Long-term acclimatization to high-altitude hypoxia modifies interhemispheric functional and structural connectivity in the adult brain

Mechanism, prevention and treatment of cognitive impairment caused by high altitude exposure

Hypobaric hypoxia (HH) characteristics induce impaired cognitive function, reduced concentration, and memory. In recent years, an increasing number of people have migrated to high-altitude areas for work and study. Headache, sleep disturbance, and cognitive impairment from HH, severely challenges the physical and mental health and affects their quality of life and work efficiency. This review summarizes the manifestations, mechanisms, and preventive and therapeutic methods of HH environment affecting cognitive function and provides theoretical references for exploring and treating high altitude-induced cognitive impairment.

Effects of long-term exposure to high altitude on brain structure in healthy people: an MRI-based systematic review and meta-analysis

Purpose

To conduct a systematic review and meta-analysis of observational studies of brain MRI, this paper assesses the effects of long-term exposure to high-altitude on brain structures in healthy people.

Methods

Observational studies related to high-altitude, brain and MRI were systematically searched based on data retrieved from PubMed, Embase and Cochrane Library. The timescale for collecting literature was from the establishment of the databases to 2023. NoteExpress 3.2 was used to manage the literature. Two investigators performed literature screening and data extraction based on inclusion criteria, exclusion criteria, and literature quality. The quality of the literature was assessed using the NOS Scale. Finally, meta-analysis of included studies was performed using Reviewer Manager 5.3.

Results

Initially, 3,626 articles were retrieved. After screening, 16 articles (n = 756 participants) were included in the systematic review, and meta-analysis was performed on 6 articles (n = 350 participants). The overall quality of the included articles was at medium level, with a mean NOS score of 5.62. The results of meta-analysis showed that the differences between the HA group and LA group were not statistically significant, in total GM volume (MD: -0.60, 95% CI: -16.78 to 15.58, P = 0.94), WM volume (MD: 3.05, 95% CI: -15.72 to 21.81, P = 0.75) and CSF volume (MD: 5.00, 95% CI: -11.10 to 21.09, P = 0.54).The differences between HA and LA in FA values of frontotemporal lobes were not statistically significant: right frontal lobe (MD: -0.02, 95% CI: -0.07 to 0.03, P = 0.38), left frontal lobe (MD: 0.01, 95% CI: -0.02 to 0.04, P = 0.65), right temporal lobe (MD: -0.00, 95% CI: -0.03 to 0.02, P = 0.78) and left temporal lobe (MD: -0.01, 95% CI: -0.04 to 0.02, P = 0.62). However, there were significant differences in GM volume, GM density and FA values in local brain regions between HA group and LA group.

Conclusion

Compared with LA area, there were no significant differences in total GM, WM and CSF volumes in healthy people living at high-altitude area for long-term, while there were significant differences in GM volume and FA values in local brain regions. Long-term exposure to high-altitude area caused the adaptive structural changes in local brain regions. Since heterogeneity existed between the studies, further studies are needed to uncover the effects of high-altitude on brain of healthy people.

Systematic review registration

https://www.crd.york.ac.uk/prospero/, identifier: CRD42023403491.

The Brain at High Altitude: From Molecular Signaling to Cognitive Performance

The brain requires over one-fifth of the total body oxygen demand for normal functioning. At high altitude (HA), the lower atmospheric oxygen pressure inevitably challenges the brain, affecting voluntary spatial attention, cognitive processing, and attention speed after short-term, long-term, or lifespan exposure. Molecular responses to HA are controlled mainly by hypoxia-inducible factors. This review aims to summarize the cellular, metabolic, and functional alterations in the brain at HA with a focus on the role of hypoxia-inducible factors in controlling the hypoxic ventilatory response, neuronal survival, metabolism, neurogenesis, synaptogenesis, and plasticity.

