Alterations in Structural and Functional Connectivities in Patients with End-Stage Renal Disease

다국어 초록 (Multilingual Abstract)

Background and Purpose The aim of this study was to evaluate the structural and functional connectivities of brain network using graph theoretical analysis in neurologically asymptomatic patients with end-stage renal disease (ESRD). We further investigated the prevalence of cognitive impairment (CI) in ESRD patients and analyzed the association between network measures of brain connectivity and cognitive function.
Methods We prospectively enrolled 40 neurologically asymptomatic ESRD patients, 40 healthy controls, and 20 disease controls. All of the subjects underwent diffusion-tensor imaging (DTI) and resting-state functional magnetic resonance imaging (rs-fMRI). We calculated measures of structural and functional connectivities based on DTI and rs-fMRI, respectively, and investigated differences therein between the ESRD patients and the healthy controls. We assessed cognitive function in the ESRD patients using the Korean version of the Consortium to Establish a Registry for Alzheimer’s Disease neuropsychological battery.
Results The ESRD patients exhibited decreased global structural and functional brain connectivities, as well as alterations of network hubs compared to the healthy controls and disease controls. About 70% of the ESRD patients had CI. Moreover, ESRD patients without CI exhibited decreased global connectivity and alterations of network hubs. Furthermore, there was a significant positive association between measures of brain connectivity and cognitive function.
Conclusions We found that ESRD patients exhibited decreased structural and functional brain connectivities, and that there was a significant association between brain connectivity and cognitive function. These alterations in the brain network may contribute to the pathophysiological mechanism of CI in ESRD patients.

참고문헌 (Reference)

1 Drew DA, "White matter damage in maintenance hemodialysis patients : a diffusion tensor imaging study" 18 : 213-, 2017

2 Pendlebury ST, "Underestimation of cognitive impairment by Mini-Mental State Examination versus the Montreal Cognitive Assessment in patients with transient ischemic attack and stroke: a population-based study" 41 : 1290-1293, 2010

3 Horn A, "The structural-functional connectome and the default mode network of the human brain" 102 (102): 142-151, 2014

4 Khalsa S, "The structural and functional connectivity of the posterior cingulate cortex : comparison between deterministic and probabilistic tractography for the investigation of structure-function relationships" 102 (102): 118-127, 2014

5 Cohen JR, "The segregation and integration of distinct brain networks and their relationship to cognition" 36 : 12083-12094, 2016

6 Davis SW, "The architecture of crosshemispheric communication in the aging brain : linking behavior to functional and structural connectivity" 22 : 232-242, 2012

7 Tiffin-Richards FE, "The Montreal Cognitive Assessment(MoCA)-a sensitive screening instrument for detecting cognitive impairment in chronic hemodialysis patients" 9 : e106700-, 2014

8 Ikuta T, "Subcortical modulation of attentional control by second-generation antipsychotics in first-episode psychosis" 221 : 127-134, 2014

9 Greicius M, "Resting-state functional connectivity in neuropsychiatric disorders" 21 : 424-430, 2008

10 Wolters AF, "Resting-state fMRI in Parkinson’s disease patients with cognitive impairment : a meta-analysis" 62 : 16-27, 2019

11 Hohenfeld C, "Resting-state connectivity in neurodegenerative disorders : is there potential for an imaging biomarker?" 18 : 849-870, 2018

12 Fjell AM, "Relationship between structural and functional connectivity change across the adult lifespan : a longitudinal investigation" 38 : 561-573, 2017

13 Yin Y, "Reduced white matter integrity with cognitive impairments in end stage renal disease" 9 : 143-, 2018

14 Zhang LJ, "Predominant gray matter volume loss in patients with end-stage renal disease:a voxel-based morphometry study" 28 : 647-654, 2013

15 McQuillan R, "Neuropsychiatric complications of chronic kidney disease" 6 : 471-479, 2010

16 Friston KJ, "Modalities, modes, and models in functional neuroimaging" 326 : 399-403, 2009

17 Kurella Tamura M, "Kidney function and cognitive impairment in US adults: the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study" 52 : 227-234, 2008

18 Hallquist MN, "Graph theory approaches to functional network organization in brain disorders : a critique for a brave new small-world" 3 : 1-26, 2018

19 Chou MC, "Disruptions of brain structural network in end-stage renal disease patients with long-term hemodialysis and normal-appearing brain tissues" 46 : 256-262, 2019

20 Lee JH, "Development of the Korean version of the Consortium to Establish a Registry for Alzheimer’s Disease Assessment Packet (CERAD-K): clinical and neuropsychological assessment batteries" 57 : P47-P53, 2002

21 Williamson BJ, "Detrended connectometry analysis to assess white matter correlates of performance in childhood" 186 : 637-646, 2019

22 Kurella Tamura M, "Dementia and cognitive impairment in ESRD : diagnostic and therapeutic strategies" 79 : 14-22, 2011

23 Levey AS, "Definition and classification of chronic kidney disease: a position statement from kidney disease: Improving Global Outcomes (KDIGO)" 67 : 2089-2100, 2005

24 Vecchio F, "Connectome : graph theory application in functional brain network architecture" 2 : 206-213, 2017

25 Lee SH, "Comparison of the montreal cognitive assessment and the mini-mental state examination as screening tests in hemodialysis patients without symptoms" 40 : 323-330, 2018

26 Kurella Tamura M, "Cognitive impairment and progression of CKD" 68 : 77-83, 2016

27 Zhang YH, "Cognitive changes in peritoneal dialysis patients : a multicenter prospective cohort study" 72 : 691-700, 2018

28 O’Lone E, "Cognition in people with end-stage kidney disease treated with hemodialysis : a systematic review and meta-analysis" 67 : 925-935, 2016

29 Berger I, "Cognition in chronic kidney disease : a systematic review and metaanalysis" 14 : 206-, 2016

30 Stanley ML, "Changes in brain network efficiency and working memory performance in aging" 10 : e0123950-, 2015

31 Lee D, "Analysis of structure-function network decoupling in the brain systems of spastic diplegic cerebral palsy" 38 : 5292-5306, 2017

32 Liang X, "Altered pattern of spontaneous brain activity in the patients with end-stage renal disease: a resting-state functional MRI study with regional homogeneity analysis" 8 : e71507-, 2013

33 Zheng G, "Altered brain functional connectivity in hemodialysis patients with end-stage renal disease : a resting-state functional MR imaging study" 29 : 777-786, 2014

34 van den Heuvel MP, "Abnormal rich club organization and functional brain dynamics in schizophrenia" 70 : 783-792, 2013

35 Li S, "Abnormal degree centrality in neurologically asymptomatic patients with end-stage renal disease : a resting-state fMRI study" 127 : 602-609, 2016

36 Dong J, "Aberrant cortical thickness in neurologically asymptomatic patients with end-stage renal disease" 14 : 1929-1939, 2018