Brain Activity in Different Brain Areas of Patients With Dry Eye During the Female Climacteric Period According to Voxel-Based Morphometry

Abstract

We aim to investigate potential morphological alterations of the brain in female climacteric patients with dry eye (DE) and their relationship to behavioral performances. Twenty-five female patients with DE disease during the female climacteric period and 25 age and education-matched healthy controls (HCs) underwent magnetic resonance imaging. Imaging data were analyzed using voxel-based morphometry (VBM) to identify group differences in DE patients and HCs. Compared with HCs, patients with DE during the female climacteric period had significantly decreased VBM in the Putamen_L, Thalamus_R, Precuneus_L, Frontal_Sup_R, Cingulum_Mid_L, and Frontal_Mid_L. There was increased VBM in the Temporal_Pole_Sup_R, Precentral_R and Insula_L. Receiver operating characteristic curve analysis indicated that the VBM method has clear potential for diagnosis of DE patients during the climacteric period. Correlation analysis found a negative correlation between the VBM values of the Putamen_L and the anxiety score (AS) and depression score (DS), a positive correlation was found between VBM values of the Temporal_Pole_Sup_R and AS. Moreover, VBM values in the Cingulum_Mid_L were positively correlated with AS and DS. These results revealed abnormal spontaneous activity in the brain regions of patients with DE during the climacteric period, which may indicate underlying pathological mechanisms. These results may help to advance clinical treatments.

Keywords: climacteric period; dry eye disease; gray matter density; magnetic resonance imaging; voxel-based morphometry.

Figure 1

Significant differences in VBM values between DE patients and HCs. The brain regions with different VBM values were the Precuneus_L, Putamen_L, Frontal_Sup_R, Frontal_Mid_L, Thalamus_R, Cingulum_Mid_L, Insula_L, Precentral_R, Temporal_Pole_Sup_R (A). The read areas denote higher fALFF brain regions and blue areas denote lower fALFF brain regions (B).

Figure 2

The average VBM values of DE patients and HCs. Compared with HCs, DE patients had significantly decreased VBM values in the left putamen, right thalamus, left precuneus, right superior frontal lobe, left middle cingulum and left middle frontal lobe; increased VBM in the right superior temporal_pole, right precentral area, and left insula lobe.

Figure 3

ROC curve analysis of the mean VBM values for altered brain regions. (A) The areas under the ROC curve were 0.548 for Precuneus_L (p = 0.562; 95% CI: 0.385–0.711); Putamen_L 0.415, (p = 0.308; 95% CI: 0.253–0.577); Frontal_Sup_R 0.525, (p = 0.764; 95% CI: 0.360–0.690); Frontal_Mid_L 0.518, (p = 0.826; 95% CI: 0.353–0.683); Thalamus_R 0.545, (p = 0.589; 95% CI: 0.381–0.709); Cingulum_Mid_L 0.590, (p = 0.280; 95% CI: 0.428–0.752). (B) The areas under the ROC curve were 0.532 for the Insula_L (p = 0.704; 95% CI: 0.367–0.696); 0.585 for the Precentral_R (p = 0.308; 95% CI: 0.423–0.747) and 0.517 for the Temporal_Pole_Sup_R (p = 0.841; 95% CI: 0.351–0.682). AUC, area under the curve; ROC, receiver operating characteristic.

Figure 4

Correlation between the VBM values of the brain regions and HADS. In the DE group, the VBM values of the Cingulum_Mid_L showed a positive correlation with the AS [r = −0.2371, p = 0.0136, (A)] and DS [r = 0.2135, p = 0.0200, (D)]. Mean VBM values in the Putamen_L of DE patients were negatively correlated with the AS [r = 0.3956, p = 0.0008, (B)] and DS [r = 0.3770, p = 0.0011, (E)]. Mean VBM values in the Temporal_Pole_Sup_R of DE patients were positively correlated with AS (C) [r = 0.2190, p = 0.0183].

Figure 5

Mean VBM values of altered brain regions. Compared to HC subjects, the VBM values of the following regions were decreased to various extents: 6- Precuneus_L (t = 6.5564), 5- Putamen_L (t = 7.5285), 3- Frontal_Sup_R (t = 9.7716), 4- Frontal_Mid_L (t = 7.7449), 7-Thalamus_R (t = 5.4554), 2- Cingulum_Mid_L (t = 12.6833). Compared with the HCs, the VBM values of the following regions were increased to various extents: 8-Insula_L (t = −4.6003), 1- Precentral_R (t = −27.6921), 9- Temporal_Pole_Sup_R (t = −4.1164). HCs, healthy controls; BA, Brodmann's area.