Qian Chen1, Jiaming Lu2, Xin Zhang2, Jilei Zhang3, and Bing Zhang1
1Department of Radiology, Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing, China, 2Department of Radiology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China, 3Philips Healthcare, Shanghai, China
Synopsis
Subjective
cognitive decline (SCD) is considered a clinically-based approach for the
detection of potential Alzheimer’s disease patients. We observed altered
temporal properties of fractional windows, mean dwell time, and the number of
transitions by dynamic functional connectivity (DFC) analysis in SCD
individuals compared to the control subjects. The altered DFC parameters showed
significant associations with cognitive performance. Our findings shed light on
the role of DFC in the early detection of subjects with potential Alzheimer’s
disease, and the alterations in DFC may suggest the neural basis underlying
early cognitive decline in the SCD stage.
Introduction
Individuals
with subjective cognitive decline (SCD), a self-perceived worsening of
cognitive function without objectively detected deficits, have been considered
at higher risk of Alzheimer’s disease1, 2. Dynamic
functional connectivity (DFC) analysis has been proven a promising approach for
exploring temporal aspects of information processing across brain networks3, 4. We
aimed to investigate the DFC and topological characteristics in SCD individuals,
and the associations of DFC and topological properties with cognitive
performance, which could benefit a better understanding of the neural basis
underlying early cognitive decline and also provide promising neuroimaging
biomarkers for the detection of incipient AD patients.Methods
Thirty-three
control subjects and thirty-two SCD individuals were enrolled and performed the
neuropsychological evaluation and resting-state functional magnetic resonance
imaging (rs-fMRI) scanning in the 3.0 T Achieva TX System (Philips Healthcare,
Best, The Netherlands). Following a previously described procedure5,
thirty-three components were selected by group independent component analysis (ICA)
to construct seven functional networks (basal ganglia, auditory, visual,
sensorimotor, cognitive executive, default mode, and cerebellar network) using
the Group ICA of fMRI Toolbox (GIFT)6.
Based on the sliding window approach and k-means clustering, distinct DFC
states with specific connectivity patterns were identified. We calculated the
temporal properties of fractional windows and mean dwell time of each state and
number of transitions between each pair of DFC states7.
The global and local topological parameters were assessed by graph theory
analysis using the GRETNA software8.
The differences in DFC and topological metrics, and the associations of the
altered neuroimaging measures with cognitive performance were assessed using
SPSS version 21.0. Results
The
whole cohort demonstrated four distinct connectivity states. Compared to the
control group, the SCD group showed increased fractional windows and mean dwell
time in state 4, the most hypo-connected state with weak connectivity located
mostly within each network and between each pair of networks. The SCD group
also showed decreased fractional windows and mean dwell time in state 2,
characterized by the predominance of strong positive intra-network and
inter-network connectivity in the auditory, visual, and sensorimotor networks.
The number of transitions between state 1 and state 2, state 2 and state 3, and
between state 2 and state 4 was significantly reduced in the SCD group. No
significant differences in global or local topological metrics were observed.
The altered DFC properties showed significant correlations with cognitive
performance on global cognition measured by Mini-mental state examination, executive
function measured by trail making test, episodic memory measured by auditory
verbal learning test, and language function measured by Boston naming test.Discussion
The
SCD group spent more time in state 4 showing a sparsely connected configuration
with the absence of strong connections, which was similar to that observed in
AD dementia patients in a previous study3.
This indicated the inability to switch out of state with weak intra-network and
inter-network connectivity into states with more highly and specifically
connected patterns in the SCD group, which may contribute to the early
cognitive decline. Contrastingly, the less time spent in state 2 may suggest
reduced auditory-visual-sensorimotor network integration and loss of
cooperation in sensory regions in the SCD stage. The state transitions were
believed to reflect neural metastability, which enables multiple brain regions
to engage and disengage flexibly in coordination without being locked into
fixed interaction patterns9.
The SCD group demonstrated significantly reduced transitions between state 1
and state 2, state 2 and state 3, and between state 2 and state 4, which
suggested the disruption of flexible information integration and intensive
information exchange across multiple specialized subnetworks. The significant
associations between DFC measures and cognitive variables provided evidence
that altered dynamic functional brain organization was linked to cognitive
function, which may further serve as the neural substrates underlying cognitive
decline in the SCD stage. The absence of significant differences in topological
properties between groups indicated that DFC may be a more informative
representation of functional brain networks compared to static FC for the
preclinical detection of incipient AD patients10.
These results elucidated the vulnerability of rs-fMRI networks in the SCD stage
and emphasized the importance of investigating the dynamic characteristics of
the brain.Conclusion
Our
findings indicated the DFC network deterioration in the SCD stage, which may
underlie the early cognitive decline in SCD subjects, and also serve as
sensitive neuroimaging biomarkers for the preclinical detection of individuals
with incipient AD.Acknowledgements
This
work was supported by the National Natural Science Foundation of China
(81720108022 B.Z., 81971596, X.Z., 82071904, Z.Q.); the Fundamental
Research Funds for the Central Universities, Nanjing University (2020-021414380462);
the key project of Jiangsu Commission of Health (K2019025); Key medical talents
of the Jiangsu province, the "13th Five-Year" health promotion
project of the Jiangsu province (ZDRCA2016064); Jiangsu Provincial Key Medical
Discipline (Laboratory) (ZDXKA2016020); the project of the sixth peak of
talented people (WSN -138). The funders had no role in the study design, data
collection and analysis, decision to publish, or preparation of the manuscript.
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