Brain Structural and Functional Alterations in Native Tibetans Living at High Altitude

Tibetans have adapted to high altitude environments. However, the genetic effects in their brains have not been identified. Twenty-five native Tibetans living in Lhasa (3650 m) were recruited for comparison with 20 Han immigrants who originated from lowlands and had been living in Lhasa for two years. The physiological characteristics, brain structure and neuronal spontaneous activity were investigated. Compared with Han immigrants, Tibetans showed higher peripheral oxygen saturation (SpO₂), and lower heart rate, red blood cell counts, hematocrit, and hemoglobin. Tibetans showed increased gray matter volume in the visual cortex, hippocampus, and rectus; increased the amplitudes of low-frequency fluctuations (ALFF) values in the left putamen and left fusiform gyrus; and decreased voxel-mirrored homotopic connectivity (VMHC) values in the precentral gyrus. Moreover, Tibetans have decreased functional connectivity (FC) between the left precentral gyrus and the frontal gyrusand right precuneus. In Tibetans and Han immigrants, hemoglobin and hematocrit were negatively correlated with total gray matter volume in males, SpO₂ was also positively correlated with ALFF in the left fusiform gyrus, while hemoglobin, and hematocrit were positively correlated with VMHC in the precentral gyrus and FC in the precentral gyrus with other brain regions, SpO₂ was also found to be negatively correlated with VMHC in the precentral gyrus, and hemoglobin and hematocrit were negatively correlated with ALFF in the left putamen and left fusiform gyrus. In summary, genetic mutations may result in modulation of some brain regions, which was further confirmed by the identification of correlations with hemoglobin and hematocrit in these regions.

Consistent differences in brain structure and functional connectivity in high-altitude native Tibetans and immigrants

It has been well-established that high-altitude (HA) environments affect the human brain; however, the differences in brain structural and functional networks between HA natives and acclimatized immigrants have not been well clarified. In this study, native HA Tibetans were recruited for comparison with Han immigrants (average of 2.3 ± 0.3 years at HA), with lowland residents recruited as controls. Cortical gray matter volume, thickness, and functional connectivity were investigated using magnetic resonance imaging data. In addition, reaction time and correct score in the visual movement task, hematology, and SpO₂ were measured. In both Tibetans and HA immigrants vs. lowlanders, decreased SpO₂, increased hematocrit and hemoglobin, and increased reaction time and correct score in the visual movement task were detected. In both Tibetans and HA immigrants vs. lowlanders, gray matter volumes and cortical thickness were increased in the left somatosensory and motor cortex, and functional connectivity was decreased in the visual, default mode, subcortical, somatosensory-motor, ventral attention, and subcortical networks. Furthermore, SpO₂ increased, hematocrit and hemoglobin decreased, and gray matter volumes and cortical thickness increased in the visual cortex, left motor cortex, and right auditory cortex in native Tibetans compared to immigrants. Movement time and correct score in task were positively correlated with the thickness of the visual cortex. In conclusion, brain structural and functional network difference in both Tibetan natives and HA immigrants were largely consistent, with native Tibetans only showing more intense brain modulation. Different populations acclimatized to HA develop similar brain mechanisms to cope with hostile HA environmental factors.

Structure and activity alteration in adult highland residents' cerebrum: Voxel-based morphometry and amplitude of low-frequency fluctuation study

Introduction

People living in highland areas may have factors that allow them to adapt to chronic hypoxia, but these physiological mechanisms remain unclear. This study aimed to investigate the brain mechanism in a cohort of adult residents of Tibet, a well-known plateau section in China, by observing differences in brain structure and function in non-plateau populations.

Methods

The study included 27 Tibetan and 27 non-plateau region residents who were matched in age, sex, and education. All participants underwent high-resolution three-dimensional T1 weighted imaging (3D-T1WI) and resting-state functional magnetic resonance imaging (rs-fMRI) scans on a 1.5 Tesla MR. Gray matter volumes and regional spontaneous neuronal activity (SNA) were calculated and compared between the two groups.

Results

When comparing gray matter in people living in high altitudes to those living in the flatlands, the results showed positive activation of gray matter in local brain regions (p < 0.05, false discovery rate (FDR) corrected), in the right postcentral [automated atomic labeling (aal)], left postcentral (aal), and right lingual (aal) regions. Comparing the people of high altitude vs. flat land in the brain function study (p < 0.05, FDR corrected), positive activation was found in the right superior motor area (aal) and left superior frontal (aal), and negative activation was found in the right precuneus (aal).

Conclusion

In high-altitude individuals, larger regional gray matter volumes and higher SNA may represent a compensatory mechanism to adapt to chronic hypoxia.

