| Objective:Structural and functional magnetic resonance multimodality imaging techniques were selected to combine with multidimensional neuropsychological scale scores to explore the multifaceted combination of Re Ho,which indicates local brain functional activity,FC functional indicators,which show the distant connectivity between brain regions,and GMV,which shows the volume of brain gray matter,and the microstructural indicators,which combine with TBSS methods to observe the integrity and degree of impairment of white matter fiber tracts.A multi-faceted approach to explore the central effects of cognitive impairment in VaMCI patients and to screen for specific diagnostic imagingtargets.At the same time,by observing the impact of the immediate effect of acupuncture at Taixi-Feiyang group on Re Ho and FC in patients with VaMCI,analyze the curative effect and mechanism of acupuncture,and find the relevant brain image indexes of cognitive function recovery and remodeling in patients with VaMCI,so as to provide some theoretical basis for clinical acupuncture treatment.Methods:1.Twenty-eight vascular mild cognitive impairment(VaMCI group)cases meeting the inclusion criteria and 28 healthy controls(HC group)were scored on multidimensional neuropsychological scales such as MMSE,Mo CA,MES,and ADL and clinically assessed,and then scanned by structural and functional magnetic resonance multimodal imaging.SPSS V25.0 software was used to compare the demographic data and neuropsychological scales between the two groups of subjects;the collected structural and functional imaging data were post-processed and statistically analyzed using the corresponding software of CAT12,DPARSF and SPM12 based on MATLAB platform,gender,age,years of education and TIV were regressed as covariates,and the data between the groups Independent samples t-test was used to obtain the regions of difference in resting-state Re Ho functional indicators and GMV structural indicators between the two groups as seed points,whole-brain voxel function connections were performed to obtain the FC of differences between the two groups,and the initial thresholds for multiple comparisons correction were P=0.001 for voxel level with uncorrected and P<0.05 for cluster level with FWEc corrected,and image results were obtained using DPABI Viewer and Brain Net Viewer software for presentation.2.The FSL 6.0 software package was used to process and settle the subjects’ DTI data,and the TBSS algorithm was selected to display the white matter fiber tracts with damage in FA,MD,AD,and RD.A nonparametric test model was established in FSL,and age gender as well as years of education were used as covariates,and a nonparametric substitution test was performed using the Randomise command,with 5000 random substitutions.Thresholdfree cluster enhancement(TFCE)correction was used,and P<0.01 was considered a statistically significant difference.The final results were overlaid with the Johns Hopkins JHU-ICBM-labels template to determine the anatomical location in MNI space,and the resulting skeleton maps were used FSLeyes,FSLView for presentation.3.Under the control of age,gender,years of education and the degree of cerebrovascular disease,Pearson correlation analysis method and multidimensional neuropsychological scale were used to evaluate the correlation between the significantly different structural and functional indexes of VaMCI patients and the field of cognitive impairment.4.Acupuncture the Taixi-Feiyang group point on the right side of VaMCI subjects,and perform f MRI scanning in the needle retention state.Compare the functional data of the acupuncture VaMCI group with that of the resting VaMCI group and HC group to obtain the differential Re Ho brain region,and the comparison between groups adopts single sample t-test and independent sample t-test respectively;The whole-brain voxel FC in the acupuncture state of the VaMCI group was extended with the seed points selected in the previous part of the study and compared with that in the resting state of VaMCI to obtain the FC difference area.The initial threshold of multiple comparison correction was voxel level P=0.001(uncorrected),cluster level P<0.05(FWEC correction).The above image results were presented by DPABI Viewer and Brain Net Viewer software.Results:1.Comparison of general clinical data There was no significant difference in age,gender,years of education and TIV between VaMCI group and HC control group(P>0.05);There were significant differences in MMSE,Mo CA and Fazekas scores between the two groups(P<0.05);Compared with HC group,there were significant differences in MES scores of immediate memory,short delayed memory,long delayed memory,finger deduction test,executive ability,executive factor(MES-E),memory factor(MES-M)and MES total score in VaMCI group(P<0.05),but there was no significant difference in fluency(P>0.05).2.Results of differences in structural and functional indexes between VaMCI test group and HC control group before acupuncture(1)Difference of gray matter volume(GMV): compared with HC group,the brain areas with reduced GMV in VaMCI group before acupuncture are:left middle temporal gyrus,right rectus muscle of right gyrus,right lenticular globus pallidus,left lingual gyrus,left hippocampus,right lingual gyrus,right hippocampus,right perispastic cortex,left anterior cingulate gyrus and paracingulate gyrus,left wedge lobe,left middle frontal gyrus,left inferior frontal gyrus of insula,right medial and paracingulate gyrus;The brain areas with increased GMV were left supraorbital frontal gyrus and left medial suprafrontal gyrus.