Li Mingyu, Shi Yachen, Ma Lin, Mao Haixia, Xu Min, Gao Qianqian, Yang Jiayi, Wang Feng, Fang Xiangming, Hu Xiaoyun
Department of Radiology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University, 299 Qingyang Road, Wuxi City, Jiangsu Province, China.
Department of Neurology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University, 299 Qingyang Road, Wuxi City, Jiangsu Province, China.
Brain Imaging Behav. 2025 Aug 23. doi: 10.1007/s11682-025-01032-7.
This study investigates how cognitive reserve (CR), developed through education and other cognitive activities, can slow cognitive dysfunction in cerebral small vessel disease (CSVD) patients by examining cerebral white matter fiber connectivity. We prospectively enrolled 125 patients with CSVD from the Department of Neurology between 2021 and 2023, including 69 patients with no cognitive impairment (nonCI) and 56 patients with mild cognitive impairment (MCI). Patients were divided into low cognitive reserve (LCR) and high cognitive reserve (HCR) subgroups based on the median of years of education (≤ 9 vs. >9 years). All participants underwent 3.0T MRI scans and neuropsychological assessments. Fractional anisotropy (FA) and mean diffusivity (MD) values of fiber bundles detected by automated fiber quantification (AFQ) were compared among groups by two-way analysis of variance, considering disease state and CR as factors. Correlation analyses examined the relationships between significant fiber segments and cognitive function. We found that the MCI group exhibited decreased FA and increased MD in specific segments of some fiber tracts, such as the corpus callosum splenium, bilateral thalamic radial tracts, and bilateral inferior frontal occipital tracts compared to the nonCI group. The LCR group had decreased FA in the left corticospinal tract and increased MD in the right corticospinal tract compared to the HCR group. Significant interactions of FA values were observed in the left arcuate fasciculus(F = 3.949, P < 0.05), particularly in segments related to information processing speed and memory. The MCI group exhibited poorer white matter fiber integrity than the nonCI group. These findings suggest that the left arcuate fasciculus may partially mediate CR's protective effects on cognitive dysfunction in patients with CSVD.
本研究通过检测脑白质纤维连通性，探讨通过教育和其他认知活动形成的认知储备（CR）如何减缓脑小血管病（CSVD）患者的认知功能障碍。我们于2021年至2023年从神经内科前瞻性纳入了125例CSVD患者，其中69例无认知障碍（nonCI），56例有轻度认知障碍（MCI）。根据受教育年限中位数（≤9年与>9年）将患者分为低认知储备（LCR）和高认知储备（HCR）亚组。所有参与者均接受了3.0T MRI扫描和神经心理学评估。将自动纤维定量（AFQ）检测的纤维束的分数各向异性（FA）和平均扩散率（MD）值作为因素，通过双向方差分析在各组之间进行比较。相关性分析检验了重要纤维节段与认知功能之间的关系。我们发现，与nonCI组相比，MCI组在某些纤维束的特定节段，如胼胝体压部、双侧丘脑放射状束和双侧额枕下束，FA降低，MD升高。与HCR组相比，LCR组左侧皮质脊髓束的FA降低，右侧皮质脊髓束的MD升高。在左侧弓状束观察到FA值有显著交互作用（F = 3.949，P < 0.05），特别是在与信息处理速度和记忆相关的节段。MCI组的白质纤维完整性比nonCI组差。这些发现表明，左侧弓状束可能部分介导CR对CSVD患者认知功能障碍的保护作用。