Sex differences in brain homotopic co-activations: a meta-analytic study

An element of great interest in functional connectivity is 'homotopic connectivity' (HC), namely the connectivity between two mirrored areas of the two hemispheres, mainly mediated by the fibers of the corpus callosum. Despite a long tradition of studying sexual dimorphism in the human brain, to our knowledge only one study has addressed the influence of sex on HC.We investigated the issue of homotopic co-activations in women and men using a coordinate-based meta-analytic method and data from the BrainMap database. A first unexpected observation was that the database was affected by a sex bias: women-only groups are investigated less often than men-only ones, and they are more often studied in certain domains such as emotion compared to men, and less in cognition. Implementing a series of sampling procedures to equalize the size and proportion of the datasets, our results indicated that females exhibit stronger interhemispheric co-activation than males, suggesting that the female brain is less lateralized and more integrated than that of males. In addition, males appear to show less intense but more extensive co-activation than females. Some local differences also appeared. In particular, it appears that primary motor and perceptual areas are more co-activated in males, in contrast to the opposite trend in the rest of the brain. This argues for a multidimensional view of sex brain differences and suggests that the issue should be approached with more complex models than previously thought.

Impaired brain networks functional connectivity after acute mild hypoxia

This study aimed to analyze the changes in brain networks functional connectivity of pilots exposed to simulated hypoxia using resting-state functional magnetic resonance imaging (fMRI). A total of 35 healthy male pilots exposed to 14.5% oxygen concentration (corresponding to an altitude of 3000 m) underwent resting-state fMRI scans. The independent component analysis (ICA) approach was used to analyze changes in the resting-state brain networks functional connectivity of pilots after hypoxic exposure, and 9 common components in brain functional networks were identified. In the functional connections that showed significant group differences, linear regression was used to examine the association between functional connectivity and clinical characteristics. The brain networks functional connectivity after hypoxia exposure decreased significantly, including the left frontoparietal network and visual network 1-area, left frontoparietal network and visual network 2-area, right frontoparietal network and visual network 2-area, dorsal attention network and ventral attention network, dorsal attention network and auditory network, and ventral attention network and visual network 1-area. We found no correlation between the altered functional connectivity and arterial oxygen saturation level. Our findings provide insights into the mechanisms underlying hypoxia-induced cognitive impairment in pilots.

The human brain in a high altitude natural environment: A review

With the advancement of in vivo magnetic resonance imaging (MRI) technique, more detailed information about the human brain at high altitude (HA) has been revealed. The present review aimed to draw a conclusion regarding changes in the human brain in both unacclimatized and acclimatized states in a natural HA environment. Using multiple advanced analysis methods that based on MRI as well as electroencephalography, the modulations of brain gray and white matter morphology and the electrophysiological mechanisms underlying processing of cognitive activity have been explored in certain extent. The visual, motor and insular cortices are brain regions seen to be consistently affected in both HA immigrants and natives. Current findings regarding cortical electrophysiological and blood dynamic signals may be related to cardiovascular and respiratory regulations, and may clarify the mechanisms underlying some behaviors at HA. In general, in the past 10 years, researches on the brain at HA have gone beyond cognitive tests. Due to the sample size is not large enough, the current findings in HA brain are not very reliable, and thus much more researches are needed. Moreover, the histological and genetic bases of brain structures at HA are also needed to be elucidated.

Effects of Long-Term Exposure to High Altitude Hypoxia on Cognitive Function and Its Mechanism: A Narrative Review

Cognitive function is affected by low pressure and hypoxia in high-altitude environments, and is regulated by altitude and exposure time. With the economic development in the Qinghai-Tibet Plateau, the increase in work and study activities, as well as the development of plateau tourism, mountaineering, and other activities, the number of plateau immigrants is increasing daily. Long-term hypoxia challenges human physical and mental health, restricts work efficiency, and thus affects plateau economic development and human wellbeing. Therefore, it is of scientific and social significance to study how long-term exposure to the hypoxic plateau environment affects the physical and mental health of lowlanders as part of the ongoing development of the current plateau region. In this paper, we reviewed the research progress and mechanism of the effects of long-term (≥1 year) high-altitude (>2500 m) hypoxia exposure on the cognitive function of lowlanders, and suggested that the scope and sample size of the research should be expanded in the future, and that follow-up studies should be carried out to explore the time threshold of cognitive impairment and its compensatory or repair mechanism.

