Vascular cognitive impairment and age-based Stroop task fMRI study

Title: Vascular cognitive impairment and age-based Stroop task fMRI studyAuthor: Li ChuanmingDegree-granting units: Third Military Medical UniversityKeywords: functional magnetic resonance;; vascular cognitive impairment;; mild cognitive impairment;; Alzheimer's disease;; Stroop task;; brain areas;; selective attention;; cerebrovascular diseaseSummary:PurposeApplication of the Stroop task-based fMRI (blood oxygen level dependency-functional magnetic resonance imaging, Bold-fMRI) technique of vascular cognitive impairment (vascular cognitive impairment, VCI) and age-related cognitive impairment in Magnetic lifter patients with attention to changes in brain function characteristics, the main objectives include:1 of subcortical ischemic vascular cognitive impairment (subcortical ischemic vascular cognitive impairment, SIVCI) in patients with attention-related changes of brain function, evaluation of subcortical small vessel disease of the attention to the impact of cognitive loop, to promote recognition of vascular damage known pathological mechanisms;(2) quantitative analysis of subcortical ischemic vascular cognitive impairment without dementia (subcortical ischemic vascular cognitive impairment no dementia, SIVCIND) and subcortical ischemic vascular dementia (subcortical ischemic vascular dementia, SIVD) patients with brain function mapping features, explore the fMRI In SIVCI diagnosis, expected to make an objective evaluation of early diagnosis;3 Analysis of Alzheimer's disease (Alzheimer disease, AD), mild cognitive impairment (mild cognitive impairment, MCI) in patients with brain function mapping features, evaluation of cognitive impairment, senile changes of the different stages of functional areas; and with the cortex Under ischemic vascular cognitive impairment, compared to cognitive impairment to explore two different mechanisms of brain function changes in different areas, and fMRI in two different differential diagnosis of cognitive impairment and indicators of meaning, and promote the diagnosis of vascular cognitive impairment levels.Subjects and MethodsThe study is divided into two parts, the study included a total of 51 cases.1 of 10 cases SIVCIND SIVD patients and 10 patients, the use of the Montreal Cognitive Assessment Scale (Montreal Cognitive Assessment, http://www.999magnet.com/products/131-magnetic-lifter MoCA, Beijing Version) and the mini-mental state examination (mini-mental state examination, MMSE) detection of overall cognitive function, and 10 age-, sex and education level matched healthy controls were compared to explore the characteristics of cognitive impairment in patients with VCI; use of computer-aided Stroop Test, red, green, blue word stimulus, font color and word meaning and conflict random presentation, subjects were asked to judge the color of the color, to analyze the error rate, false negative rate and reaction time, reaction of VCI patients with behavioral characteristics; using SIEMENS Magnetom Sonata 1.5 T superconductive whole body magnetic resonance imaging and fMRI technology systems brain image data acquisition. FMRI using single-factor single-level group of block (block) design, blocks the activation state (activation state) and the control state (control state) alternate form. The use of fast spin-echo (turbo spin echo, TSE) sequence acquisition axial T1WI layer structure 20 image (TE = 13 msec, TR = 500 msec, field of view = 40 × 40 cm, 256 × 192 data matrix), EPI ( echoplanar imaging) sequence of oxygen-dependent functional imaging data acquisition (64 x 64 matrix, 220 x 220mm field of view, echo time (TE) 40 ms, volume repetition time (TR) 3000 ms, flip angle 90 °). Using MPRAGE sequence for the loss of state-bit capture three-dimensional anatomical images TLC. Data processing and analysis using AFNI (analysis of functional neuroimages) software. First, the head movement and inter-level correction, except for subjects with a slight head movement impact. Then use three-dimensional 3mm FWHM spatial smoothing. Using correlation analysis, the time course of functional image correlation analysis within the region, selected to stimulate the tasks set to the desired time curve reference waveform (3 square wave), the time intensity curve of each pixel and the reference waveform were analyzed and compared to calculate the ideal curve for each voxel and the correlation coefficient, as the brain BOLD signal intensity and target-related tasks, where the correlation coefficient greater than or equal to the set threshold value of pixels as a significant event, to be time - signal strength Dynamic graphs and images of brain function is activated. Activation of brain function will be three-dimensional anatomical images and images into Talairach coordinate system, to obtain standardized images of brain structure and function. Statistical analysis SIVCIND, SIVD patients and normal control group of brain activation area location, extent and volume differences, different stages of evaluation SIVCI changes of brain areas and explore a sensitive indicator of early diagnosis.2 for age, gender and education matched 11 patients with AD and 10 MCI patients with Chinese Stroop task operation and functional brain imaging, laboratory parameters and methods are identical with the former. Analysis and Determination of AD and MCI behavioral test error rate, false negative rate, reaction time, evaluation of age-related cognitive impairment with subcortical vascular