慢性单侧前庭病患者认知功能障碍：一项静息态功能磁共振研究

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中文摘要

背景： 慢性单侧前庭病（CUVP）与认知功能障碍之间的关联仍不明确。前庭功能障碍与阿尔茨海默病（AD）风险增加相关，提示CUVP中的认知缺陷可能有助于理解AD相关的早期过程。
目的： 评估CUVP患者的认知功能，并探讨其与脑功能和结构改变的相关性。
方法： 招募37例左侧CUVP（LCUVP）患者、30例右侧CUVP（RCUVP）患者和38例健康对照（HC）。患者接受前庭评估、神经心理量表、功能磁共振（fMRI）和结构磁共振（sMRI）。分析低频波动分数振幅（fALFF）、局部一致性（ReHo）、功能连接（FC）和基于体素的形态学分析（VBM）。
结果： 与HC相比，CUVP患者表现出广泛的认知功能障碍。CUVP患者右侧楔前叶的fALFF、右侧舌回和楔前叶的ReHo降低，右侧楔前叶与双侧角回之间、右侧舌回与中枕回之间的FC发生改变（体素p < 0.001，簇p < 0.01，经GRF校正）。探索性相关分析提示脑功能与认知/前庭指标之间存在趋势。控制情绪症状的敏感性分析证实了大多数影像学发现的稳健性。VBM显示CUVP患者与HC之间无显著灰质差异。
结论： 在CUVP患者中，异常功能活动主要涉及与认知表现相关的枕叶和顶叶，而脑结构未发生改变，提示脑功能改变可能比结构改变更敏感。这些发现提示前庭相关认知下降的潜在神经相关因素，可能与AD早期阶段有关。

英文摘要

BACKGROUND: The association between cognitive impairment and chronic unilateral vestibulopathy (CUVP) remains unclear. Vestibular dysfunction is linked to increased risk of Alzheimer's disease (AD), suggesting that cognitive deficits in CUVP may provide insight into early AD-related processes.
OBJECTIVE: To assess cognition in CUVP patients, and investigate its correlation with brain functional and structural changes.
METHODS: 37 patients with left CUVP (LCUVP), 30 patients with right CUVP (RCUVP), and 38 healthy control (HC) were recruited. Patients underwent vestibular evaluations, neuropsychological scales, functional MRI (fMRI), and structural MRI (sMRI). The fractional amplitude of low frequency fluctuations (fALFF), regional homogeneity (ReHo), functional connectivity (FC) and voxel-based morphometry (VBM) were analyzed.
RESULTS: Compared with HC, CUVP patients showed extensive cognitive impairment. The fALFF of right precuneus, the ReHo of right lingual gyrus and precuneus were decreased in CUVP patients, and the FC between right precuneus and bilateral angular gyrus, between right lingual gyrus and middle occipital gyrus were changed (voxel p < 0.001 and cluster p < 0.01, corrected by GRF). Exploratory correlation analyses suggested trends between brain function and cognitive/vestibular measures. Sensitivity analyses controlling for mood symptoms confirmed the robustness of most imaging findings. VBM revealed no significant gray matter differences between CUVP patients and HC.
CONCLUSIONS: In CUVP patients, abnormal functional activities mainly involved occipital and parietal lobes related to cognitive performance, while brain structure did not change, suggesting that functional brain alterations may be more sensitive than structural changes. These findings suggest potential neural correlates of vestibular-related cognitive decline that may be relevant to early stages of AD.