Resting-State Neuronal Activity and Functional Connectivity Changes in the Visual Cortex after High Altitude Exposure: A Longitudinal Study

Damage to the visual cortex structures after high altitude exposure has been well clarified. However, changes in the neuronal activity and functional connectivity (FC) of the visual cortex after hypoxia/reoxygenation remain unclear. Twenty-three sea-level college students, who took part in 30 days of teaching at high altitude (4300 m), underwent routine blood tests, visual behavior tests, and magnetic resonance imaging scans before they went to high altitude (Test 1), 7 days after they returned to sea level (Test 2), as well as 3 months (Test 3) after they returned to sea level. In this study, we investigated the hematological parameters, behavioral data, and spontaneous brain activity. There were significant differences among the tests in hematological parameters and spontaneous brain activity. The hematocrit, hemoglobin concentration, and red blood cell count were significantly increased in Test 2 as compared with Tests 1 and 3. As compared with Test 1, Test 3 increased amplitudes of low-frequency fluctuations (ALFF) in the right calcarine gyrus; Tests 2 and 3 increased ALFF in the right supplementary motor cortex, increased regional homogeneity (ReHo) in the left lingual gyrus, increased the voxel-mirrored homotopic connectivity (VMHC) value in the motor cortex, and decreased FC between the left lingual gyrus and left postcentral gyrus. The color accuracy in the visual task was positively correlated with ALFF and ReHo in Test 2. Hypoxia/reoxygenation increased functional connection between the neurons within the visual cortex and the motor cortex but decreased connection between the visual cortex and motor cortex.

GP-14 protects against severe hypoxia-induced neuronal injury through the AKT and ERK pathways and its induced transcriptome profiling alteration

Gypenosides are major bioactive ingredients of G. pentaphyllum. In our previous study, we found that gypenosides had neuroprotective effects against hypoxia-induced injury. In the current study, we focused on the protective effects of gypenoside-14 (GP-14), which is one of the newly identified bioactive components, on neuronal injury caused by severe hypoxia (0.3% O₂). The results showed that GP-14 pretreatment alleviated the cell viability damage and apoptosis induced by hypoxia in PC12 cells. Moreover, GP-14 pretreatment also attenuated primary neuron injuries under hypoxic conditions. Additionally, GP-14 pretreatment significantly ameliorated neuronal damage in the hippocampal region induced by high-altitude cerebral edema (HACE). At the molecular level, GP-14 pretreatment reversed the decreased activities of the AKT and ERK signaling pathways caused by hypoxia in PC12 cells and primary neurons. To comprehensively explore the possible mechanisms, transcriptome sequencing was conducted, and these results indicated that GP-14 could alter the transcriptional profiles of primary neuron. Taken together, our results suggest that GP-14 acts as a neuroprotective agent to protect against neuronal damage induced by severe hypoxia and it is a promising compound for the development of neuroprotective drugs.

Effects of Chronic Hypoxic Environment on Cognitive Function and Neuroimaging Measures in a High-Altitude Population

Objective

This study aimed to investigate the effects of long-term hypoxic environment exposure on cognitive ability and neuroimaging characteristics in a highland population in China.

Methods

Health system workers in Maduo County (4,300 m above sea level) and Minhe County (1,700 m above sea level) were selected as research participants and divided into a high-altitude (HA) group and low-altitude (LA) group, respectively. Cognitive ability was assessed using the Montreal Cognitive Assessment (MoCA), Verbal Fluency Test (VFT), Symbol Digit Modalities Test (SDMT), Trail Making Test A and B (TMT), Digit Span Test (DST), and Rey Auditory Verbal Learning Test (RAVLT). All participants underwent a magnetic resonance imaging (MRI) scan, resting state functional MRI scan, and diffusion tensor imaging to clarify changes in regional gray matter (GM) volume, anisotropy index (FA), local consistency (ReHo), and low-frequency oscillation amplitude (ALFF).

Results

The HA group had significantly lower MoCA, DST, VFT, RAVLT, and TMT scores compared to the control group. No significant differences were found in SDMT score. Furthermore, compared to the LA group, the HA group had significantly lower GM density of the left olfactory cortex, right medial orbital superior frontal gyrus, bilateral insula, left globus pallidus, and temporal lobe (left superior temporal gyrus temporal pole, bilateral middle temporal gyrus temporal pole, and right middle temporal gyrus). In terms of FA, compared with the LA group, the HA group had lower values for the corpus callosum, corpus callosum knee, bilateral radiative corona, and left internal capsule. The HA group had lower ALFF values of the left cerebellum, left putamen, left orbital inferior frontal gyrus, and left precuneus, but higher ALFF values of the left fusiform gyrus, bilateral inferior temporal gyrus, left orbital superior frontal gyrus and medial superior frontal gyrus, compared to the LA group. There was no significant group difference in ReHo values.