cognitive impairment, behavioral responses of the similarities and differences; analysis of AD, MCI brain activation area of ​​the location, extent and volume changes and evaluate the different stages of cognitive impairment, senile changes of functional areas; and with vascular cognitive impairment, compared to cognitive impairment to explore two different mechanisms of brain function changes in different areas, and fMRI in two different recognition know the differential diagnosis of damage and indicators, to promote the improvement of the diagnosis of cognitive impairment.Result1 subcortical ischemic vascular cognitive impairment in general cognitive function evaluation SIVD group MOCA and the sub-score for age, sex and education matched normal control group found that the execution, attention, delayed recall, abstraction, orientation and other recognized reduce the level of cognitive function (P <0.05), the level of cognitive function naming ability did not change significantly (P> 0.05). SIVCIND group and normal control group, execution, attention, language, and delayed recall and so reduce the level of cognitive function (P <0.05), abstract, orientation, naming ability to the level of cognitive function such as no significant decrease (P> 0.05).(2) subcortical ischemic vascular cognitive impairment in patients with behavioral testsSIVD group with age, sex and education matched normal control group found that, Stroop reaction time to extend the operation (P <0.05), false negative rate increased (P <0.05), the error rate increased (P <0.05). SIVCIND patients and normal control group, extended reaction time (P <0.05), false negative rate increased (P <0.05), error rates did not change significantly (P> 0.05).3 subcortical ischemic vascular cognitive function in patients with damage to the damage zoneSIVCI patients with bilateral anterior cingulate activation key, dorsolateral prefrontal cortex (superior frontal gyrus, middle frontal gyrus), ventromedial prefrontal cortex (inferior frontal gyrus, insular cortex), posterior parietal (inferior parietal lobule), the central gyrus, basal ganglia and occipital lobe visual areas. SIVCIND parts count in brain activation with no significant difference in the control group (χ2 test or Fisher exact test, P> 0.05); SIVD group in the right basal ganglia activation count is less than the control group (χ2 test or Fisher exact test, P <0.05 .) Brain areas activated volume quantitative analysis, SIVCIND group with bilateral dorsolateral prefrontal cortex (dosolateral prefrontal cortex, DLPFC), ventral medial prefrontal cortex (ventralateral prefrontal cortex, VLPFC) and right posterior parietal cortex activation volume was significantly greater than the control group (two independent samples Mann-Whitney U test, P <0.05), left posterior parietal and the control group no significant difference (two independent samples Mann-Whitney U test, P> 0.05); SIVD group in the bilateral DLPFC, VLPFC , posterior parietal activation volume was significantly smaller than the control group (two independent samples Mann-Whitney U test, P <0.05).4 and the side of the correlation analysis ofSIVCIND group parts count and function of the brain areas activated activation volume no significant differences between left and right side (χ2 test or Fisher exact test, P> 0.05; two independent samples Mann-Whitney U test, P> 0.05); SIVD group had no significant brain activation parts count left and right side differences (χ2 test or Fisher exact test, P> 0.05), left posterior parietal cortex activation volume was significantly larger than the right (two independent samples Mann-Whitney U test, P <0.05), prompted SIVD brain areas exist side of technology. The pearson correlation \ Spearman rank correlation analysis, SIVCI group with bilateral DLPFC, VLPFC and posterior parietal activation volume with MoCA score, depending on space and execution, attention to sub-score was significantly related (P <0.05). Bilateral DLPFC and left VLPFC activation volume and the breakdown of language scores were significantly related (P <0.05); bilateral DLPFC, bilateral posterior parietal activation volume and delayed recall sub-score was significantly related (P <0.05); the right DLPFC , the left VLPFC and right posterior parietal activation volume and the directional sub-score was significantly related (P <0.05).5 patients with age-related cognitive impairment, behavioral responsesMCI patients with age, gender, education matched control group, extended reaction time (P> 0.05), false negative rate increased (P <0.05); AD patients compared with control group, the reaction time prolonged (P < 0.05), false negative rate increased (P <0.05), the error rate increased (P <0.05). SIVCIND group and MCI group compared to the error rate (P> 0.05), the false negative rate (P> 0.05), reaction time (P> 0.05) compared with no significant difference. SIVD and AD compared to the error rate (P> 0.05), the false negative rate (P> 0.05), reaction time (P> 0.05) were not significantly different.6 patients with age-related cognitive impairment, brain damage in areaMCI and AD patients are mainly activated bilateral anterior cingulate, dorsolateral prefrontal cortex (superior frontal gyrus, middle frontal gyrus), ventromedial prefrontal cortex (inferior frontal gyrus, insular cortex), posterior parietal (inferior parietal lobule) central gyrus, basal ganglia and occipital lobe visual areas. Parts of the brain activation count MCI group and the control group no significant difference (χ2 test or Fisher exact test, P> 0.05), AD group in the right basal ganglia count than the control group (χ2 test or Fisher exact test, P <0.01) . Brain areas that quantitative analysis of the activation volume, MCI group in the bilateral DLPFC, bilateral posterior parietal activation volume was significantly greater than the control group (two independent samples Mann-Whitney U test, P <0.05), bilateral VLPFC and the control group, no significant difference (two independent samples Mann-Whitney U test, P> 0.05); AD group with bilateral DLPFC, VLPFC activation volume was significantly smaller than the control group (two independent samples Mann-Whitney U test, P <0.01), bilateral posterior parietal leaves and the control group no significant difference (two independent samples Mann-Whitney U test, P> 0.05). Side of the analysis show that, MCI, AD group with bilateral brain areas activated parts of the count was no significant difference (χ2 test or Fisher exact test, P> 0.05); MCI group on the left posterior parietal activation volume was significantly larger than the right ( two independent samples Mann-Whitney U test, P <0.05); bilateral DLPFC, VLPFC activation volume was no significant difference (two independent samples Mann-Whitney U test, P> 0.05); AD group left VLPFC activation volume was significantly greater than the right side (two independent samples Mann-Whitney U test, P <0.05), bilateral DLPFC, posterior parietal activation volume was no significant difference (two independent samples Mann-Whitney U test, P> 0.05).7, two different fMRI comparison of cognitive impairmentPositioning in the brain activation, MCI and SIVCIND group showed no significant difference (χ2 test or Fisher exact test, P> 0.05), AD and SIVD group, no significant difference (χ2 test or Fisher exact test, P> 0.05); brain area quantitative analysis of the activation volume, MCI and SIVCIND group showed no significant difference (two independent samples Mann-Whitney U test, P> 0.05), AD group with bilateral posterior parietal activation volume is greater than the SIVD group were significantly different (two independent samples Mann-Whitney U test, P <0.05), bilateral DLPFC, VLPFC activation volume with SIVD was no significant difference (two independent samples Mann-Whitney U test, P> 0.05). FMRI prompted the identification of MCI and SIVCIND no obvious meaning, but the identification of AD and SIVD has great value, mainly to identify indicators of bilateral posterior parietal activation volume and scope.Conclusion1 study found that the overall evaluation of cognitive function subcortical ischemic vascular cognitive impairment in patients with early (SIVCIND) to perform, attention, language, delayed recall and other cognitive impairment, more prominent, and patients with advanced (SIVD) mainly perform, pay attention to , language, delayed recall, abstraction, and orientation and so reduce the level of awareness.(2) computer-aided operation Stroop found that subcortical ischemic vascular cognitive impairment in patients with early (SIVCIND) and in patients with early age-related cognitive impairment (MCI) to increase the false negative rate, reaction time extended to the main performance, and subcortical ischemic vascular cognitive impairment in patients with advanced (SIVD) and Alzheimer's disease in order to increase the false negative rate, reaction time extended, the error rate increased for the performance. However, cognitive impairment, senile and vascular cognitive impairment in patients with matching error rate, false negative rate, reaction time were not significantly different, suggesting that they are not identified in two different indicators of cognitive impairment.3 attention and executive functions of the brain areas including bilateral anterior cingulate, DLPFC, VLPFC, posterior parietal, and basal ganglia. Subcortical ischemic vascular cognitive impairment, early (SIVCIND) changes in brain areas primarily bilateral DLPFC, VLPFC compensatory increase in the main; late (SIVD) mainly in the right basal ganglia, bilateral DLPFC, VLPFC, posterior parietal lobe dysfunction in the main round. SIVCI fMRI at different stages have different performance, fMRI in the early diagnosis of SIVCI have greater significance.4. SIVCIND attention and executive function in the brain does not exist in the side of the technology; SIVD side of the existence of the right side is more serious damage than the left. SIVCI patients with bilateral DLPFC, VLPFC and posterior parietal activation volume and functional areas MoCA score, depending on space and execution, attention to sub-scores were significantly related. Prompt action in the Stroop task activation volume of brain areas may be better reflected SIVCI cognitive function, functional magnetic resonance imaging is a cognitive evaluation and reflection SIVCI a good way.5 Early senile cognitive impairment (MCI) brain area change mainly bilateral DLPFC, posterior parietal-based compensation; late (AD) in the right basal ganglia, bilateral DLPFC, VLPFC dysfunction based. MCI and AD brain are there side of technology, MCI was the left hemisphere compensatory, AD right hemisphere damage apparent.6.MCI and SIVCIND brain areas show no significant differences in fMRI, fMRI can not be identified between the two. AD and SIVD brain dysfunction with different performance characteristics and fMRI, fMRI can be the differential diagnosis of posterior parietal activation volume is the differential between the two indicators.Degree Year: 2009