortex were observed in the CCT group (P < 0.05, Bonferroni correction). Significant correspondences were found between global cognitive function and DMN coupling values (P(unc.) = 0.007), between immediate memory and SOM as well as FPC coupling values (P(unc.) = 0.037, P(unc.) = 0.030), between delayed memory and SOM coupling values (P(unc.) = 0.030), and between visual memory and VIS coupling values (P(unc.) = 0.007). CONCLUSIONS: Eight weeks of CCT effectively improved global cognitive and memory functions; these changes were correlated with increases in SC-FC coupling and changes in the topography of the DMN and SOM in individuals with MCI. The CCT regimen also modulated the clustering coefficient and the capacity for information transformation in functional networks; these effects appeared to underlie the cognitive improvement associated with CCT. TRIAL REGISTRATION: Chinese Clinical Trial Registry, ChiCTR2000034012. Registered on 21 June 2020.

摘要

背景:轻度认知障碍(MCI)患者会出现认知功能丧失,其机制的特征是异常的结构-功能(SC-FC)耦合和多个网络的拓扑属性。本研究旨在揭示计算机认知训练(CCT)引发的网络级 SC-FC 耦合和内部拓扑变化,以解释该训练对 MCI 个体的治疗效果。

方法:在这项随机分组实验中,我们招募了 60 名 MCI 患者,并将他们随机分为 8 周的多领域 CCT 组和健康教育对照组。神经心理学评估包括蒙特利尔认知评估(MoCA)、中国听觉词语学习测验(CAVLT)、中国斯特鲁普色词测验(SCWT)和 Rey-Osterrieth 复杂图形测验(Rey CFT)。脑影像评估包括使用功能磁共振成像和弥散张量成像方法测量 SC-FC 耦合和拓扑属性。我们应用线性模型分析来评估结果测量的差异,并确定 CCT 前后脑网络和认知功能变化之间的对应关系。

结果:在排除了 3 名辍学者和 7 名 MRI 扫描质量低的参与者后,有 50 名参与者纳入了分析。MoCA、CAVLT 和 Rey CFT 回忆评分的变化在 CCT 组和对照组之间存在显著的组间时间效应。默认模式网络(DMN)和躯体运动网络(SOM)的 SC-FC 耦合值在 CCT 组的变化高于对照组(Punc. = 0.033,Punc. = 0.019),而视觉网络(VIS)的耦合值则相反(Punc. = 0.039)。在 CCT 组中,观察到功能性 DMN 和 SOM 的聚类系数增加,右侧背内侧前额叶皮质、后扣带回皮质、左侧顶叶、躯体运动区和视觉皮层的节点度中心性和节点效率的细微变化(P < 0.05,Bonferroni 校正)。在 CCT 组中,还发现了整体认知功能与 DMN 耦合值之间(Punc. = 0.007)、即刻记忆与 SOM 以及 FPC 耦合值之间(Punc. = 0.037,Punc. = 0.030)、延迟记忆与 SOM 耦合值之间(Punc. = 0.030)以及视觉记忆与 VIS 耦合值之间(Punc. = 0.007)的显著对应关系。

结论:8 周的 CCT 可有效改善整体认知和记忆功能;这些变化与 MCI 患者 SC-FC 耦合的增加以及 DMN 和 SOM 拓扑的变化有关。CCT 方案还调节了功能网络的聚类系数和信息转换能力;这些效应似乎是 CCT 相关认知改善的基础。

试验注册:中国临床试验注册中心,ChiCTR2000034012。注册于 2020 年 6 月 21 日。

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本文引用的文献

[1]
Nonlinear changes in delayed functional network topology in Alzheimer's disease: relationship with amyloid and tau pathology.

Alzheimers Res Ther. 2023-6-16

[2]
Structural But Not Functional Connectivity Differences within Default Mode Network Indicate Conversion to Dementia.

J Alzheimers Dis. 2023

[3]
Coupling of brain activity and structural network in multiple sclerosis: A graph frequency analysis study.

J Neurosci Res. 2022-5

[4]
Convergent Functional Changes of Default Mode Network in Mild Cognitive Impairment Using Activation Likelihood Estimation.

Front Aging Neurosci. 2021-10-5

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Increased segregation of structural brain networks underpins enhanced broad cognitive abilities of cognitive training.

Hum Brain Mapp. 2021-7

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Cereb Cortex. 2021-3-5

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Brain functional network integrity sustains cognitive function despite atrophy in presymptomatic genetic frontotemporal dementia.

Alzheimers Dement. 2021-3

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Functional MRI-Specific Alterations in Executive Control Network in Mild Cognitive Impairment: An ALE Meta-Analysis.

Front Aging Neurosci. 2020-10-9

[9]
Selective Aberrant Functional-Structural Coupling of Multiscale Brain Networks in Subcortical Vascular Mild Cognitive Impairment.

Neurosci Bull. 2021-3

[10]
Sex modulates the apolipoprotein E ε4 effect on white matter and cortical functional connectivity in individuals with amnestic mild cognitive impairment.

Eur J Neurol. 2020-8

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