Conclusion

Our findings suggest that a chronic hypoxic environment can induce extensive cognitive impairment. Decreased GM density in multiple brain regions, damaged nerve fibers, and unbalanced neuronal activity intensity in different brain regions may be the structural and functional basis of cognitive impairment due to hypoxia.

High altitude modulates concussion incidence, severity, and recovery in young athletes

BACKGROUND

High altitude may affect concussion, but prior studies are limited . We tested whether high altitude affects sport-related concussion (SRC) incidence, severity, and recovery.

METHODS

Twenty-five thousand eight hundred fifteen baseline and post-injury Immediate Post-Concussion Assessment and Cognitive Testing results were compiled from Florida and Colorado, low (27 m or 62 m) and high (1,640 m or 1,991 m) altitude locations, respectively. Incidence, severity, and recovery of injury were compared between altitudes.

RESULTS

High altitude was associated with increased suspected concussion incidence (adjusted OR, 2.04 [95% CI, 1.86 to 2.24];P < .0001). However, high altitude was associated with lower concussion severity measured by Severity Index (SI) (adjusted OR, 0.42 [95% CI, 0.37 to 0.49];P < .0001). High altitude was associated with decreased recovery from post-concussive symptoms in the migraine (β, -2.72 [95% CI, -3.31 to -2.13]; P < .0001), cognitive (β, -1.88 [95% CI, -2.40 to -1.36]; P < .0001), and sleep symptom clusters (β, -0.30 [95% CI, -0.52 to -0.08]; P = .007). Athletes with initial SI≥8 showed prolonged neurocognitive dysfunction at high altitude (HR, 1.38 [95% CI, 1.06 to 1.81]; P = .02).

CONCLUSIONS

High altitude was associated with increased suspected concussions and prolonged recovery but less severe initial injury.

Neuropsychological and Neuroimaging Correlates of High-Altitude Hypoxia Trekking During the "Gokyo Khumbu/Ama Dablam" Expedition

Committeri Giorgia, Danilo Bondi, Carlo Sestieri, Ginevra Di Matteo, Claudia Piervincenzi, Christian Doria, Roberto Ruffini, Antonello Baldassarre, Tiziana Pietrangelo, Rosamaria Sepe, Riccardo Navarra, Piero Chiacchiaretta, Antonio Ferretti, and Vittore Verratti. Neuropsychological and neuroimaging correlates of high-altitude hypoxia trekking during the "Gokyo Khumbu/Ama Dablam" expedition. High Alt Med Biol 00:000-000, 2021. Background: Altitude hypoxia exposure may produce cognitive detrimental adaptations and damage to the brain. We aimed at investigating the effects of trekking and hypoxia on neuropsychological and neuroimaging measures. Methods: We recruited two balanced groups of healthy adults, trekkers (n = 12, 6 F and 6 M, trekking in altitude hypoxia) and controls (gender- and age-matched), who were tested before (baseline), during (5,000 m, after 9 days of trekking), and after the expedition for state anxiety, depression, verbal fluency, verbal short-term memory, and working memory. Personality and trait anxiety were also assessed at a baseline level. Neuroimaging measures of cerebral perfusion (arterial spin labeling), white-matter microstructural integrity (diffusion tensor imaging), and resting-state functional connectivity (functional magnetic resonance imaging) were assessed before and after the expedition in the group of trekkers. Results: At baseline, the trekkers showed lower trait anxiety (p = 0.003) and conscientiousness (p = 0.03) than the control group. State anxiety was lower in the trekkers throughout the study (p < 0.001), and state anxiety and depression decreased at the end of the study in both groups (p = 0.043 and p = 0.007, respectively). Verbal fluency increased at the end of the study in both groups (p < 0.001), whereas verbal short-term memory and working memory performance did not change. No significant differences between before and after the expedition were found for neuroimaging measures. Conclusions: We argue that the observed differences in the neuropsychological measures mainly reflect aspecific familiarity and learning effects due to the repeated execution of the same questionnaires and task. The present results thus suggest that detrimental effects on neuropsychological and neuroimaging measures do not necessarily occur as a consequence of short-term exposure to altitude hypoxia up to 5,000 m, especially in the absence of altitude sickness.

