Altered effective connectivity within brain lesioned regions and cognitive impairment after stroke

Poststroke cognitive impairments (PSCI) reflect widespread network dysfunction due to structural damage, abnormal neural activity, or abnormal connections in affected brain regions. The exact influence of these lesioned regions on the related functional network and their role in PSCI remains unclear. We recruited 35 first-time stroke patients who had basal ganglia infarcts and PSCI, along with 29 age-matched healthy controls. We utilized T1-weighted imaging to inspect structural damage with regional gray matter volume (GMV). Resting-state fMRI data were utilized to examine spontaneous activities with regional Wavelet-ALFF metric, investigate dynamic functional connectivity (dFC) by seeding the region with damaged GMV, and further study effective connectivity within the abnormal dFC network and its impact on PSCI. In comparison to HC, patients showed significant reduced GMV in the bilateral Rolandic operculum (ROL), along with notable abnormal Wavelet-ALFF values in the right Precuneus (PCUN) and left Cerebellum_9 (CER9). Particularly, an abnormal dFC network seeded in the left ROL, demonstrating significantly differential between PSCI and HC groups and remaining consistent across all time windows, was observed. This abnormal dFC network comprised the left ROL as the seed region, the right ROL, bilateral PCUN, bilateral CER9, right Superior Temporal Gyrus (STG), and right Parahippocampal Gyrus (PHG). Notably, in patients, impaired functions across various cognitive domains significantly influenced the altered effective connections among the abnormal regions, particularly impacting the connections between structurally damaged regions and those with abnormal spontaneous activity. These findings suggest that altered effective connectivity networks within lesioned regions may contribute to deficits in various cognitive domains in PSCI.