Clinical Significance of Fronto-Temporal Gray Matter Atrophy in Executive Dysfunction in Patients with Chronic Kidney Disease: The VCOHP Study.
Clinical Significance of Fronto-Temporal Gray Matter Atrophy in Executive Dysfunction in Patients with Chronic Kidney Disease: The VCOHP Study.
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DOI：
10.1371/journal.pone.0143706
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发表时间：
2015
期刊：
影响因子：
3.7
通讯作者：
Kitazono T
中科院分区：
文献类型：
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作者：
Tsuruya K;Yoshida H;Haruyama N;Fujisaki K;Hirakata H;Kitazono T
众所周知，慢性肾脏病（CKD）患者的认知障碍的特征是执行功能障碍，而不是记忆功能障碍，尽管其确切机制仍有待阐明。本研究旨在探讨慢性肾脏病患者灰质体积（GMV）与执行功能的相关性。这项横断面研究招募了95例无脑血管病史的非透析依赖性CKD（NDD-CKD）患者，这些患者在VCOHP研究中接受了脑磁共振成像（MRI）和连线试验（TMT）。受试者接受脑部MRI和TMT A部分（TMT-A）和B部分（TMT-B）。将Statistical Parameter Mapping 8软件的分割算法应用于每个T1加权MRI扫描，以提取对应于灰质、白色物质和脑脊液的组织图。GMV通过除以颅内总体积进行标准化，颅内总体积通过将GMV、白色物质体积和脑脊液空间体积相加计算。然后，将标准化的全脑GMV分为四类脑叶：额叶、顶叶、颞叶和枕叶。我们使用多变量回归分析评估了归一化GMV和TMT之间的相关性。标准化全脑GMV与TMT-A、TMT-B和ΔTMT（TMT-B减去TMT-A）评分呈显著负相关。即使在调整相关混杂因素后，这些相关性仍然显着。多变量回归分析显示，额叶和颞叶GMV与TMT-A、TMT-B和ΔTMT呈显著负相关，而顶叶和枕叶GMV与TMT-A、TMT-B和ΔTMT无相关。本研究表明，正常化GMV，特别是在额叶和颞叶，和执行功能之间的相关性，表明额颞灰质萎缩可能有助于在NDD-CKD的执行功能障碍。
It is well known that cognitive impairment in patients with chronic kidney disease (CKD) is characterized by executive dysfunction, rather than memory dysfunction, although the precise mechanism of this remains to be elucidated. The purpose of the present study is to examine the correlation between gray matter volume (GMV) and executive function in CKD patients. This cross-sectional study recruited 95 patients with non-dialysis-dependent CKD (NDD-CKD) with no history of cerebrovascular disease, who underwent brain magnetic resonance imaging (MRI) and Trail Making Test (TMT) in the VCOHP Study. The subjects underwent brain MRI and TMT part A (TMT-A) and part B (TMT-B). The segmentation algorithm from Statistical Parametric Mapping 8 software was applied to every T1-weighted MRI scan to extract tissue maps corresponding to gray matter, white matter, and cerebrospinal fluid. GMV was normalized by dividing by the total intracranial volume, calculated by adding GMV, white matter volume, and cerebrospinal fluid space volume. Then, normalized whole-brain GMV was divided into four categories of brain lobes; frontal, parietal, temporal, and occipital. We assessed the correlation between normalized GMV and TMT using multivariable regression analysis. Normalized whole-brain GMV was significantly inversely correlated to the scores of TMT-A, TMT-B, and ΔTMT (TMT-B minus TMT-A). These correlations remained significant even after adjusting for relevant confounding factors. Normalized frontal and temporal GMV, but not parietal and occipital GMV, were significantly inversely correlated with TMT-A, TMT-B, and ΔTMT using multivariable regression analysis. The present study demonstrates the correlation between normalized GMV, especially in the frontal and temporal lobes, and executive function, suggesting that fronto-temporal gray matter atrophy might contribute to executive dysfunction in NDD-CKD.