Electrophysiological mechanisms underlying hypoxia-induced deficits in visual spatial and non-spatial discrimination

Impaired visual cognition in residents of hypoxic environment has been widely reported; however, the underlying electrophysiological mechanisms remain unclear. In this study, 23 college students underwent three sessions of a Clock task test before a 30-day high-altitude exposure (Test 1) and 1 week (Test 2) and 3 months (Test 3) after they returned to lowlands. The Clock task consists of a visual spatial angle and a visual non-spatial color discrimination subtask. Simultaneously, electroencephalography (EEG) was recorded during the Clock task. The behavioral results showed that, compared with Test 1, accuracy in Test 2 was significantly decreased in both the Angle and Color tasks, and reaction time (RT) was significantly increased in the Angle task. The event-related potentials results showed that, during both tasks amplitudes of the occipital N1 and P3 components during both tasks were significantly decreased in Test 2, compared with Test 1. Moreover, N1 amplitude was negatively correlated with RT and positively correlated with accuracy. Further time-frequency EEG analysis showed that theta power at occipital sites was significantly decreased in both tasks in Test 2, compared with Test 1, and was negatively correlated with RT in the Angle task. In Test 3, both the behavioral performance and EEG activity recovered to the baseline level in Test 1. These findings suggested that hypoxia impairs both visual spatial and visual non-spatial discriminations, and these impairments can recover after subjects return to lowlands. Inhibition of brain electrophysiological activity in the visual cortex may explain the deficits in visual cognition.

Association of Peripheral Plasma Neurotransmitters with Cognitive Performance in Chronic High-altitude Exposure

Long-term living at high altitude causes significant impairment of cognitive function. Central neurotransmitters are potential mediators of cognitive performance. We aimed to determine whether there were significant associations between select peripheral plasma neurotransmitters and cognitive performance in humans with chronic high-altitude (HA) exposure and to determine the association between peripheral plasma neurotransmitters and brain neurotransmitters in rats after chronic hypobaric hypoxia (HH) exposure. We demonstrated that 3,4-dihydroxy-L-phenylalanine (DOPA), dopamine, serotonin, 5-hydroxyindole-3-acetic acid (5-HIAA) and GABA in the peripheral plasma were associated with cognitive performance in humans with HA exposure. Consistent with this result, peripheral plasma DOPA, dopamine, serotonin, 5-HIAA and glutamate were associated with brain neurotransmitter levels after chronic HH exposure in rats. These results provide experimental data indicating that neurotransmitter levels and cognitive performance are modified in chronic high-altitude exposure, with a possible causal effect.

Abnormal brain activity in rats with sustained hypobaric hypoxia exposure: a resting-state functional magnetic resonance imaging study

Background:

Hypobaric hypoxia (HH) exposure at high altitudes can result in a decline in cognitive function, which may have a serious impact on the daily life of people who migrate to high altitudes. However, the specific HH-induced changes in brain function remain unclear. This study explored changes in brain activity in rats exposed to a sustained HH environment using functional magnetic resonance imaging (fMRI).

Methods:

Healthy male rats (8 weeks old) were randomly divided into a model group and a control group. A rat model of cognitive impairment induced by sustained HH exposure was established. The control and model groups completed training and testing in the Morris water maze (MWM). A two-sample t-test for between-group difference comparisons was performed. Repeated measures analyses of variance for within-group comparisons were performed and post-hoc comparisons were made using the Tukey test. Between-group differences in spontaneous brain activity were assessed using a voxel-wise analysis of resting-state fMRI (rs-fMRI), combined with analyses of the fractional amplitude of low frequency fluctuations (fALFF) in statistical parametric mapping.

Results:

In the MWM test, the escape latencies of the model group were significantly longer compared with those of the control group (control group vs. model group, day 1: 21.6 ± 3.3 s vs. 40.5 ± 3.4 s, t = –11.282; day 2: 13.5 ± 2.2 s vs. 28.7 ± 5.3 s, t = –7.492; day 3: 10.5 ± 2.8 s vs. 22.6 ± 6.1 s, t = –5.099; day 4: 9.7 ± 2.5 s vs. 18.6 ± 5.2 s, t = –4.363; day 5: 8.8 ± 2.7 s vs. 16.7 ± 5.0 s, t = –3.932; all P < 0.001). Within both groups, the escape latency at day 5 was significantly shorter than those at other time points (control group: F = 57.317, P < 0.001; model group: F = 50.718, P < 0.001). There was no within-group difference in average swimming speed (control group, F = 1.162, P = 0.956; model group, F = 0.091, P = 0.880). Within the model group, the time spent within the original platform quadrant was significantly shorter (control group vs. model group: 36.1 ± 5.7 s vs. 17.8 ± 4.3 s, t = 7.249, P < 0.001) and the frequency of crossing the original platform quadrant was significantly reduced (control group vs. model group: 6.4 ± 1.9 s vs. 2.0 ± 0.8 s, t = 6.037, P < 0.001) compared with the control group. In the rs-fMRI study, compared with the control group, rats in the model group showed widespread reductions in fALFF values throughout the brain.

