综述:阿尔茨海默病的神经影像学研究进展

阿尔茨海默病(Alzheimer's disease,AD)是以记忆和其他高级认知功能下降为特征的神经退行性疾病．早期的神经影像学研究通常是探索AD患者局部脑区的结构和功能变化．随着多模态神经影像技术和人脑连接组学研究方法的发展,研究者已经能够考察AD患者脑结构和功能连接通路．采用这些方法,最近的研究已经发现,AD患者脑网络的连接强度、网络效率、模块化组织和核心脑区连接的下降,并发现这些变化与患者的记忆评分等密切相关．这些新方法和新技术的出现不仅提供了新颖的观点来解释AD病的脑区失连接病理生理机制,而且发现的AD异常脑连接模式可能作为敏感特征应用于AD早期辅助诊断的影像标记物研究．特别重要的是,研究表明,在AD患者脑神经网络出现的异常连接模式,在AD前期即轻度认知障碍期患者中也已出现,表明了将AD影像学研究的重点前移到AD前期这一可治疗阶段的重要性和迫切性．     

经颅磁刺激对强直迟缓亚型帕金森病患者脑功能网络的影响

目的 重复经颅磁刺激（r TMS）作为一种无创的神经调控技术，对帕金森病（PD）患者的疗效目前尚未完全明确。本文结合临床量表评估、脑电溯源以及脑功能网络以探讨高频r TMS对强直迟缓亚型帕金森病（AR-PD）患者的作用效应。方法 共纳入18例AR-PD患者，利用标准低分辨率电磁断层成像（s LORETA）对脑电信号进行溯源分析，进而通过复杂网络理论构建脑功能网络，从脑区之间协同工作的角度对比分析网络拓扑特征。结果 磁刺激后前额叶、初级运动皮层出现显著性差异（P<0.05）；与运动感觉产生、运动规划和运动执行相关脑区的网络连通性显著增强（P<0.05）且脑功能网络的拓扑特征平均聚类系数的变化与帕金森病统一评定量表评分的变化存在显著相关性（P<0.05）。结论 推测r TMS改善了AR-PD患者在运动感觉产生到运动执行过程中的信息传递能力，本研究可为r TMS对AR-PD患者运动症状的改善作用与感觉运动网络重新整合的关系提供一定的理论依据。     

基于FPGA的随机字符发生器在ERP中的应用

脑电领域的众多探索一直以来都是各国科学家研究的热点。刺激源是脑电实验中不可或缺的一部分。刺激序列正确编排和稳定发生是诱发脑电信号被正确提取的先决条件。利用可编程逻辑器件作为随机字符信号发生器,使之同时具有计数和VGA显示功能,由此产生的视觉ERP刺激序列,可以作为脑区功能存在病变的病人的理想刺激源。     

心脏右向左分流对偏头痛患者临床症状的影响

目的:探讨心脏右向左分流(RLS)对偏头痛患者临床特征是否存在影响,并研究RLS分级与头痛强度之间的关系。方法:选择2016年6月-2018年12月青岛大学附属医院收治的偏头痛患者216例作为偏头痛组,选择于青岛大学附属医院体检的健康志愿者60例作为对照组。216例偏头痛患者根据有无RLS分为有RLS偏头痛组(127例)和无RLS偏头痛组(89例)。有RLS偏头痛患者根据RLS分级将其分为大分流组(n=51)、中分流组(n=11)和小分流组(n=65)。观察对照组与偏头痛组RLS情况,比较有RLS偏头痛组和无RLS偏头痛组患者的一般资料情况,比较大分流组、中分流组和小分流组患者的一般资料情况,采用多因素Logistic回归分析偏头痛患者产生RLS的危险因素。结果:对照组与偏头痛组小分流、中分流患病率比较差异无统计学意义(P0.05),而偏头痛组大分流患病率高于对照组(P0.05)。有RLS偏头痛组患者的视觉先兆、感觉先兆的比例均大于无RLS偏头痛组,头痛初始年龄均小于无RLS偏头痛组,头痛强度均高于无RLS偏头痛组(P0.05),两组患者年龄、性别、吸烟、饮酒、高血压、糖尿病、高血脂、运动先兆、遗传、头痛频率、头痛持续时间比较差异无统计学意义(P0.05)。不同RLS分级的偏头痛患者的视觉先兆、感觉先兆、头痛初始年龄、头痛强度整体比较差异有统计学意义(P0.05)。多因素Logistic回归分析显示,视觉先兆、感觉先兆、头痛初始年龄是偏头痛患者产生RLS的独立危险因素(P0.05)。结论:偏头痛发病年龄较小或有视觉先兆、感觉先兆可能提示偏头痛患者伴有RLS,RLS分级与头痛强度没有关系。     

