Liu Zijun, Li Muzi, Li Jingwen, Xu Guang, Tian Junzhang, Ma Xiaofen
Guangdong Medical University, Zhanjiang, P. R. China.
Department of Nuclear Medicine, The Affiliated Guangdong Second Provincial General Hospital of Jinan University, No.466 Road XinGang, Guangzhou, 510317, P. R. China.
Brain Imaging Behav. 2025 Jul 17. doi: 10.1007/s11682-025-01041-6.
BACKGROUND: Research has indicated that anti-N-methyl-d-aspartate receptor (anti-NMDAR) encephalitis involves global network dysfunction, linking memory deficits to connectivity in the hippocampus, default mode network (DMN), and medial temporal lobe network (MTL). Most relevant cognitive studies have focused on functional connectivity (FC) rather than effective connectivity (EC), meaning that the directed interactions and causal relationships between the DMN and MTL remain unexplored. METHODS: Herein, we collected resting-state functional MRI (fMRI) data from 23 patients with anti-NMDAR encephalitis (mean age 30.04 ± 12.67 years) and 23 matched controls (mean age 28.87 ± 9.36 years). Spectral dynamic causal modelling (spDCM) was applied to assess the effective connectivity among the 12 predefined regions of interest in the DMN and MTL. RESULTS: Effective connectivity (EC) within and between the DMN and MTL networks significantly differed in the NMDAR-resistant encephalitis group compared to controls; the positive EC within the DMN and from the MTL to the DMN was enhanced, while the negative EC from the DMN to the MTL increased, and the positive EC within the MTL decreased. The mean DMN connectivity values in the anti-NMDAR group were negatively correlated with California Verbal Learning Test (CVLT) and Modified Mental State Examination (MMSE) scores, an effect which remained significant after adjusting for age, sex, and body mass index. CONCLUSION: This study identified differences in the connectivity between the DMN and MTL networks in patients with post-acute anti-NMDAR encephalitis, suggesting a possible disconnection. The parahippocampal gyrus (PHG) mediates connections between the hippocampus and the posterior cingulate cortex (PCC). Structural or functional loss of the PHG may affect the integration between the MTL memory system and DMN nodes, correlating with cognitive deficits. This study provides crucial results to improve our understanding of the directed integration between the DMN and MTL networks, providing new evidence.
背景：研究表明，抗N-甲基-D-天冬氨酸受体（抗NMDAR）脑炎涉及全球网络功能障碍，将记忆缺陷与海马体、默认模式网络（DMN）和内侧颞叶网络（MTL）的连通性联系起来。大多数相关的认知研究都集中在功能连通性（FC）而非有效连通性（EC）上，这意味着DMN和MTL之间的定向相互作用和因果关系仍未得到探索。 方法：在此，我们收集了23例抗NMDAR脑炎患者（平均年龄30.04±12.67岁）和23例匹配对照（平均年龄28.87±9.36岁）的静息态功能磁共振成像（fMRI）数据。应用频谱动态因果模型（spDCM）来评估DMN和MTL中12个预定义感兴趣区域之间的有效连通性。 结果：与对照组相比，抗NMDAR脑炎组DMN和MTL网络内部及之间的有效连通性（EC）存在显著差异；DMN内部以及从MTL到DMN的正向EC增强，而从DMN到MTL的负向EC增加，MTL内部的正向EC减少。抗NMDAR组的平均DMN连通性值与加利福尼亚言语学习测试（CVLT）和简易精神状态检查（MMSE）得分呈负相关，在调整年龄、性别和体重指数后，这种效应仍然显著。 结论：本研究确定了急性抗NMDAR脑炎患者DMN和MTL网络之间连通性的差异，提示可能存在连接中断。海马旁回（PHG）介导海马体与后扣带回皮质（PCC）之间的连接。PHG的结构或功能丧失可能会影响MTL记忆系统与DMN节点之间的整合，与认知缺陷相关。本研究提供了关键结果，以增进我们对DMN和MTL网络之间定向整合的理解，提供了新的证据。
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