| Part OneBrain grey matter volume analysis in End-Stage Renal Disease hemodialysis patients based on Voxel-Based MorphometryPurpose:To determine whether the gray matter volume changes in patients with end-stage renal disease?ESRD?and to observe which pattern of this change in follow-up.Materials and methods:This investigation was authorized by the local medical ethics committee.All the enrolled participants were informed and provided written consent before involving this study.Forty-five ESRD patients?male:26,female:19,51.7 ± 8.4 years old,from 27 to 71 years old?with ESRD,as well as 32 age-,sex-and education-matched healthy controls?HC??male:16,female:16,48.9 ± 10.9 years old,from 25 to 66 years old?were recruited.MRI,blood and cognitive function tests were performed in all subjects before dialysis.Among the ESRD patients,18 patients?male:11,female:7,48.9 ± 8.3 years old?were recruited again after 15.4 ±8.2 months and went through all the same examination as follow-up group.Nine neuropsychological tests were used to evaluate the cognitive function,including mini-mental state examination?MMSE?,digital span test?DST?,semantic similarity test?SST?,digital symbol Substitution test?DSST?,verbal fluency test?VFT?,trail making test parts A and B?TMT-A and TMT-B?,clock drawing test?CDT?,Auditory Verbal Learning Test?AVLT?and Hamilton's Depression Scale?HAMD?.The differences between each group were compared using t test and correlation analysis were performed to assess the relationships between gray matter volumes and cognitive impairment as well as clinical data in ESRD patients.Results:Compared to HC,the gray volumes with bilateral limbic system?parahippocampus,amygdaloid nucleus,caudatum,putamen,lenticular nucleus and hippocampus?and occipital lobe?bilateral cuneus,left lingual gyrus,left calcarine sulcus and left occipital gyrus?were significantly decreased in ESRD patients?p<0.01 AlphaSim corrected?,moreover,the scores in DST?11.2 ± 2.6 vs13.5±3.0,p=0.003?,SST?12.7±5.5vs17.3±4.0,p = 0.001?,DSST?31.0±12.8vs 45.6±13.8,p<0.001?,TMT-A?72.4 ± 36.0 vs 49.6 ± 13.5,p = 0.001?,TMT-B?170.2 ± 665 vs 116.5 ± 36.3,p<0.001?,and CDT?2.61 ± 0.79 vs 3.48 ± 0.60,p<0.001?were also lower.The gray matter volumes of left limbic system were positively correlated with DSST scores?r = 0.331,p = 0.045?,but negatively with TMT-B scores?r =-0.471,p = 0.003?,The gray matter volumes of left limbic system were negatively with TMT-B scores?r =-0.465,p-0.003?,the gray matter volumes of cuneus were negatively correlated with the level of low density lipoprotein?LDL??r =-0.349,p = 0.023?in ESRD patients.In follow up,the gray matter volumes of left superior temporal gyrus,left insular lobe,left central sulcus and left transverse temporal gyrus were significantly decreased,but bilateral limbic system?lenticular nucleus,caudatum,putamen,and pallidum?were increased?p<0.01 AlphaSim corrected?.Conclusion:the gray matter volume significantly decrease in patients with ESRD,which is associated with the cognitive impairment,and serum LDL level is one of the risk factors;the gray matter of ESRD patients is remolding and the cognitive function holds stable in follow up.Part TwoAberrant Regional Homogeneity and Spontaneous Brain Activity in Patients with End-Stage Renal Disease and Its Relationship with Cognitive FunctionPurpose:To detect the abnormal alteration of the Regional Homogeneity?ReHo?and Amplitude of Low-Frequency Fluctuation?ALFF?in end-stage renal disease?ESRD?hemodialysis patients,and to observe if there will change in follow up.Materials and methods:This investigation was authorized by the local medical ethics committee.All the enrolled participants were informed and provided written consent before involving this study.Forty-three ESRD patients?male:24,female:19,51.3 ± 8.5 years old,from 27 to 71 years old?with ESRD,as well as 37 age-,sex-and education-matched healthy controls?HC??male:16,female:21,51.4 ± 12.0 years old,from 27 to 70 years old?were recruited.All the subjects went through MRI,blood and cognitive function tests before dialysis.Among the ESRD patients,16 patients?male:10,female:6,49.1 ± 8.6 years old?were recruited again after 16.1 ± 8.4 months as follow-up group.t test was used to compared the difference between each group and correlation analysis between ReHo,ALFF values and cognitive tests scores were performed.Results:In ESRD patients,the ALFF in bilateral precuneus and the ReHo in left medial prefrontal cortex,left rectus gyrus,right middle frontal gyrus and bilateral precuneus were significantly decreased?P<0.01,FDR corrected?,and the cognitive tests scores were also lower in DST?11.2 ±2.7 vs 13.4 ± 3.0,p = 0.003?,SST?12.8 ± 5.6 vs 17.4 ± 3.6,p<0.001?,DSST?31.1 ± 12.7 vs 44.3? 