时域相干刺激研究进展

脑深部电刺激已成为许多神经和精神疾病的有效治疗方法。然而,侵入性的电极植入会带来手术并发症的风险,并且刺激靶区在植入后很难改变。经颅磁刺激和经颅电刺激等非侵入性刺激方法为调节大脑功能提供了新的途径。但是,尚未证明这些非侵入性脑刺激方法可以直接调节脑深部神经元活动而不影响皮层神经元。因此,这些方法主要用于调节大脑表层脑区的神经活动。时域相干（temporal interference,TI）刺激是通过两个高频电场相互作用,产生低频包络调节神经活动的一种非侵入式脑深部电刺激的新方法,该方法有望解决无创脑深部刺激的需求。本文首先介绍TI刺激的概念以及安全性,然后阐述TI刺激现有研究中的电场分析方法,并讨论电场分析相关的生理模型建模方法和仿真平台以及TI刺激诱发场分布的研究进展与在动物和人体中的应用进展。最后,本文展望了TI刺激技术未来发展方向,以期为无创脑深部刺激研究提供新的研究思路。     

老化和精神疾病引起的皮层抑制功能变化

脑神经网络信息加工的实现方式主要依赖于兴奋性和抑制性突触连接.脑内抑制性神经元数量较少,但在信息加工和神经可塑性等方面作用极其重要,而且抑制系统失常与多种脑功能障碍有关联.脑内抑制性神经环路可粗略分为皮层内和皮层间(包括前馈和反馈)两种,分别介导同一脑区内和不同脑区间的抑制作用.本文先围绕中心-外周抑制和运动方向互斥介绍了皮层间、皮层内抑制的行为表现和作用机制,然后以老化和精神疾病为例综述了脑功能障碍与视觉系统皮层抑制功能变化间的联系,希望能对相关研究工作有所助益.     

发展性阅读障碍的脑机制——来自脑成像研究的证据

发展性阅读障碍是一种特殊的学习障碍,发展性阅读障碍的脑机制一直是研究者们关心的一个重要问题．随着脑成像技术的应用,人们在发展性阅读障碍的脑机制研究方面取得了重大进展．脑结构研究发现,发展性阅读障碍者在颞-顶叶、颞-枕叶、额下回、小脑等区域都存在一定的脑结构异常,这些脑结构异常要么表现在某个脑区的结构上,要么表现某个脑区结构的左右不对称性上．脑功能研究发现,发展性阅读障碍者出现脑结构异常的区域也大多表现出脑功能的异常．脑功能连接的研究发现,发展性阅读障碍者脑功能连接的异常不仅涉及到同侧脑区前后部分的连接,还涉及双侧脑区相应部分的连接．另外,中文发展性阅读障碍的研究发现了与拼音文字发展性阅读障碍不同的脑机制．这些研究成果为进一步揭示发展性阅读障碍的脑机制以及拓展中文发展性阅读障碍的研究提供了借鉴．     