(2)Before acupuncture,the brain areas with higher Re Ho value in VaMCI group than HC group were: left inferior temporal gyrus,right orbital middle frontal gyrus,left lingual gyrus and left orbital inferior frontal gyrus;The brain areas with reduced Re Ho value are: left thalamus,left middle temporal gyrus,left middle occipital gyrus,right medial and paracingulate gyrus,right posterior central gyrus and left anterior central gyrus.(3)Based on the difference between the structural and functional outcomes of the two groups of subjects: GMV and Re Ho values,six seed points were selected for functional connection analysis with whole brain voxels.The seed points were: left inferior frontal gyrus(seed 1),right middle frontal gyrus(seed 2),left wedge lobe(seed 3),right perispastic cortex(seed4),left middle temporal gyrus(seed 5)and left hippocampus(seed 6).The functional connection between seed 1 and the right fusiform gyrus,the right suboccipital gyrus,the right middle temporal gyrus and the left middle frontal gyrus decreased,and the functional connection with the right perithalamic cortex and the right central posterior gyrus increased;The connection between seed 2 and left inferior temporal gyrus,left inferior occipital gyrus and right medial superior frontal gyrus decreased,and there was no area with increased functional connection;The connection between seed 3 and right caudate nucleus,left precuneus decreased,and the connection between seed 3and right temporal pole superior temporal gyrus,left insula,left middle frontal gyrus and right dorsolateral superior frontal gyrus increased;The connection between seed 4 and the inferior frontal gyrus of the right orbital,the right superior temporal gyrus and the right inferior frontal gyrus of the right triangle decreased,and the connection with the right cerebellar peduncle1 area increased;The connection between seed 5 and right middle frontal gyrus,right superior parietal gyrus and right dorsolateral superior frontal gyrus decreased,and there was no brain area with enhanced functional connection;Seed 6 decreased the connection with the left parahippocampal gyrus and the right thalamus,and increased the connection with the left fusiform gyrus,the left middle occipital gyrus,the left inferior frontal gyrus and the left posterior central gyrus.3.Before acupuncture,the DTI indexes of VaMCI test group were different from those of HC control group(1)Before acupuncture,the FA of VaMCI group was significantly lower than that of HC control group.The white matter tracts were: corpus callosum radiation occipital,corpus callosum,right inferior longitudinal tract,left anterior thalamic radiation,left inferior longitudinal tract,left corticospinal tract,right inferior frontal occipital tract and right inferior cerebellar foot;No obvious increase of FA was found in white matter tract.(2)Before acupuncture,the MD of VaMCI group was significantly higher than that of HC control group.The white matter tracts were: left anterior posterior radiation,left upper longitudinal tract,right corticospinal tract,occipital part of corpus callosum radiation line;MD did not significantly reduce the white matter bundle.(3)Before acupuncture,the RD of VaMCI group was significantly higher than that of HC control group.The white matter bundles were: corpus callosum,right lower frontal occipital bundle,right external capsule,right upper longitudinal bundle,occipital part of corpus callosum radiation line and left upper longitudinal bundle;No white matter bundle was found.(4)The significantly higher white matter bundles in the VaMCI group compared to the HC group with AD were: left lower frontal occipital tract,right lower frontal occipital tract and left upper longitudinal tract;No ad reduced white matter tract was found.4.The difference between acupuncture VaMCI group and resting VaMCI group and HC control group before acupuncture(1)In VaMCI group,the brain regions with lower Re Ho in acupuncture state than in resting state are: left upper cerebellar region 1,right cerebellar region 6 and right insula;Re Ho increased brain areas include left suboccipital gyrus,left anterior central gyrus and right posterior central gyrus.(2)VaMCI subjects in the acupuncture state compared to HC controls in the resting state Re Ho-reduced brain regions were: left orbital middle frontal gyrus and right orbital middle frontal gyrus;Re Ho increased brain areas include: left suboccipital gyrus,right anterior central gyrus,left posterior central gyrus and left paracentral lobule.