Functional MRI study of working memory impairment in patients with symptomatic carotid artery disease

Functional MRI evaluation of the effect of carotid artery stenting: a case study demonstrating cognitive improvement

Background

The narrowing of the carotid arteries with plaque formation represents a major risk factor for ischemic stroke and cognitive impairments. Carotid angioplasty and stenting is a standard clinical treatment to reduce stroke risk. The cognitive effect of carotid angioplasty and stenting remains largely unknown.

Purpose

This study aims to provide direct evidence of possible effects of carotid angioplasty and stenting on cognition, using task-phase functional magnetic resonance imaging.

Material and Methods

This study received harmonized institutional ethics board approval (Grant number REB ID =H18-02495/FHREB 2018-058). Two patients had MRI scans pre-carotid angioplasty and stenting and two-month post-carotid angioplasty and stenting. Case 1 had severe (>95%) flow-limiting stenosis in the right carotid artery. Case 2 had 70% non-flow limiting stenosis in the left carotid artery. At each scan, patients completed two functional magnetic resonance imaging sessions while performing a working memory task. Accuracy, reaction time, and brain activation were analyzed for each patient for possible pre-post carotid angioplasty and stenting changes.

Results

Case 1 showed increased activation in the right (treated-side) frontal and temporal lobes post-carotid angioplasty and stenting; associated with improvements in accuracy (from 58% to 74%) and task completion rate (from 17% to 72%). Case 2 completed the tasks pre- and post-carotid angioplasty and stenting with >90% accuracy, while decreased functional magnetic resonance imaging activation in the contralateral (untreated) hemisphere and mildly increased activation in the left (treated -side) anterior circulation territory were observed post-carotid angioplasty and stenting.

Conclusion

These cases provided the first task-phase functional magnetic resonance imaging data demonstrating that carotid angioplasty and stenting improved cognitive function in the re-perfused vascular territory. The finding supports the role of carotid angioplasty and stenting in improving cognitive performance beyond reducing stroke risk.

Effects of site, cerebral perfusion and degree of cerebral artery stenosis on cognitive function

OBJECTIVE

To investigate the effects of site, cerebral perfusion and degree of cerebral artery stenosis (CAS) on cognitive function.

METHODS

A total of 57 patients with CAS and 53 controls from January 2019 to December 2019 were included. The former group was further divided into different subgroups according to the site, cerebral perfusion and degree of CAS. A series of neuropsychological tests were performed to evaluate the cognitive domains (such as memory, executive function, psychomotor speed, etc.). Rank sum test, t test, Chi-square test and analysis of variance were used for data analysis. Spearman correlation analysis was used to examine the relationship between the site, cerebral perfusion and degree of CAS and all tests' scores.

RESULTS

For patients with CAS who have decreased cerebral perfusion, their global cognitive function, memory, psychomotor speed, executive function and frontal lobe function were significantly impaired (all P < 0.05). There was a significant decrease in global cognitive function, psychomotor speed, memory, executive function and frontal lobe function in patients with anterior circulation stenosis (all P < 0.05). Moderate and severe CAS impaired subjects' global cognitive function, memory, psychomotor speed, executive function and frontal lobe function (all P < 0.05). There was a correlation between the site, cerebral perfusion, the degree of CAS and cognitive function.

CONCLUSION

Global cognitive function, memory, psychomotor speed, frontal lobe function and executive function are impaired in patients with CAS, especially in those with anterior circulatory stenosis, moderate to severe stenosis and low cerebral perfusion.See Video Abstract, http://links.lww.com/WNR/A613.

Cortical Morphological Changes in Congenital Amusia: Surface-Based Analyses

Background: Congenital amusia (CA) is a rare disorder characterized by deficits in pitch perception, and many structural and functional magnetic resonance imaging studies have been conducted to better understand its neural bases. However, a structural magnetic resonance imaging analysis using a surface-based morphology method to identify regions with cortical features abnormalities at the vertex-based level has not yet been performed. Methods: Fifteen participants with CA and 13 healthy controls underwent structural magnetic resonance imaging. A surface-based morphology method was used to identify anatomical abnormalities. Then, the surface parameters' mean value of the identified clusters with statistically significant between-group differences were extracted and compared. Finally, Pearson's correlation analysis was used to assess the correlation between the Montreal Battery of Evaluation of Amusia (MBEA) scores and surface parameters. Results: The CA group had significantly lower MBEA scores than the healthy controls (p = 0.000). The CA group exhibited a significant higher fractal dimension in the right caudal middle frontal gyrus and a lower sulcal depth in the right pars triangularis gyrus (p < 0.05; false discovery rate-corrected at the cluster level) compared to healthy controls. There were negative correlations between the mean fractal dimension values in the right caudal middle frontal gyrus and MBEA score, including the mean MBEA score (r = -0.5398, p = 0.0030), scale score (r = -0.5712, p = 0.0015), contour score (r = -0.4662, p = 0.0124), interval score (r = -0.4564, p = 0.0146), rhythmic score (r = -0.5133, p = 0.0052), meter score (r = -0.3937, p = 0.0382), and memory score (r = -0.3879, p = 0.0414). There was a significant positive correlation between the mean sulcal depth in the right pars triangularis gyrus and the MBEA score, including the mean score (r = 0.5130, p = 0.0052), scale score (r = 0.5328, p = 0.0035), interval score (r = 0.4059, p = 0.0321), rhythmic score (r = 0.5733, p = 0.0014), meter score (r = 0.5061, p = 0.0060), and memory score (r = 0.4001, p = 0.0349). Conclusion: Individuals with CA exhibit cortical morphological changes in the right hemisphere. These findings may indicate that the neural basis of speech perception and memory impairments in individuals with CA is associated with abnormalities in the right pars triangularis gyrus and middle frontal gyrus, and that these cortical abnormalities may be a neural marker of CA.