基于脑结构子网络分析的颞叶肿瘤患者认知功能研究

本研究旨在结合图论讨论颞叶肿瘤对整个大脑结构网络的影响以及患者认知功能变化情况.本文基于弥散张量成像技术,构建颞叶肿瘤患者以及正常对照组脑结构网络,依据纤维束连接长度,将整个脑网络分为3个子网络,对比分析各个子网络的网络参数全局效率和局部效率,进而对颞叶肿瘤患者大脑内纤维束的再生以及消亡情况做简单分析.并对两组受试者进行认知能力评估,分析患者认知能力与节点效率之间的相关性,从而得到患者大脑认知分布情况.研究结果显示,全局效率和局部效率在全脑网络结构中均无显著差异,子网络拓扑参数显示,仅在短距离子网络中,患者组较正常组有显著升高,局部参数研究结果显示,正常组均优于患者组,且患者认知能力普遍低于正常组.脑区内部纤维束再生以及不同功能区之间纤维束连接发生变化从而使得颞叶肿瘤患者脑结构网络发生重组,且患者在注意力、记忆功能、学习能力等方面较正常人有显著降低,患者额颞-顶叶部分脑区参与认知过程,特殊脑区信息处理效率的变化可间接反映认知变化情况.     

未服药精神分裂症患者视觉刺激的功能磁共振成像研究

目的:探讨未服药精神分裂症患者和健康对照视觉刺激的脑区激活的差异.方法:对10例未服药精神分裂症患者(患者组)和10名年龄、教育程度和性别匹配的健康人(对照组)进行视觉信息处理过程的检查,应用功能磁共振成像(fMRI)技术,采用组块设计,以翻转棋盘格为视觉信息输入,以"十"型为对照,比较两组脑区激活区域的差异.结果:两组在中枢视觉区都有激活.但与对照组相比,患者组在视觉刺激时左侧顶下小叶激活增高.结论:精神分裂症患者视觉刺激后,左侧顶下小叶的异常激活,可能反映精神分裂症患者的代偿性,是其视觉信息加工受损的影像学证据.     

基于fMRI的脑功能整合数据分析方法综述

脑功能成像在人脑信息处理和认知活动的神经关联中发挥了不可轻视的作用.从大脑功能整合出发,可以将脑功能成像数据分析方法分为探测大脑功能整合的功能连接和有效连接两方面,功能连接探究空间远离的两个脑区之间的连接,有效连接研究一个脑区对另一个脑区作用的大小.根据这两个概念,相应地可以将功能磁共振数据分析方法分为两大类.本文着重...     

Temporal Lobe Cortical Thickness Correlations Differentiate the Migraine Brain from the Healthy Brain

BackgroundInterregional cortical thickness correlations reflect underlying brain structural connectivity and functional connectivity. A few prior studies have shown that migraine is associated with atypical cortical brain structure and atypical functional connectivity amongst cortical regions that participate in sensory processing. However, the specific brain regions that most accurately differentiate the migraine brain from the healthy brain have yet to be determined. The aim of this study was to identify the brain regions that comprised interregional cortical thickness correlations that most differed between migraineurs and healthy controls.MethodsThis was a cross-sectional brain magnetic resonance imaging (MRI) investigation of 64 adults with migraine and 39 healthy control subjects recruited from tertiary-care medical centers and their surrounding communities. All subjects underwent structural brain MRI imaging on a 3T scanner. Cortical thickness was determined for 70 brain regions that cover the cerebral cortex and cortical thickness correlations amongst these regions were calculated. Cortical thickness correlations that best differentiated groups of six migraineurs from controls and vice versa were identified.ResultsA model containing 15 interregional cortical thickness correlations differentiated groups of migraineurs from healthy controls with high accuracy. The right temporal pole was involved in 13 of the 15 interregional correlations while the right middle temporal cortex was involved in the other two.ConclusionsA model consisting of 15 interregional cortical thickness correlations accurately differentiates the brains of small groups of migraineurs from those of healthy controls. Correlations with the right temporal pole were highly represented in this classifier, suggesting that this region plays an important role in migraine pathophysiology.     

Intrinsic Brain Network Abnormalities in Migraines without Aura Revealed in Resting-State fMRI

Background

Previous studies have defined low-frequency, spatially consistent intrinsic connectivity networks (ICN) in resting functional magnetic resonance imaging (fMRI) data which reflect functional interactions among distinct brain areas. We sought to explore whether and how repeated migraine attacks influence intrinsic brain connectivity, as well as how activity in these networks correlates with clinical indicators of migraine.