(3)Results of FC changes in acupuncture state compared with resting state in VaMCI test group: the FC of seed 1 and right inferior temporal gyrus,right middle temporal gyrus,left middle temporal gyrus,left central posterior gyrus,right superior marginal gyrus,right central posterior gyrus,left precuneus and right superior parietal gyrus decreased;The FC of seed 2 and left superior temporal gyrus,right medial superior frontal gyrus,right wedge lobe and left central posterior gyrus decreased;Seed 3 and FC decreased in left middle temporal gyrus,left fusiform gyrus,right lingual gyrus,left insula,right middle temporal gyrus,right perithalamic cortex and left central posterior gyrus;Seed 4 decreased with FC in left lingual gyrus,left wedge,right supplementary motor area and left precuneus;The FC of seed 5 and right lingual gyrus,left lingual gyrus,right fusiform gyrus and right middle temporal gyrus decreased;The FC of seed 6 and left orbital middle frontal gyrus,left dorsolateral superior frontal gyrus and left anterior central gyrus decreased;None of the above showed enhanced brain areas with seed point FC.5.Correlation between resting imaging indexes and neuropsychological scale scores In this study,there were significant differences between the resting VaMCI group and the healthy control group.The correlation between the structural or functional index data extracted from the brain region and the score of the clinical scale was analyzed.It was found that the Re Ho value of the left anterior central gyrus in the resting VaMCI group was significantly positively correlated with MMSE score(r=0.400,P=0.035)and long delayed memory(r= 0.445,P=0.018);The Re Ho value of left inferior temporal gyrus was significantly negatively correlated with MMSE score(r=-0.523,P=0.004);There was a significant positive correlation between GMV in the inferior frontal gyrus of the left insula and short delayed memory(r=0.431,P=0.040);There was a significant positive correlation between GMV value of left orbital superior frontal gyrus and MES-E score(r=0.510,P=0.013);The FC values of left wedge lobe and left middle frontal gyrus were significantly negatively correlated with Mo CA score(r=-0.490,P=0.008)and mes-t(r=-0.470,P=0.012);The FC values of left hippocampus and left fusiform gyrus were significantly negatively correlated with immediate memory(r=-0.448,P=0.017)and short delayed memory(r=-0.510,P=0.006);There was a significant positive correlation between the FC values of the left parastriatal cortex and the right superior temporal gyrus and long-term delayed memory(r=0.553,P=0.002).Conclusion:1.The decrease of gray matter volume(GMV),local consistency(Re Ho)and functional connectivity(FC)in multiple brain regions in patients with VaMCI suggest that the brain structure and function damage in specific regions is the central mechanism of cognitive impairment in patients with VaMCI.At the same time,there is an increase in the structural and functional indexes of some brain regions,which is speculated to be a compensation mechanism for the cognitive function of VaMCI.2.In VaMCI patients,the microstructure of white matter fiber bundle in the areas of controlling attention and executive function,language semantic processing and discriminative memory is damaged in many aspects,resulting in the possible damage of corresponding cognitive domain due to the obstacle of information transmission,indicating that the integrity of brain tissue structure is the basis of brain function execution.3.The changes of brain structural indexes(GMV,FA,MD,AD,RD)and functional indexes(Re Ho,FC)in patients with VaMCI describe the damage of cognitive domain and cognitive dimension from multiple angles,which can be used as specific imaging diagnostic indexes of VaMCI,and provide a certain objective basis for early identification,prognosis and curative effect of patients.4.Screening of functional indicators of brain regions that appear relatively specific to VaMCI under the immediate effect of acupuncture at the right Taixi-Feiyang group of points: Re Ho of right orbital middle frontal gyrus,left suboccipital gyrus,right central posterior gyrus and left central anterior gyrus;FC of left orbital inferior frontal gyrus and right middle temporal gyrus,right central posterior gyrus,left wedge lobe and left insula.The changes of these brain function indexes objectively reflect that acupuncture at Taixi-Feiyang group regulates the corresponding changes of brain center in patients with VaMCI.The full range decrease of FC under acupuncture may be caused by acupuncture inhibiting DMN function and slowing down cerebral blood flow.5.The Re Ho values of left anterior central gyrus and left inferior temporal gyrus,the GMV values of left inferior frontal gyrus and left supraorbital frontal gyrus,the FC values of left wedge lobe and left middle frontal gyrus,left hippocampus and left fusiform gyrus,right prefrontal cortex and right superior temporal gyrus have strong correlation with the scores of some clinical scales,which can be used as an imaging biomarker to predict the clinical outcome of VaMCI patients. |
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