Differential Abnormality in Regional Brain Spontaneous Activity and Functional Connectivity in Patients of Non-Acute Subcortical Stroke With Versus Without Global Cognitive Functional Impairment

Abstract

Introduction

Cognitive impairment after a stroke significantly affects patients' quality of life, yet not all strokes lead to such impairment, and the underlying reasons remain unclear. This study employs resting-state functional magnetic resonance imaging (rs-fMRI) to compare subcortical stroke patients with and without cognitive impairment. Our goal is to identify distinct abnormalities in regional brain spontaneous activity and functional connectivity (FC) to better understand the neural basis of post-stroke cognitive outcomes.

Methods

A total of 62 first-ever non-acute subcortical stroke patients were classified into post-stroke with abnormal cognition (PSAC) and with normal cognition (PSNC) groups. Rs-MRI was utilized to assess regional homogeneity (ReHo) in 32 PSAC, 30 PSNC, and 62 age- and sex-matched healthy controls (HC). Then we performed the seed-based whole-brain FC analysis based on the ReHo results. A partial correlation analysis examined the relationship between altered ReHo or FC and Montreal Cognitive Assessment (MoCA) scores.

Results

It showed varied activity in cognitive-related brain regions in both stroke groups compared to HC, such as the right superior frontal gyrus, the right middle temporal gyrus, the right postcentral gyrus, and the left cerebellar lobules. The PSAC group had increased activity in the bilateral inferior temporal gyrus as well. Significant differences in activity were also found between PSAC and PSNC groups, with the PSAC group showing decreased activity in the left gyrus rectus (REC) and increased activity in cerebellar lobules. FC analysis revealed decreased connections in the PSAC group, particularly involving the left REC. Activity and FC in left REC and cerebellum also significantly correlated with MoCA scores.

Conclusions

These findings suggest unique patterns of brain activity and connectivity in non-acute subcortical stroke patients with cognitive impairment, shedding light on potential neural mechanisms underlying post-stroke cognitive impairment. While the left REC may be a potential neural regulatory stimulus target in clinical applications.