利用静息态功能磁共振探究颈动脉狭窄患者的认知障碍研究
|
摘要
目的采用静息态功能磁共振成像探讨无症状严重颈动脉狭窄患者产生认知障碍的机制。方法对2016年1月至2018年06月南京大学医学院附属鼓楼医院血管外科收治的21例无症状严重颈动脉狭窄患者和招募的21名健康人为对照组行认知量表评估和静息态磁共振检查,前瞻性分析两组人群的认知水平与影像数据的差异。结果患者组简易精神状态量表(MMSE)和蒙特利尔认知评估量表(MoCA)评分明显低于对照组,差异具有统计学意义(P<0.001)。与对照组相比,患者组在右脑内侧额上回处低频振幅(ALFF)水平增加,在舌回处ALFF减少;在左侧额下回低频振幅比率较对照组增加;在颞上回局部一致性(ReHo)值较对照组增加,在右侧枕下回ReHo减少。患者组在右背外侧额上回与后扣带皮层的相关性显著低于对照组。影像学差异和认知评分之间没有显着相关性(P>0.05)。结论无症状严重颈动脉狭窄存在不同程度的认知障碍,右内侧额上回、左侧额下回、颞上回、右背外侧额上回在与颈动脉狭窄相关的认知障碍的发生中可能起着重要的作用。
Objective To investigate the mechanisms of cognitive impairment in patients with asymptomatic severe carotid stenosis by using resting-state functional MRI. Methods Twenty-one asymptomatic severe carotid artery stenosis patients and 21 normal persons from January 2016 to June 2018 were enrolled and administered cognitive assessment and rs-fMRI in Department of Vascular Surgery, Drum Tower Clinical Medical College of Nanjing Medical University. Their cognition and MRI data were analyzed prospectively. Results Asymptomatic carotid artery stenosis patients' scores in MMSE and MoCA were significantly lower than normal. Patients showed increased ALFF in the right medial superior frontal gyrus,decreasing ALFF in the lingual gyrus, increased fALFF in the left inferior frontal gyrus, increased ReHo in the superior temporal gyrus and decreasing ReHo in the right inferior occipital gyrus than normal. Patients showed increased connectivity to the posterior cingulate cortex in the right superior frontal gyrus. There was no correlation between cognitive assessment and imaging date. Conclusion Asymptomatic severe carotid stenosis could lead different degree of cognitive impairment. The right medial frontal gyrus, left inferior frontal gyrus, superior temporal gyrus, and right superior dorsolateral gyrus may play a significant role in the cognitive impairment.
Objective To investigate the mechanisms of cognitive impairment in patients with asymptomatic severe carotid stenosis by using resting-state functional MRI. Methods Twenty-one asymptomatic severe carotid artery stenosis patients and 21 normal persons from January 2016 to June 2018 were enrolled and administered cognitive assessment and rs-fMRI in Department of Vascular Surgery, Drum Tower Clinical Medical College of Nanjing Medical University. Their cognition and MRI data were analyzed prospectively. Results Asymptomatic carotid artery stenosis patients' scores in MMSE and MoCA were significantly lower than normal. Patients showed increased ALFF in the right medial superior frontal gyrus,decreasing ALFF in the lingual gyrus, increased fALFF in the left inferior frontal gyrus, increased ReHo in the superior temporal gyrus and decreasing ReHo in the right inferior occipital gyrus than normal. Patients showed increased connectivity to the posterior cingulate cortex in the right superior frontal gyrus. There was no correlation between cognitive assessment and imaging date. Conclusion Asymptomatic severe carotid stenosis could lead different degree of cognitive impairment. The right medial frontal gyrus, left inferior frontal gyrus, superior temporal gyrus, and right superior dorsolateral gyrus may play a significant role in the cognitive impairment.
引文
[1]Arning C.Carotid artery screening for stroke prevention[J].Radiologe,2013,53(9):783-790.