13.6,p<0.001?,TMT-A?73.4 ? 36.8 vs 50.9 ? 13.3,p = 0.001?,TMT-B?169.4 ± 66.3 vs 115.4 ±34.2,p<0.001?,and CDT?2.6 ± 0.8 vs 3.5 ± 0.6,p<0.001?.The ALFF values of precuneus were positively correlated with the level of hemoglobin?HB??r = 0.307,p = 0.045?,the ReHo values of left precuneus were also positively correlated with HB?r = 0.330,p = 0.049?,the ReHo values of right middle frontal gyrus were positively correlated with AVLT scores?r = 0.307,p = 0.045?,and the ReHo values of right precuneus were positively correlated with AVLT-20 scores?r = 0.399,p ?0.016?in ESRD patients.The ReHo and ALFF as well as the cognitive tests scores of ESRD patients didn't change in follow up.Conclusion:ReHo and ALFF alters in multiple brain regions of ESRD patients,which is associated with HB and the cognitive function,and they hold stable in follow up consistent with the neuropsychological tests results.They maybe as a biomarker to evaluate the cognitive function in these patients in future.Part ThreeDecreased functional connectivity of Executive Control Network in patients with End-Stage Renal Disease:A follow-up study by Resting-State Functional MR imagingPurpose:To investigate whether functional connectivity?FC?of Executive Control Network?ECN?separated by Independent Component Analysis can be used to detect and monitor the executive dysfunction in End-Stage Renal Disease?ESRD?patients.Materials and methods:Forty-three patients?51.6 ± 8.5 years old?with ESRD,including 21?53.0±9.1 years old?with executive function decrease?EFD?and 22?50.3 ± 8.0 years old?with non-EFD,as well as 25 age-,sex-and education-matched healthy controls?HCs??53.0 ±10.5 years old?were recruited.All the subjects who were without a history of neurologic or psychiatric disease underwent a resting-state functional MR imaging and a set of neuropsychological test.Among the ESRD patients,20 patients?48.8 ± 8.3 years old?with ESRD experienced a follow-up of the same process after about 14.2 ± 7.9 months.Group Independent Component Analysis was used to separate the ECN.To compare the FC in the ECN,the intensity values in the spatial map were converted to z scores.Maps of the ECN were compared among each groups using ANOVA,and pearson correlation analysis was implemented to correlate the abnormal functional connectivity in the ECN and neuropsychological tests scores.Results:Functional connectivity in ECN of the ESRD patients were significantly reduced in mid-cingulate cortex?MCC?,bilateral inferior parietal cortex?IPC?and superior temporal gyrus?p<0.05 AlphaSim corrected?compared to HCs.The functional connectivity were decreased in MCC and right IPC further in EFD patients.Besides,in ESRD patients,functional connectivity of the mid-cingulate was positively correlated with DST?r = 0.449,p = 0.003?and DSST?r = 0.417,p = 0.007?scores,and negatively correlate with TMT-B?r =-0.510,p = 0.001?scores,and the left IPC were negatively correlate with TMT-A scores?r =-0.428,p = 0.005?,indicating that the impairment of the ECN FC in patients was associated with reduced performance of these patients on neuropsychological tests.The FC of ECN of the 20 follow-up ESRD patients did not show significant functional connectivity of ECN changes and corresponded with the results of neuropsychological tests.Conclusion:Functional connectivity in the ECN is decreased in patients with ESRD and correlated to the neuropsychological tests results which maybe as a clinical biomarker to evaluate and monitor the executive functional state in the future. |
PDF Full Text Request