Regional homogeneity of primary insomnia with cognitive impairment: a blood oxygenation level dependent functional MRI study

Objective To investigate the regional homogeneity (ReHo) changes of primary insomnia (PI) with cognitive impairment using resting-state fMRI. Methods Twenty-one patients with primary insomnia and cognitive impairment and 25 healthy volunteers matched with age, gender and education level were collected from Southwest Hospital of China from November 2014 to June 2015. Pittsburgh sleep quality index (PSQI), Montreal Cognitive Assessment (MoCA), Mini-mental State Examination (MMSE), Activity of Daily Living Scale (ADL), Hamilton depression scale (HAMD), and Hamilton Anxiety Scale (HAMA) were conducted to evaluate the sleep and cognitive conditions of all subjects. Independent sample t-test was performed to evaluate the significant difference of neuropsychology scores of two groups. ReHo of rs-fMRI were evaluated and compared between two groups using independent sample T-test, meanwhile, the partial correlation analysis was conducted in ReHo values of different brain regions and neuropsychology scores (age, gender and education level were regarded as covariates). Results Compared with normal controls, patients with primary insomnia and cognitive impairment showed significant higher PSQI score and lower MoCA and MMSE scores(P<0.05). The patient group also showed significant increased ReHo in the left medial temporal gyrus(54 voxels, t=3.14), left inferior temporal gyrus(76 voxels, t=4.80), right inferior temporal gyrus(84 voxels, t=4.30) and left parahippocampal gyrus(301 voxels, t=4.44) (P<0.05) and decreased ReHo in the left superior temporal lobe(79 voxels, t=-3.38), right fusiform gyrus(50 voxels, t=-3.17), right superior temporal gyrus(283 voxels, t=-5.34), right inferior frontal gyrus(56 voxels, t=-3.98), right anterior cingulate(233 voxels, t=-3.91), left parietal lobe angular gyrus(67 voxels, t=-3.27) and superior parietal lobule(65 voxels, t=-3.45) (P<0.05). The partial correlation analysis showed positive correlations between the ReHo values and PSQI scores of the left parahippocampal gyrus (R=0.771, P<0.01), negative correlations between the ReHo values and PSQI scores of the right anterior cingulate gyrus (R=-0.649, P<0.01) and positive correlations between the ReHo values and MoCA scores of the right anterior cingulate gyrus(R=0.555, P<0.05). Conclusions Patients with primary insomnia and cognitive impairment have ReHo alterations in various brain regions. The decreasing ReHo in the right anterior cingulate gyrus can reflect the level of sleep disorder and cognitive impairment, and increasing ReHo in the left parahippocampal gyrus can reflect the compensation of sleep disorders of PI. Key words: Sleep initiation and maintenance disorders; Magnetic resonance imaging; Cognition disorders