| Objective:To screen brain regions or networks with significant differences in structural and functional indexes of a MCI patients before acupuncture,and explore the central effect mechanism of Yuan-Luo Tongjing acupuncture method in improving cognitive function of a MCI patients.This study confirms the hypothesis that Yuan-Luo Tongjing acupuncture method can remodel the function of memory-related brain regions in a MCI patients and improve cognitive impairment by reconstructing microstructure and functional network connectivity of brain regions.To provide an objective theoretical basis for clinical acupuncture treatment.Materials and Methods:1.30 a MCI patients(a MCI group)and 32 healthy control volunteers(HC group)who met the inclusion criteria were scored with multidimensional neuropsychological scales,and structural and functional multimodal magnetic resonance imaging scans were performed in parallel.Demographic data and neuropsychological test scores were compared between with two groups using SPSS V25.0 software.The image data were preprocessed and statistically analyzed using FSL6.0 software package and corresponding software of CAT12,DPARSF and SPM12 based on MATLAB platform.Independent sample t-test was used to regress gender,age,years of education and total intracranial volume(TIV)as covariates.The differences in structural index(GMV,FA)and functional index(Re Ho,FC)between the two groups were obtained(FC was calculated using GMV and Re Ho differential brain regions as seed points),and brain regions and networks with significant differences were screened.The results were presented using xj View and Brain Net Viewer software.The initial thresholds for multiple comparison correction were voxels level P = 0.001(uncorrected),clusters level P < 0.05(FWEc corrected).2.30 patients with a MCI were treated with Yuan-Luo Tongjing acupuncture method,14 days as a course of treatment,a total of 2 courses.After the end of the treatment,a multi-dimensional neuropsychological scale scores was performed on the a MCI patients,and the structure and function of the multi-modal magnetic resonance imaging scan was performed.The clinical scale score and imaging data of patients with a MCI before and after acupuncture treatment were statistically analyzed(paired sample t-test)using the above software package,calculating the difference in structure index(FA)and function index(Re Ho,FC,FC calculation using the same seed points as above).The multiple comparison correction is the same as above.3.Local network analysis.Further analysis of the local brain function network among the selected 5 seed points was carried out to obtain the network connection mode of HC group,a MCI group before and after acupuncture,and the network differences of a MCI group before and after treatment compared with HC group.FDR was used for multiple comparison correction,P < 0.05.4.Correlation analysis.SPSS V25.0 software was used to make Pearson correlation analysis between the values of GMV,FA,Re Ho and FCz in brain areas with significant differences and scores of neuropsychological scale.Gender,age,years of education and TIV were used as covariates for regression.The difference is statistically significant in terms of P < 0.05.Results:1.Comparative results of demographic and neuropsychological scale scoresThere are no significant differences between with two groups in age,gender,education years and TIV(P > 0.05),while there are significant differences in neuropsychological scores,namely MMSE,Mo CA,TMT-A,TMT-B,DST sequential recitation,DST reverse recitation,VFT,AVLT immediate memory,AVLT delay memory,AVLT recognition(P < 0.05).Compared with before acupuncture,in group a MCI after acupuncture treatment,multidimensional neuropsychological scores,namely MMSE,Mo CA,TMT-A,TMT-B,DST sequential recitation,DST reverse recitation,VFT,AVLT instant memory,AVLT delay memory are statistically significant(P < 0.05),whereas there is not significant difference in AVLT recognition score(P > 0.05).2.The differences of structure and function MRI indexes between the a MCI group before acupuncture and the HC group(1)Changes in gray matter volume(GMV)Compared with the HC group,the brain areas with decreased GMV in the a MCI group before acupuncture include the right cerebellum area 6,right parahippocampal gyrus,right inferior occipital gyrus,right temporal superior gyrus,right insular,right occipital middle gyrus,left inferior frontal gyrus of triangular part,right thalamus,right hippocampus,while the brain areas of GMV enlargement include left calcarine cortex,left lingual gyrus.(2)Changes in fractional anisotropy(FA)Compared with the HC group,the brain areas with decreased FA values include the right calcarine cortex,bilateral middle frontal gyrus and right superior parietal gyrus,while the brain areas with increased FA values include the left lingual gyrus in the a MCI group before acupuncture.