[2]Popovic IM,Lovrencic-Huzjan A,Simundic AM,et al.Cognitive performance in asymptomatic patients with advanced carotid disease[J].Cogn Behav Neurol,2011,24(3):145-151.
[3]Johnston SC,O'meara ES,Manolio TA,et al.Cognitive impairment and decline are associated with carotid artery disease in patients without clinically evident cerebrovascular disease[J].Ann Intern Med,2004,140(4):237-247.
[4]Pucite E,Krievina I,Miglane E,et al.Influence of severe carotid stenosis on cognition,depressive symptoms and quality of life[J].Clin Pract Epidemiol Ment Health,2017,13:168-180.
[5]Zavoreo I,Basic Kes V,Lisak M,et al.Cognitive decline and cerebral vasoreactivity in asymptomatic patients with severe internal carotid artery stenosis[J].Acta Neurol Belg,2013,113(4):453-458.
[6]Buratti L,Balucani C,Viticchi G,et al.Cognitive deterioration in bilateral asymptomatic severe carotid stenosis[J].Stroke,2014,45(7):2072-2077.
[7]Lin CJ,Tu PC,Chern CM,et al.Connectivity features for identifying cognitive impairment in presymptomatic carotid stenosis[J].PLoS One,2014,9(1):e85441.
[8]Smith SM,Fox PT,Miller KL,et al.Correspondence of the brain's functional architecture during activation and rest[J].Proc Natl Acad Sci U S A,2009,106(31):13040-13045.
[9]Fox MD,Snyder AZ,Vincent JL,et al.The human brain is intrinsically organized into dynamic,anticorrelated functional networks[J].Proc Natl Acad Sci U S A,2005,102(27):9673-9678.
[10]Petty GW,Brown RD,Jr.,Whisnant JP,et al.Ischemic stroke subtypes:a population-based study of incidence and risk factors[J].Stroke,1999,30(12):2513-2516.
[11]Hankey GJ.Secondary stroke prevention[J].Lancet Neurol,2014,13(2):178-194.
[12]Wang T,Mei B,Zhang J.Atherosclerotic carotid stenosis and cognitive function[J].Clin Neurol Neurosurg,2016,146:64-70.
[13]Everts R,Wapp M,Burren Y,et al.Cognitive and emotional effects of carotid stenosis[J].Swiss Med Wkly,2014,144:w13970.
[14]Jokinen H,Melkas S,Ylikoski R,et al.Post-stroke cognitive impairment is common even after successful clinical recovery[J].Eur J Neurol,2015,22(9):1288-1294.
[15]Mesulam M.Defining neurocognitive networks in the BOLDnew world of computed connectivity[J].Neuron,2009,62(1):1-3.
[16]Xie C,Goveas J,Wu Z,et al.Neural basis of the association between depressive symptoms and memory deficits in nondemented subjects:resting-state fMRI study[J].Hum Brain Mapp,2012,33(6):1352-1363.
[17]Raichle ME.The brain's default mode network[J].Annu Rev Neurosci,2015,38:433-447.
[18]Tomasi D,Volkow ND.Resting functional connectivity of language networks:characterization and reproducibility[J].Mol Psychiatry,2012,17(8):841-854.
[19]Fox MD,Corbetta M,Snyder AZ,et al.Spontaneous neuronal activity distinguishes human dorsal and ventral attention systems[J].Proc Natl Acad Sci U S A,2006,103(26):10046-10051.
[20]Kannurpatti SS,Motes MA,Biswal BB,et al.Assessment of unconstrained cerebrovascular reactivity marker for large agerange FMRI studies[J].PLoS One,2014,9(2):e88751.
[21]De Vis JB,Bhogal AA,Hendrikse J,et al.Effect sizes of BOLD CVR,resting-state signal fluctuations and time delay measures for the assessment of hemodynamic impairment in carotid occlusion patients[J].Neuroimage,2018,179:530-539.
[22]Golestani AM,Wei LL,Chen JJ.Quantitative mapping of cerebrovascular reactivity using resting-state BOLD fMRI:Validation in healthy adults[J].Neuroimage,2016,138:147-163.
