ArticleFrontiers in aging neuroscience2026
Associations among structural brain alterations, respiratory symptoms and cognitive impairment in patients with chronic obstructive pulmonary disease-related subclinical cognitive vulnerability: a multimodal neuroimaging study.
Article in Frontiers in aging neuroscience, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Chronic obstructive pulmonary disease (COPD) is a systemic condition that often results in cognitive impairment. Nevertheless, the central nervous system correlates of COPD-related cognitive decline are not well-defined, representing a critical knowledge gap. The present study aimed to investigate the relationship among respiratory symptoms, structural brain changes, and cognitive impairment in patients with COPD who have subclinical cognitive vulnerability (COPD-SCV). Methods: This cross-sectional study included 60 patients with stable COPD-SCV and 60 age-, sex-, and education-matched controls. Multimodal magnetic resonance imaging was used to measure cortical thickness, fractional anisotropy (FA), radial diffusivity (RD), and graph-theoretical network metrics. Two tests were used to evaluate cognitive performance: the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA). The St. George's Respiratory Questionnaire (SGRQ) was used to estimate respiratory symptoms. To investigate the relationship among respiratory symptoms, structural brain alterations, and cognitive impairment, we conducted correlation and mediation analyses. Results: MoCA scores, used as a screening tool, indicated lower cognitive performance in patients with COPD than in healthy controls (25.03 ± 3.13 vs. 27.13 ± 2.32; Conclusion: Patients with COPD-SCV exhibit deterioration of grey matter morphology, white matter microstructure, and structural network. The relationship between respiratory symptoms and cognitive impairment shows a statistical association with variations in SMA_L connectivity, a key network hub. These findings identify a distinct neuroanatomical phenotype and suggest that SMA connectivity may be a potential imaging marker associated with cognitive risk. However, given the cross-sectional design, these results reflect correlational patterns consistent with a lung-brain axis hypothesis rather than definitive evidence of causation.
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