Brain Functional Network in Chronic Asymptomatic Carotid Artery Stenosis and Occlusion: Changes and Compensation

Asymptomatic carotid artery stenosis (CAS) and occlusion (CAO) disrupt cerebral hemodynamics. There are few studies on the brain network changes and compensation associated with the progression from chronic CAS to CAO. In the current study, our goal is to improve the understanding of the specific abnormalities and compensatory phenomena associated with the functional connection in patients with CAS and CAO. In this prospective study, 27 patients with CAO, 29 patients with CAS, and 15 healthy controls matched for age, sex, education, handedness, and risk factors underwent neuropsychological testing and resting-state functional magnetic resonance (rs-fMRI) imaging simultaneously; graph theoretical analysis of brain networks was performed to determine the relationship between changes in brain network connectivity and the progression from internal CAS to CAO. The global properties of the brain network assortativity (p = 0.002), hierarchy (p = 0.002), network efficiency (p = 0.011), and small-worldness (p = 0.009) were significantly more abnormal in the CAS group than in the control and CAO groups. In patients with CAS and CAO, the nodal efficiency of key nodes in multiple brain regions decreased, while the affected hemisphere lost many key functional connections. In this study, we found that patients with CAS showed grade reconstruction, invalid connections, and other phenomena that impaired the efficiency of information transmission in the brain network. A compensatory functional connection in the contralateral cerebral hemisphere of patients with CAS and CAO may be an important mechanism that maintains clinical asymptomatic performance. This study not only reveals the compensation mechanism of cerebral hemisphere ischemia but also validates previous explanations for brain function connectivity, which can help provide interventions in advance and reduce the impairment of higher brain functions. This trial is registered with Clinical Trial Registration-URL http://www.chictr.org.cn and Unique identifier ChiCTR1900023610.

The correlation of asymmetrical functional connectivity with cognition and reperfusion in carotid stenosis patients

Objective

Neural disruption and cognitive impairment have been reported in patients with carotid stenosis (CS), but carotid artery stenting (CAS) may not contribute to the cognitive recovery. Although functional hyper-connectivity is one of the physiological over-compensation phenomena in neurological diseases, the literature on the cognitive influence of functional hyper-connectivity in CS patients is limited. We aimed to investigate the longitudinal changes of hyper-connectivity after CAS and its association with cognition in CS patients.

Methods

Thirteen patients with unilateral CS and 17 controls without CS were included. Cognitive function was evaluated at baseline, and resting-state functional MRI was performed 1 week before and 1 month and 1 year after CAS. Comparisons of functional connectivity (FC) between CS patients and controls in multiple brain networks were performed.

Results

In patients before CAS, FC in the cerebral hemispheres ipsilateral and contralateral to CS was mainly decreased and increased, respectively, compared with normal controls. Part of the FC alterations gradually recovered to the normal condition after CAS. The stronger FC abnormality (both hypo- and hyper-connectivity compared with normal controls) was associated with poorer cognitive performances, especially in memory and executive functions.

Conclusion

The study demonstrated the lateralization of hyper-connectivity and hypo-connectivity in patients with unilateral CS in contrast to the FC in normal controls. These FC alterations were associated with poor cognitive performances and tended to recover after CAS, implying that hyper-connectivity is served as a compensation for neural challenge.

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Cerebral hypoconnectivity on functional MRI is lateralized to carotid stenosis side.

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Cerebral hyperconnectivity is in regions contralateral to carotid stenosis side.

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Abnormal connectivity gradually returns back to normal after carotid stenting.

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Hypo- and hyper-connectivity associate with poor cognitive performances.

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Hyperconnectivity could be served as a compensation for neural challenge.

Carotid Stenosis and Impaired Cognition: The Effect of Intervention

There is a clear association between carotid artery stenosis and cognitive impairment. However, there is no consensus as to how to interpret this association, and what, if any, impact this connection should have on the management of carotid stenosis. A review of the relevant literature suggests that although an intervention to relieve carotid stenosis in patients without clinically significant cognitive impairment does not improve cognition, there may be a cognitive benefit with intervention for carotid stenosis in those patients with clinically significant cognitive disorders.

Gender differences in cerebral regional homogeneity of adult healthy volunteers: a resting-state FMRI study

Objective. We sought to use the regional homogeneity (ReHo) approach as an index in the resting-state functional MRI to investigate the gender differences of spontaneous brain activity within cerebral cortex and resting-state networks (RSNs) in young adult healthy volunteers. Methods. One hundred and twelve healthy volunteers (56 males, 56 females) participated in the resting-state fMRI scan. The ReHo mappings in the cerebral cortex and twelve RSNs of the male and female groups were compared. Results. We found statistically significant gender differences in the primary visual network (PVN) (P < 0.004, with Bonferroni correction) and left attention network (LAtN), default mode network (DMN), sensorimotor network (SMN), executive network (EN), and dorsal medial prefrontal network (DMPFC) as well (P < 0.05, uncorrected). The male group showed higher ReHo in the left precuneus, while the female group showed higher ReHo in the right middle cingulate gyrus, fusiform gyrus, left inferior parietal lobule, precentral gyrus, supramarginal gyrus, and postcentral gyrus. Conclusions. Our results suggested that men and women had regional specific differences during the resting-state. The findings may improve our understanding of the gender differences in behavior and cognition from the perspective of resting-state brain function.