Methods/Principal Findings

Resting-state fMRI data in twenty-three patients with migraines without aura (MwoA) and 23 age- and gender-matched healthy controls (HC) were analyzed using independent component analysis (ICA), in combination with a “dual-regression” technique to identify the group differences of three important pain-related networks [default mode network (DMN), bilateral central executive network (CEN), salience network (SN)] between the MwoA patients and HC. Compared with the HC, MwoA patients showed aberrant intrinsic connectivity within the bilateral CEN and SN, and greater connectivity between both the DMN and right CEN (rCEN) and the insula cortex - a critical region involving in pain processing. Furthermore, greater connectivity between both the DMN and rCEN and the insula correlated with duration of migraine.

Conclusions

Our findings may provide new insights into the characterization of migraine as a condition affecting brain activity in intrinsic connectivity networks. Moreover, the abnormalities may be the consequence of a persistent central neural system dysfunction, reflecting cumulative brain insults due to frequent ongoing migraine attacks.     

Reduced Fractional Anisotropy of Corpus Callosum Modulates Inter-Hemispheric Resting State Functional Connectivity in Migraine Patients without Aura

Background

Diffusion tensor imaging (DTI) study revealed reduced fractional anisotropy (FA) values in the corpus callosum (CC) in migraine patients without aura. Abnormalities in white matter integrity, particularly in the CC, may affect inter-hemispheric resting state functional connectivity (RSFC). Unfortunately, relatively little is known about the alterations in functional interactions between the cerebral hemispheres during resting state in migraine patients without aura, and even less about how the inter-hemispheric RSFC are affected by the abnormalities of the CC.

Methods and findings

Twenty-one migraine patients without aura and 21 healthy controls participated in this study, age-, sex-, and education-matched. Tract-based spatial statistics (TBSS) was employed to investigate the white matter alterations of the CC. Meanwhile, voxel-mirrored homotopic connectivity (VMHC) was used to compare the inter-hemispheric RSFC differences between the patients and controls. TBSS analysis revealed reduced FA values in the genu and the splenium of CC in patient group. VMHC analysis showed decreased inter-hemispheric RSFC of anterior cingulate cortex (ACC) in migraine patients without aura relative to that of the controls. Furthermore, in migraine patients without aura, the reduced FA values of the genu of CC correlated with the decreased inter-hemispheric RSFC of the ACC.

Conclusions

Our findings demonstrated that the migraine patients without aura showed reduced FA values of the genu of CC and decreased inter-hemispheric RSFC of the ACC. The correlation between the above structural and functional changes suggested that the reduced fractional anisotropy (FA) of CC modulates inter-hemispheric VMHC in migraine patients without aura. Our results demonstrated that the VMHC alterations of ACC can reflect the FA changes of the genu of CC in migraine patients without aura.     

Hierarchical Alteration of Brain Structural and Functional Networks in Female Migraine Sufferers

Background

Little is known about the changes of brain structural and functional connectivity networks underlying the pathophysiology in migraine. We aimed to investigate how the cortical network reorganization is altered by frequent cortical overstimulation associated with migraine.

Methodology/Principal Findings

Gray matter volumes and resting-state functional magnetic resonance imaging signal correlations were employed to construct structural and functional networks between brain regions in 43 female patients with migraine (PM) and 43 gender-matched healthy controls (HC) by using graph theory-based approaches. Compared with the HC group, the patients showed abnormal global topology in both structural and functional networks, characterized by higher mean clustering coefficients without significant change in the shortest absolute path length, which indicated that the PM lost optimal topological organization in their cortical networks. Brain hubs related to pain-processing revealed abnormal nodal centrality in both structural and functional networks, including the precentral gyrus, orbital part of the inferior frontal gyrus, parahippocampal gyrus, anterior cingulate gyrus, thalamus, temporal pole of the middle temporal gyrus and the inferior parietal gyrus. Negative correlations were found between migraine duration and regions with abnormal centrality. Furthermore, the dysfunctional connections in patients'' cortical networks formed into a connected component and three dysregulated modules were identified involving pain-related information processing and motion-processing visual networks.