(3)Changes in regional homogeneity(Re Ho)Compared with the HC group,the brain areas with decreased Re Ho values in the a MCI group include the right cerebellum area 9,bilateral parahippocampal gyrus,left superior temporal gyrus,right inferior frontal gyrus of triangular part,left medial superior frontal gyrus,while the brain areas with increased Re Ho values include the left cerebellum area 8,right thalamus,right middle cingulate gyrus.(4)Changes in functional connectivity(FC)According to the differences of GMV and Re Ho values between the two groups,5 seed points were selected,namely the left calcarine cortex(seed 1),the left inferior frontal gyrus of triangular part(seed 2),the right parahippocampal gyrus(seed 3),the left superior temporal gyrus(seed 4),and the right hippocampus(seed 5),which were respectively analyzed for correlation functional connectivity with whole brain voxels.Compared with HC group,in a MCI group before acupuncture,the FC between the seed 1 and right parahippocampal gyrus and right superior temporal gyrus decreases,while the FC between the seed 1 and right cerebellar area 9 enhances.The FC between the seed 2 and left superior temporal gyrus,right insular,left paracentral lobule decreases,and brain areas of FC enhancement are not found.The FC between the seed 3 and right hippocampus,left calcarine cortex,left middle frontal gyrus and right superior parietal gyrus decreases,while the FC between the seed 3 and left cerebellum area 8,left inferior temporal gyrus,right supramarginal gyrus enhances.The FC between the seed 4 and right middle cingulate,left inferior frontal gyrus of triangular part decreases,while the FC between the seed 4 and left cerebellar foot area 1 enhances.The FC between the seed 5 and bilateral parahippocampal gyrus,right posterior cingulate and left precuneus decreases,and brain areas of FC enhancement are not found.3.Comparison of structure and functional MRI indicators in a MCI group before and after acupuncture treatment(1)Changes in fractional anisotropy(FA)Compared with before acupuncture,the brain areas of FA enlargement in group a MCI after acupuncture include the right cerebellar peduncles area 2,left middle frontal gyrus,right superior parietal gyrus,left precuneus,right calcarine cortex,while the brain areas of FA decrease include the right middle occipital gyrus.Among them,the FA values of the left middle frontal gyrus,right superior parietal gyrus,right calcarine cortex and white matter decrease before acupuncture,and increase after acupuncture.There are not significant differences between a MCI group after acupuncture and HC group(P > 0.05).(2)Changes in regional homogeneity(Re Ho)Compared with before acupuncture,the brain areas with increased Re Ho value in a MCI group after acupuncture treatment include the left superior temporal gyrus,left angular gyrus,right medial superior frontal gyrus,left posterior central gyrus and left medial superior frontal gyrus,while the brain areas with decreased Re Ho values include the right cerebellum 8 area and left inferior occipital gyrus.Among them,the Re Ho values of the left medial superior frontal gyrus and the left superior temporal gyrus decrease before acupuncture,increase after acupuncture,while the R e Ho values of the right cerebellum area 8 increase before acupuncture,and decrease after acupuncture.There are not significant differences in Re Ho values between a MCI group after acupuncture and HC group(P > 0.05).(3)Changes in functional connectivity(FC)Select the same 5 seed points as above.Compared with before acupuncture,in a MCI group after acupuncture,the FC between the seed 1 and right inferior frontal gyrus of triangular part,right middle frontal gyrus,right medial superior frontal gyrus,right superior temporal gyrus enhances,and no brain areas with decreased FC are found.The FC between the seed 2 and right inferior frontal gyrus of triangular part,right dorsolateral superior frontal gyrus,right insula,right cerebellar foot area 1 enhances,whereas between the seed 2 and left middle temporal gyrus,left supramarginal gyrus decreases.The FC between the seed 3 and right orbital medial frontal gyrus,right dorsolateral superior frontal gyrus,right superior parietal gyrus,right superior temporal gyrus enhances,and no brain areas with decreased FC are found.The FC between the seed 4 and right hippocampus,right middle cingulate gyrus,right orbital frontal medial gyrus,right central anterior gyrus,right putamen enhances,and no brain areas with decreased FC are found.The FC between the seed 5 and left superior temporal gyrus,left precuneus,right supramarginal gyrus enhances,and no brain areas with decreased FC are found.Among them,The FCz values between seed 1 and right