Conclusions:

The abnormalities in spontaneous brain activity indicated by the fALFF measurements may reflect changes in brain function after HH exposure. This widespread abnormal brain activity may help to explain and to provide new insights into the mechanism underlying the impairment of brain function under sustained exposure to high altitudes.

Neural network correlates of high-altitude adaptive genetic variants in Tibetans: A pilot, exploratory study

Although substantial progress has been made in the identification of genetic substrates underlying physiology, neuropsychology, and brain organization, the genotype–phenotype associations remain largely unknown in the context of high‐altitude (HA) adaptation. Here, we related HA adaptive genetic variants in three gene loci (EGLN1, EPAS1, and PPARA) to interindividual variance in a set of physiological characteristics, neuropsychological tests, and topological attributes of large‐scale structural and functional brain networks in 135 indigenous Tibetan highlanders. Analyses of individual HA adaptive single‐nucleotide polymorphisms (SNPs) revealed that specific SNPs selectively modulated physiological characteristics (erythrocyte level, ratio between forced expiratory volume in the first second to forced vital capacity, arterial oxygen saturation, and heart rate) and structural network centrality (the left anterior orbital gyrus) with no effects on neuropsychology or functional brain networks. Further analyses of genetic adaptive scores, which summarized the overall degree of genetic adaptation to HA, revealed significant correlations only with structural brain networks with respect to local interconnectivity of the whole networks, intermodule communication between the right frontal and parietal module and the left occipital module, nodal centrality in several frontal regions, and connectivity strength of a subnetwork predominantly involving in intramodule edges in the right temporal and occipital module. Moreover, the associations were dependent on gene loci, weight types, or topological scales. Together, these findings shed new light on genotype–phenotype interactions under HA hypoxia and have important implications for developing new strategies to optimize organism and tissue responses to chronic hypoxia induced by extreme environments or diseases.

Combined fractional anisotropy and subcortical volumetric abnormalities in healthy immigrants to high altitude: A longitudinal study

The study of individuals at high-altitude (HA) exposure provides an important opportunity for unraveling physiological and psychological mechanism of brain underlying hypoxia condition. However, this has rarely been assessed longitudinally. We aim to explore the cognitive and cerebral microstructural alterations after chronic HA exposure. We recruited 49 college freshmen who immigrated to Tibet and followed up for 2 years. Control group consisted of 49 gender and age-matched subjects from sea level. Neuropsychological tests were also conducted to determine whether the subjects' cognitive function had changed in response to chronic HA exposure. Surface-based cortical and subcortical volumes were calculated from structural magnetic resonance imaging data, and tract-based spatial statistics (TBSS) analysis of white matter (WM) fractional anisotropy (FA) based on diffusion weighted images were performed. Compared to healthy controls, the high-altitude exposed individuals showed significantly lower accuracy and longer reaction times in memory tests. Significantly decreased gray matter volume in the caudate region and significant FA changes in multiple WM tracts were observed for HA immigrants. Furthermore, differences in subcortical volume and WM integration were found to be significantly correlated with the cognitive changes after 2 years' HA exposure. Cognitive functions such as working memory and psychomotor function were found to be impaired during chronic HA. Differences of brain subcortical volumes and WM integration between HA and sea-level participants indicated potential impairments in the brain structural modifications and microstructural integrity of WM tracts after HA exposure.