Conclusions

Our results may reflect brain alteration dynamics resulting from migraine and suggest that long-term and high-frequency headache attacks may cause both structural and functional connectivity network reorganization. The disrupted information exchange between brain areas in migraine may be reshaped into a hierarchical modular structure progressively.     

Altered Resting-State Functional Connectivity of the Frontal-Striatal Reward System in Social Anxiety Disorder

We investigated differences in the intrinsic functional brain organization (functional connectivity) of the human reward system between healthy control participants and patients with social anxiety disorder. Functional connectivity was measured in the resting-state via functional magnetic resonance imaging (fMRI). 53 patients with social anxiety disorder and 33 healthy control participants underwent a 6-minute resting-state fMRI scan. Functional connectivity of the reward system was analyzed by calculating whole-brain temporal correlations with a bilateral nucleus accumbens seed and a ventromedial prefrontal cortex seed. Patients with social anxiety disorder, relative to the control group, had (1) decreased functional connectivity between the nucleus accumbens seed and other regions associated with reward, including ventromedial prefrontal cortex; (2) decreased functional connectivity between the ventromedial prefrontal cortex seed and lateral prefrontal regions, including the anterior and dorsolateral prefrontal cortices; and (3) increased functional connectivity between both the nucleus accumbens seed and the ventromedial prefrontal cortex seed with more posterior brain regions, including anterior cingulate cortex. Social anxiety disorder appears to be associated with widespread differences in the functional connectivity of the reward system, including markedly decreased functional connectivity between reward regions and between reward regions and lateral prefrontal cortices, and markedly increased functional connectivity between reward regions and posterior brain regions.     

Characteristics of Resting-State Functional Connectivity in HIV-Associated Neurocognitive Disorder

BackgroundHIV-associated neurocognitive disorder (HAND) can occur in patients without prior AIDS defining illness and can be debilitating. This study aimed to evaluate the difference in the patterns of intrinsic brain activity between patients with or without HAND for deepening our understanding of HAND.MethodsWe evaluated 24 HIV-infected individuals, 12 with previously diagnosed HAND and 12 previously diagnosed without HAND, and 11 seronegative individuals. These individuals then underwent repeat NP testing and a functional brain MRI scan. For functional MRI analysis, seed-based analysis with bilateral precuneus cortex seed was applied.ResultsAmong the 12 individuals with previously diagnosed HAND, 3 showed improvement of their neurocognitive function and 1 was excluded for worsening liver disease. Among the 12 patients who previously had normal neurocognitive function, 2 showed neurocognitive impairment. Overall, the HAND group, who had impaired cognitive function at the time of MRI scan, showed significant decrease of resting status functional connectivity between bilateral precuneus and prefrontal cortex (PFC) compared with nonHAND group, those who had normal neurocognitive function (Corrected P<0.05). The functional connectivity with the right inferior frontal operculum and right superior frontal gyrus was positively correlated with memory and learning ability.ConclusionsThis cross-sectional study found a significant difference in fMRI patterns between patients with and without HAND. Decreased functional connectivity between precuneus and PFC could be possible functional substrate for cognitive dysfunction in HIV patients, which should be characterized in a longitudinal study.     

Functional connectivity for somatosensory and motor cortex in spastic diplegia

Functional connectivity (fcMRI) was analyzed in individuals with spastic diplegia and age-matched controls. Pearson correlations (r-values) were computed between resting state spontaneous activity in selected seed regions (sROI) and each voxel throughout the brain. Seed ROI were centered on foci activated by tactile stimulation of the second fingertip in somatosensory and parietal dorsal attention regions. The group with diplegia showed significantly expanded networks for the somatomotor but not dorsal attention areas. These expanded networks overran nearly all topological representations in somatosensory and motor areas despite a sROI in a fingertip focus. A possible underlying cause for altered fcMRI in the group with dipegia, and generally sensorimotor deficits in spastic diplegia, is that prenatal third trimester white-matter injury leads to localized damage to subplate neurons. We hypothesize that intracortical connections become dominant in spastic diplegia through successful competition with diminished or absent thalamocortical inputs. Similar to the effects of subplate ablations on ocular dominance columns (Kanold and Shatz, Neuron 2006;51:627–638), a spike timing-dependent plasticity model is proposed to explain a shift towards intracortical inputs.     