superior temporal gyrus,between seed 2 and right insula,between seed 3 and right parietal gyrus,between seed 4 and right middle cingulate gyrus,between seed 5 and left precuneus decrease before acupuncture and increase after acupuncture treatment,whereas the FCz values between seed 2 and left middle temporal gyrus increase before acupuncture and decrease after acupuncture.There are not significant differences in FCz values between the a MCI group after acupuncture and the HC group(P>0.05).4.Changes of local network connection among seed pointsThe results show that HC group is fully connected network mode after single sample t test;the numbers of edges in a MCI before acupuncture network decrease significantly.After acupuncture treatment,the numbers of brain network functional junction edges in the a MCI group increase and approache the HC group.Compared with HC group,the FC between right hippocampus and right parahippocampal gyrus,left superior temporal gyrus,between right parahippocampal gyrus and left inferior frontal gyrus of triangular part,left calcarine cortex,between left inferior frontal gyrus of triangular part and left superior temporal gyrus decreases in a MCI group before acupuncture.The FC between the left inferior frontal gyrus of triangular part and left calcarine cortex,left superior temporal gyrus decreases in a MCI group after acupuncture.5.The correlation between imaging indicators and neuropsychological scale scoresThis study analyzed the correlation between the structural and functional indicator data extracted from the brain regions with significant differences and the clinical scale scores,and found that the GMV of the left inferior frontal gyrus of triangular part is significantly positively correlated with verbal fluency test(VFT)score(r = 0.469,p = 0.010)in the a MCI group before acupuncture.After acupuncture,there is a significant positive correlation between FA and MMSE score in the right superior parietal gyrus in the a MCI group(r = 0.426,P = 0.019).The Re Ho values of the left medial superior frontal gyrus is significantly negatively correlated with TMT-B(r =-0.449,P = 0.013).The Re Ho values of left superior temporal gyrus is positively correlated with the DST sequential recitation test scores(r = 0.442,P = 0.015).The FCz values between the left superior temporal gyrus and the right hippocampus is significantly positively correlated with the Mo CA score(r = 0.479,P = 0.007).The FCz values between the left inferior frontal gyrus of triangular part and the right insular is significantly positively correlated with the AVLT delayed memory test score(r = 0.415,p = 0.023).The FCz values between the right parahippocampal gyrus and right superior parietal gyrus is significantly positively correlated with DST sequential recitation test scores(r = 0.488,P = 0.006).The FCz values between the right hippocampus and the left praecuneus is significantly positively correlated with AVLT immediate memory test scores(r = 0.431,P = 0.018).Conclusion:1.The decrease of gray matter volume(GMV),fractional anisotropy(FA),regional homogeneity(Re Ho)and functional connectivity(FC)in multiple brain functional areas in patients with a MCI suggests that the impairment of brain structure and functional connectivity is the central mechanism leading to cognitive impairment.The increase of structural and functional imaging indexes in some brain regions presumably compensates for the damaged brain regions.2.Compared with HC group,brain regions or networks with significant differences in structural and functional indicators of a MCI patients were screened out.After acupuncture treatment,these brain regions or networks indicators changed significantly,and multiple indicators had strong correlation with clinical scale scores,which objectively reflected that acupuncture treatment can promote the reconstruction of brain structural and functional connectivity in a MCI patients.Some indicators are expected to become imaging biomarkers for diagnosis,evaluation and prediction of a MCI.3.It has been proved that the Yuan-Luo Tongjing acupuncture method can improve the cognitive function of patients with a MCI,and the curative effect is significant.Acupuncture has not only relatively specific therapeutic effect,but also two-way benign regulatory effect.4.The theoretical hypothesis that Yuan-Luo Tongjing acupuncture method can remodel the function of memory-related brain regions in a MCI patients and improve cognitive impairment by reconstructing microstructure and functional network connectivity of brain regions was elaborated.It indicates that acupuncture can remodel and integrate brain function.To objectively reveal the brain center response mechanism of acupuncture treatment from the perspective of imaging. |
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