The homotopic connectivity of the functional brain: a meta-analytic approach

Homotopic connectivity (HC) is the connectivity between mirror areas of the brain hemispheres. It can exhibit a marked and functionally relevant spatial variability, and can be perturbed by several pathological conditions. The voxel-mirrored homotopic connectivity (VMHC) is a technique devised to enquire this pattern of brain organization, based on resting state functional connectivity. Since functional connectivity can be revealed also in a meta-analytical fashion using co-activations, here we propose to calculate the meta-analytic homotopic connectivity (MHC) as the meta-analytic counterpart of the VMHC. The comparison between the two techniques reveals their general similarity, but also highlights regional differences associated with how HC varies from task to rest. Two main differences were found from rest to task: (i) regions known to be characterized by global hubness are more similar than regions displaying local hubness; and (ii) medial areas are characterized by a higher degree of homotopic connectivity, while lateral areas appear to decrease their degree of homotopic connectivity during task performance. These findings show that MHC can be an insightful tool to study how the hemispheres functionally interact during task and rest conditions.

Abnormal subcortical nuclei shapes in patients with type 2 diabetes mellitus

OBJECTIVES

Type 2 diabetes mellitus (T2DM) increases the risk of brain atrophy and dementia. We aimed to elucidate deep grey matter (GM) structural abnormalities and their relationships with T2DM cognitive deficits by combining region of interest (ROI)-based volumetry, voxel-based morphometry (VBM) and shape analysis.

METHODS

We recruited 23 T2DM patients and 24 age-matched healthy controls to undergo T1-weighted structural MRI scanning. Images were analysed using the three aforementioned methods to obtain deep GM structural shapes and volumes. Biochemical and cognitive assessments were made and were correlated with the resulting metrics.

RESULTS

Shape analysis revealed that T2DM is associated with focal atrophy in the bilateral caudate head and dorso-medial part of the thalamus. ROI-based volumetry only detected thalamic volume reduction in T2DM when compared to the controls. No significant between-group differences were found by VBM. Furthermore, a worse performance of cognitive processing speed correlated with more severe GM atrophy in the bilateral dorso-medial part of the thalamus. Also, the GM volume in the bilateral dorso-medial part of the thalamus changed negatively with HbA_1c.

CONCLUSIONS

Shape analysis is sensitive in identifying T2DM deep GM structural abnormalities and their relationships with cognitive impairments, which may greatly assist in clarifying the neural substrate of T2DM cognitive dysfunction.

KEY POINTS

• Type 2 diabetes mellitus is accompanied with brain atrophy and cognitive dysfunction • Deep grey matter structures are essential for multiple cognitive processes • Shape analysis revealed local atrophy in the dorso-medial thalamus and caudatum in patients • Dorso-medial thalamic atrophy correlated to cognitive processing speed slowing and high HbA1c. • Shape analysis has advantages in unraveling neural substrates of diabetic cognitive deficits.

Long-term acclimatization to high-altitude hypoxia modifies interhemispheric functional and structural connectivity in the adult brain

BACKGROUND

Structural and functional networks can be reorganized to adjust to environmental pressures and physiologic changes in the adult brain, but such processes remain unclear in prolonged adaptation to high-altitude (HA) hypoxia. This study aimed to characterize the interhemispheric functionally and structurally coupled modifications in the brains of adult HA immigrants.

METHODS

We performed resting-state functional magnetic resonance imaging (fMRI) and diffusion tensor imaging (DTI) in 16 adults who had immigrated to the Qinghai-Tibet Plateau (2300-4400 m) for 2 years and in 16 age-matched sea-level (SL) controls. A recently validated approach of voxel-mirrored homotopic connectivity (VMHC) was employed to examine the interhemispheric resting-state functional connectivity. Areas showing changed VMHC in HA immigrants were selected as regions of interest for follow-up DTI tractography analysis. The fiber parameters of fractional anisotropy and fiber length were obtained. Cognitive and physiological assessments were made and correlated with the resulting image metrics.

RESULTS

Compared with SL controls, VMHC in the bilateral visual cortex was significantly increased in HA immigrants. The mean VMHC value extracted within the visual cortex was positively correlated with hemoglobin concentration. Moreover, the path length of the commissural fibers connecting homotopic visual areas was increased in HA immigrants, covarying positively with VMHC.

CONCLUSIONS

These observations are the first to demonstrate interhemispheric functional and structural connectivity resilience in the adult brain after prolonged HA acclimatization independent of inherited and developmental effects, and the coupled modifications in the bilateral visual cortex indicate important neural compensatory mechanisms underlying visual dysfunction in physiologically well-acclimatized HA immigrants. The study of human central adaptation to extreme environments promotes the understanding of our brain's capacity for survival.