[23]Jung J,Kang J,Won E,et al.Impact of lingual gyrus volume on antidepressant response and neurocognitive functions in Major Depressive Disorder:a voxel-based morphometry study[J].J Affect Disord,2014,169:179-187.
[24]Sheng K,Fang W,Su M,et al.Altered spontaneous brain activity in patients with Parkinson's disease accompanied by depressive symptoms,as revealed by regional homogeneity and functional connectivity in the prefrontal-limbic system[J].PLoS One,2014,9(1):e84705.
[25]Schmahmann JD,Caplan D.Cognition,emotion and the cerebellum[J].Brain,2006,129(Pt2):290-292.
[26]Stoodley CJ,Valera EM,Schmahmann JD.Functional topography of the cerebellum for motor and cognitive tasks:an f MRI study[J].Neuroimage,2012,59(2):1560-1570.
[27]Wang T,Sun D,Liu Y,et al.The Impact of carotid artery stenting on cerebral perfusion,functional connectivity,and cognition in severe asymptomatic carotid stenosis patients[J].Front Neurol,2017,8:403.
[28]Buckner RL,Andrews-Hanna JR,Schacter DL.The brain's default network:anatomy,function,and relevance to disease[J].Ann N Y Acad Sci,2008,1124:1-38.
[29]Zou QH,Zhu CZ,Yang Y,et al.An improved approach to detection of amplitude of low-frequency fluctuation(ALFF)for resting-state fMRI:fractional ALFF[J].J Neurosci Methods,2008,172(1):137-141.
[30]Lindauer U,Dirnagl U,Fuchtemeier M,et al.Pathophysiological interference with neurovascular couplingwhen imaging based on hemoglobin might go blind[J].Front Neuroenergetics,2010,2.
[31]Stoberock K,Debus ES,Atlihan G,et al.Gender differences in patients with carotid stenosis[J].Vasa,2016,45(1):11-6.
[2]Popovic IM,Lovrencic-Huzjan A,Simundic AM,et al.Cognitive performance in asymptomatic patients with advanced carotid disease[J].Cogn Behav Neurol,2011,24(3):145-151.
[3]Johnston SC,O'meara ES,Manolio TA,et al.Cognitive impairment and decline are associated with carotid artery disease in patients without clinically evident cerebrovascular disease[J].Ann Intern Med,2004,140(4):237-247.
[4]Pucite E,Krievina I,Miglane E,et al.Influence of severe carotid stenosis on cognition,depressive symptoms and quality of life[J].Clin Pract Epidemiol Ment Health,2017,13:168-180.
[5]Zavoreo I,Basic Kes V,Lisak M,et al.Cognitive decline and cerebral vasoreactivity in asymptomatic patients with severe internal carotid artery stenosis[J].Acta Neurol Belg,2013,113(4):453-458.
[6]Buratti L,Balucani C,Viticchi G,et al.Cognitive deterioration in bilateral asymptomatic severe carotid stenosis[J].Stroke,2014,45(7):2072-2077.
[7]Lin CJ,Tu PC,Chern CM,et al.Connectivity features for identifying cognitive impairment in presymptomatic carotid stenosis[J].PLoS One,2014,9(1):e85441.
[8]Smith SM,Fox PT,Miller KL,et al.Correspondence of the brain's functional architecture during activation and rest[J].Proc Natl Acad Sci U S A,2009,106(31):13040-13045.
[9]Fox MD,Snyder AZ,Vincent JL,et al.The human brain is intrinsically organized into dynamic,anticorrelated functional networks[J].Proc Natl Acad Sci U S A,2005,102(27):9673-9678.
[10]Petty GW,Brown RD,Jr.,Whisnant JP,et al.Ischemic stroke subtypes:a population-based study of incidence and risk factors[J].Stroke,1999,30(12):2513-2516.
[11]Hankey GJ.Secondary stroke prevention[J].Lancet Neurol,2014,13(2):178-194.
