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. 2023 Sep;13(9):e3169.
doi: 10.1002/brb3.3169. Epub 2023 Aug 3.

Functional changes in the salience network of patients with amnesic mild cognitive impairment before and after repetitive transcranial magnetic stimulation

Qianqian Yuan  1 , Chen Xue  1 , Xuhong Liang  1 , Wenzhang Qi  1 , Shanshan Chen  1 , Yu Song  1 , Huimin Wu  1 , Xulian Zhang  1 , Chaoyong Xiao  1 , Jiu Chen  2   3   4
Affiliations

Functional changes in the salience network of patients with amnesic mild cognitive impairment before and after repetitive transcranial magnetic stimulation

Qianqian Yuan et al. Brain Behav. 2023 Sep.

Abstract

Background: Amnestic mild cognitive impairment (aMCI) is considered to be the prodromal stage of Alzheimer's disease (AD). The precuneus (PCUN) may be an imaging marker for monitoring the progression of AD. Meanwhile, cognitive impairment in AD patients is closely related to functional connectivity (FC) changes in the salience network (SN). We hypothesize that there are specific neuroimaging biomarkers in the SN and that FC changes in aMCI patients after repetitive transcranial magnetic stimulation (rTMS) intervention are associated with cognitive function. The purpose of this study was to first investigate the pattern of functional changes in aMCI patients and healthy controls (HCs) and then compare the functional changes in aMCI patients before and after rTMS targeting to PCUN and its correlation with cognitive function.

Methods: Thirty-six HCs and 61 aMCIs were recruited for our study. Eleven people in the aMCI group received rTMS intervention 5 days a week for 4 weeks. Using the right anterior insula as the seed-of-interest, we first compared FC changes in HC and aMCI patients and then compared cognitive function in aMCI patients before and after rTMS. The above is the functional connection analysis of seed-to-voxel. Moreover, we investigated the FC changes in aMCI patients after rTMS intervention and its correlation with cognitive function.

Results: Compared with HC, the aMCI group showed altered FC in bilateral parahippocampal gyrus, bilateral inferior parietal lobule, left middle frontal gyrus, and left middle temporal gyrus. Moreover, rTMS at PCUN improved the cognitive function of aMCI patients, which was related to the altered FC in posterior cerebellar lobes (CPL).

Conclusions: Our findings suggest that rTMS targeting PCUN is a promising, noninvasive approach to ameliorating cognitive dysfunction in aMCI patients, and that this cognitive improvement is accompanied by brain connectivity modulation.

Keywords: Alzheimer's disease (AD); amnesic mild cognitive impairment (aMCI); functional connectivity (FC); precuneus (PCUN), repetitive transcranial magnetic stimulation (rTMS).

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Conflict of interest statement

There is no conflict of interest in this article.

Figures

FIGURE 1
FIGURE 1
Mean cognitive performance in before repetitive transcranial magnetic stimulation (rTMS) and after rTMS. AVLT‐20 min DR, auditory‐verbal learning test delay of 20 min; DRS‐2, dementia rating scale; CFT, complex figure test; DSST, digit symbol substitution test; VFT, verbal fluency test.
FIGURE 2
FIGURE 2
Functional connectivity (FC) of right anterior insula (rAI) in different brain regions in the amnestic mild cognitive impairment (aMCI) and healthy control (HC) groups. All results are displayed after adjusting for age, sex, and education. A threshold of p < .05 was applied, with a Gaussian random field (GRF) correction with cluster size >50 mm3. IPL, inferior parietal lobule; L, left; MFG, middle frontal gyrus; MTG, middle temporal gyrus; PHG, parahippocampal gyrus; R, right.
FIGURE 3
FIGURE 3
Functional connectivity (FC) of right anterior insula (rAI) in different brain regions in the before repetitive transcranial magnetic stimulation (rTMS) and after rTMS groups. All results are displayed after adjusting for age, sex, and education. A threshold of p < .05 was applied, with a Gaussian random field (GRF) correction with cluster size >50 mm3. ; CPL, cerebellum posterior Lobe; L, left; R, right.
FIGURE 4
FIGURE 4
Results of the correlation analysis: (a) showing significant negative correlation with episodic memory (EM) score against functional connectivity (FC) between the right anterior insula (rAI) and the parahippocampal gyrus.left (PHG.L); (b) showing significant positive correlation with EM score against FC between the rAI and the cerebellum posterior lobe.right (CPL.R).
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