Abnormalities of cortical and subcortical spontaneous brain activity unveil mechanisms of disorders of consciousness and prognosis in patients with severe traumatic brain injury

IF 5.3 1区心理学 Q1 PSYCHOLOGY, CLINICAL

International Journal of Clinical and Health Psychology Pub Date : 2024-10-01 DOI:10.1016/j.ijchp.2024.100528

Chang Li , Peng Chen , Yongbing Deng , Lei Xia , Xiaodong Wang , Min Wei , Xingdong Wang , Lun Dong , Jun Zhang

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引用次数: 0

Abstract

Objective

To investigate the spatial distribution characteristics of alterations in spontaneous brain activity in severe traumatic brain injury (sTBI) patients with disorders of consciousness (DOC), based on the mesocircuit theoretical framework, and to establish models for predicting recovery of consciousness.

Methods

Resting-state functional magnetic resonance imaging was employed to measure the mean fractional amplitude of low-frequency fluctuations (mfALFF) in sTBI patients with DOC and healthy controls, identifying differential brain regions for conducting gene and functional decoding analyses. Patients were classified into wake and DOC groups according to Extended Glasgow Outcome Score at 6 months. Furthermore, predictive models for consciousness recovery were developed using Nomogram and Linear Support Vector Machine (LSVM) based on mfALFF.

Results

In total, 28 sTBI patients with DOC and 30 healthy controls were included, with no significant baseline differences between groups (P > 0.05). The results revealed increased mfALFF of subcortical Ascending Reticular Activating System and decreased cortical mfALFF (default mode network) in DOC patients within the framework of the mesocircuit model (FDR_P < 0.001, Clusters > 100). The study identified 2080 differentially expressed genes associated with reduced brain activity regions, indicating mechanisms involving synaptic function, the oxytocin signaling pathway, and GABAergic processes in DOC formation. In addition, significantly higher mfALFF values were observed in the left angular gyrus, supramarginal gyrus, and inferior parietal lobule of DOC group compared to the wake group (AlphaSim_P < 0.01, Cluster > 19). The Nomogram prediction model highlighted the pivotal role of these regions' activity levels in prognosis (AUC = 0.90). Validation using LSVM demonstrated robust predictive performance with an AUC of 0.90 and positive predictive values of 80% for wake and 83% for DOC.

Conclusions

This study offered crucial insights underlying DOC in sTBI patients, demonstrating the dissociation between cortical and subcortical brain activities. The findings supported the use of mfALFF as a robust and non-invasive biomarker for evaluating brain function and predicting recovery outcomes.

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皮层和皮层下自发脑活动异常揭示了严重脑外伤患者意识障碍和预后的机制

方法采用静态功能磁共振成像技术测量严重创伤性脑损伤（sTBI）伴意识障碍（DOC）患者和健康对照组的低频波动平均分数振幅（mfALFF），确定差异脑区以进行基因和功能解码分析。根据 6 个月时的扩展格拉斯哥结果评分，将患者分为清醒组和 DOC 组。结果共纳入了28名患有DOC的sTBI患者和30名健康对照组患者，组间基线差异不显著（P> 0.05）。结果显示，在中枢回路模型框架内，DOC 患者皮层下上升网状激活系统的 mfALFF 增加，皮层 mfALFF（默认模式网络）减少（FDR_Plt; 0.001，群集数 >100）。研究发现了 2080 个与大脑活动减少区域相关的差异表达基因，表明 DOC 的形成机制涉及突触功能、催产素信号通路和 GABA 能过程。此外，与唤醒组相比，在 DOC 组的左侧角回、边际上回和顶叶下小叶观察到明显更高的 mfALFF 值（AlphaSim_P < 0.01，Cluster > 19）。Nomogram 预测模型强调了这些区域的活动水平在预后中的关键作用（AUC = 0.90）。使用 LSVM 进行的验证显示了强大的预测性能，AUC 为 0.90，唤醒和 DOC 的阳性预测值分别为 80% 和 83%。研究结果支持使用 mfALFF 作为评估大脑功能和预测康复结果的可靠、非侵入性生物标记物。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International Journal of Clinical and Health Psychology PSYCHOLOGY, CLINICAL-

CiteScore

10.70

自引率

5.70%

发文量

审稿时长

33 days

期刊介绍： The International Journal of Clinical and Health Psychology is dedicated to publishing manuscripts with a strong emphasis on both basic and applied research, encompassing experimental, clinical, and theoretical contributions that advance the fields of Clinical and Health Psychology. With a focus on four core domains—clinical psychology and psychotherapy, psychopathology, health psychology, and clinical neurosciences—the IJCHP seeks to provide a comprehensive platform for scholarly discourse and innovation. The journal accepts Original Articles (empirical studies) and Review Articles. Manuscripts submitted to IJCHP should be original and not previously published or under consideration elsewhere. All signing authors must unanimously agree on the submitted version of the manuscript. By submitting their work, authors agree to transfer their copyrights to the Journal for the duration of the editorial process.