[12]Wang T,Mei B,Zhang J.Atherosclerotic carotid stenosis and cognitive function[J].Clin Neurol Neurosurg,2016,146:64-70.
[13]Everts R,Wapp M,Burren Y,et al.Cognitive and emotional effects of carotid stenosis[J].Swiss Med Wkly,2014,144:w13970.
[14]Jokinen H,Melkas S,Ylikoski R,et al.Post-stroke cognitive impairment is common even after successful clinical recovery[J].Eur J Neurol,2015,22(9):1288-1294.
[15]Mesulam M.Defining neurocognitive networks in the BOLDnew world of computed connectivity[J].Neuron,2009,62(1):1-3.
[16]Xie C,Goveas J,Wu Z,et al.Neural basis of the association between depressive symptoms and memory deficits in nondemented subjects:resting-state fMRI study[J].Hum Brain Mapp,2012,33(6):1352-1363.
[17]Raichle ME.The brain's default mode network[J].Annu Rev Neurosci,2015,38:433-447.
[18]Tomasi D,Volkow ND.Resting functional connectivity of language networks:characterization and reproducibility[J].Mol Psychiatry,2012,17(8):841-854.
[19]Fox MD,Corbetta M,Snyder AZ,et al.Spontaneous neuronal activity distinguishes human dorsal and ventral attention systems[J].Proc Natl Acad Sci U S A,2006,103(26):10046-10051.
[20]Kannurpatti SS,Motes MA,Biswal BB,et al.Assessment of unconstrained cerebrovascular reactivity marker for large agerange FMRI studies[J].PLoS One,2014,9(2):e88751.
[21]De Vis JB,Bhogal AA,Hendrikse J,et al.Effect sizes of BOLD CVR,resting-state signal fluctuations and time delay measures for the assessment of hemodynamic impairment in carotid occlusion patients[J].Neuroimage,2018,179:530-539.
[22]Golestani AM,Wei LL,Chen JJ.Quantitative mapping of cerebrovascular reactivity using resting-state BOLD fMRI:Validation in healthy adults[J].Neuroimage,2016,138:147-163.
[23]Jung J,Kang J,Won E,et al.Impact of lingual gyrus volume on antidepressant response and neurocognitive functions in Major Depressive Disorder:a voxel-based morphometry study[J].J Affect Disord,2014,169:179-187.
[24]Sheng K,Fang W,Su M,et al.Altered spontaneous brain activity in patients with Parkinson's disease accompanied by depressive symptoms,as revealed by regional homogeneity and functional connectivity in the prefrontal-limbic system[J].PLoS One,2014,9(1):e84705.
[25]Schmahmann JD,Caplan D.Cognition,emotion and the cerebellum[J].Brain,2006,129(Pt2):290-292.
[26]Stoodley CJ,Valera EM,Schmahmann JD.Functional topography of the cerebellum for motor and cognitive tasks:an f MRI study[J].Neuroimage,2012,59(2):1560-1570.
[27]Wang T,Sun D,Liu Y,et al.The Impact of carotid artery stenting on cerebral perfusion,functional connectivity,and cognition in severe asymptomatic carotid stenosis patients[J].Front Neurol,2017,8:403.
[28]Buckner RL,Andrews-Hanna JR,Schacter DL.The brain's default network:anatomy,function,and relevance to disease[J].Ann N Y Acad Sci,2008,1124:1-38.
[29]Zou QH,Zhu CZ,Yang Y,et al.An improved approach to detection of amplitude of low-frequency fluctuation(ALFF)for resting-state fMRI:fractional ALFF[J].J Neurosci Methods,2008,172(1):137-141.
[30]Lindauer U,Dirnagl U,Fuchtemeier M,et al.Pathophysiological interference with neurovascular couplingwhen imaging based on hemoglobin might go blind[J].Front Neuroenergetics,2010,2.
[31]Stoberock K,Debus ES,Atlihan G,et al.Gender differences in patients with carotid stenosis[J].Vasa,2016,45(1):11-6.