脑小血管病患者认知障碍早期功能网络连接性研究

目的 研究脑小血管病（cerebral small vessel disease，CSVD）患者认知障碍早期大尺度静息态网络
（resting-state network，RSN）之间连接模式的变化。
方法 2015年7月-2018年12月，从上海交通大学医学院附属仁济医院神经内科脑卒中门诊前瞻性
连续招募非痴呆CSVD患者，收集患者的基线人口社会学资料、血管危险因素，进行神经心理学评估
和多模态MRI检查，分为无认知障碍（no cognitive impairment，NCI）组和轻度认知障碍（mild cognitive
impairment，MCI）组。对两组患者的功能网络连接性（functional network connectivity，FNC）进行比较，
并与认知功能进行相关性分析。
结果 ①本研究共纳入CSVD患者185例，其中MCI组117例（63.2%），NCI组68例（36.8%），平均
年龄为64.6±7.2岁，男性86例（78.4%）。MCI组与NCI组相比，男性较少（P =0.035），教育年限偏低
（P =0.003），两组患者的年龄和血管危险因素无统计差异。②校正年龄、性别、教育年限后，在RSN
水平，MCI组比NCI组执行控制网络（executive control network，ECN）和右额顶网络（right frontoparietal
network，RFPN）之间的功能连接减弱（P＜0.05）；在独立成分（independent component，IC）水平，MCI组
比NCI组在涉及听觉网络（auditory network，AN）、默认模式网络（default mode network，DMN）、ECN及
RFPN的部分IC之间的功能连接减弱（均P＜0.05），在涉及DMN、AN及视觉网络（visual network，VN）的
部分IC之间的功能连接增强（均P＜0.05）。③除AN-13与DMN-16、RFPN-26与ECN-19外，FNC与总体认知、
注意与执行和视空间功能均呈正相关（均P＜0.05）。
结论 CSVD患者认知障碍早期，ECN和RFPN之间的功能连接减弱，FNC在涉及AN、DMN、ECN、RFPN
的IC之间减弱，涉及DMN、AN、VN的IC之间代偿性增强，且FNC与认知功能相关。FNC可能成为CSVD认
知障碍新的神经网络标志物。

Functional Network Connectivity in Patients with Early Cognitive Impairment due to Cerebral Small Vessel Disease

Objective To investigate the changes of the resting state network (RSN) connection pattern in
patients with early cognitive impairment due to cerebral small vessel disease (CSVD).
Methods From July 2015 to December 2018, non-dementia CSVD patients were consecutively
recruited from the stroke clinic. They were divided into two groups: no cognitive impairment (NCI)
and mild cognitive impairment (MCI). The baseline demographic, sociological data and vascular
risk factors were collected. Detailed neuropsychological assessments and multimodal MRI were
performed. The functional network connectivity (FNC) was compared between the two groups, andthe correlation between FNC and cognitive function of patients was analyzed.
Results (1) A total of 185 CSVD patients were enrolled in this study, including 117 (63.2%) in
MCI group and 68 (36.8%) in NCI group, with a mean age of 64.6±7.2 years old and 86 males
(78.4%). Compared with the NCI group, the MCI group had fewer males (P =0.035) and education
years (P =0.003). There was no statistical difference in age and vascular risk factors between the
two groups. (2) After adjusting for age, gender and education years, at RSN level, the functional
connection between executive control network (ECN) and right frontoparietal network (RFPN) in
MCI group was weaker than that in NCI group (P <0.05). At the level of independent component
(IC), compared with NCI, the functional connections among some ICs involving auditory network
(AN), default mode network (DMN), ECN and RFPN in MCI group weakened (all P <0.05), while
the functional connections among ICs involving DMN, AN and visual network (VN) enhanced (all
P <0.05). (3) Except for FNC among AN-13 and DMN-16, RFPN-26 and ECN-19, the FNCs were
all correlated with general cognition, attention, executive and visuospatial function (all P <0.05).
Conclusions In CSVD patients with early cognitive impairment, the functional connection between
ECN and RFPN weakened. FNCs of ICs significantly weakened involving AN, DMN, ECN and
RFPN, and enhanced involving DMN, AN and VN. FNCs were correlated with cognitive function.
FNCs may become a new neural network marker for cognitive impairment due to CSVD.