Primary Somatosensory Cortices Contain Altered Patterns of Regional Cerebral Blood Flow in the Interictal Phase of Migraine

The regulation of cerebral blood flow (CBF) is a complex integrated process that is critical for supporting healthy brain function. Studies have demonstrated a high incidence of alterations in CBF in patients suffering from migraine with and without aura during different phases of attacks. However, the CBF data collected interictally has failed to show any distinguishing features or clues as to the underlying pathophysiology of the disease. In this study we used the magnetic resonance imaging (MRI) technique—arterial spin labeling (ASL)—to non-invasively and quantitatively measure regional CBF (rCBF) in a case-controlled study of interictal migraine. We examined both the regional and global CBF differences between the groups, and found a significant increase in rCBF in the primary somatosensory cortex (S1) of migraine patients. The CBF values in S1 were positively correlated with the headache attack frequency, but were unrelated to the duration of illness or age of the patients. Additionally, 82% of patients reported skin hypersensitivity (cutaneous allodynia) during migraine, suggesting atypical processing of somatosensory stimuli. Our results demonstrate the presence of a disease-specific functional deficit in a known region of the trigemino-cortical pathway, which may be driven by adaptive or maladaptive functional plasticity. These findings may in part explain the altered sensory experiences reported between migraine attacks.     

Testing of the Excitability of a Peripheral Nerve in Migraine Patients

AbvDisorders in the functioning of ion channels, especially of Na⁺ channels, are at present suggested to play a role in the pathogenesis of migraine. Thus, migraine can be considered a channelopathy. The following question, however, remains open: Are such disorders related exclusively to the brain or also to the periphera nervous system? In our study, we compared the excitability characteristics of the n. medianus in migraine patients and control-group subjects and also tried to find possible differences between subgroups of the patients suffering from migraine with or without aura. For this purpose, we measured the strength-duration time constant and rheobase using stimulation of the above nerve and EMG recording from the m. abductor pollicis brevis. We found no statistically significant differences in the indices of excitability of the peripheral nerve between the groups of control subjects and migraine patients and also between the above-mentioned subgroups of patients.     

Loss of 'small-world' networks in Alzheimer's disease: graph analysis of FMRI resting-state functional connectivity

Background

Local network connectivity disruptions in Alzheimer''s disease patients have been found using graph analysis in BOLD fMRI. Other studies using MEG and cortical thickness measures, however, show more global long distance connectivity changes, both in functional and structural imaging data. The form and role of functional connectivity changes thus remains ambiguous. The current study shows more conclusive data on connectivity changes in early AD using graph analysis on resting-state condition fMRI data.

Methodology/Principal Findings

18 mild AD patients and 21 healthy age-matched control subjects without memory complaints were investigated in resting-state condition with MRI at 1.5 Tesla. Functional coupling between brain regions was calculated on the basis of pair-wise synchronizations between regional time-series. Local (cluster coefficient) and global (path length) network measures were quantitatively defined. Compared to controls, the characteristic path length of AD functional networks is closer to the theoretical values of random networks, while no significant differences were found in cluster coefficient. The whole-brain average synchronization does not differ between Alzheimer and healthy control groups. Post-hoc analysis of the regional synchronization reveals increased AD synchronization involving the frontal cortices and generalized decreases located at the parietal and occipital regions. This effectively translates in a global reduction of functional long-distance links between frontal and caudal brain regions.

Conclusions/Significance

We present evidence of AD-induced changes in global brain functional connectivity specifically affecting long-distance connectivity. This finding is highly relevant for it supports the anterior-posterior disconnection theory and its role in AD. Our results can be interpreted as reflecting the randomization of the brain functional networks in AD, further suggesting a loss of global information integration in disease.