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Integr. Neurosci."],"abstract":"<jats:p>Background: Although donepezil alleviates Alzheimer\u2019s disease (AD) symptoms by raising acetylcholine levels, its impact on cholinergic pathways remains unclear. In this longitudinal, resting-state functional magnetic resonance imaging (rs-fMRI) study, we investigated donepezil-induced changes in cholinergic pathway networks in AD. Methods: AD patients and healthy controls (HCs) were enrolled. AD patients received 24 weeks of donepezil treatment. Cognitive and emotional symptoms were assessed using the Mini-Mental State Examination (MMSE), Cornell Scale for Depression in Dementia (CSDD), and Neuropsychiatric Inventory (NPI) pre- and post-treatment. rs-fMRI was used to examine basal forebrain (BF) functional connectivity. Results: Sixteen AD patients and 16 HCs completed the study. Post-treatment MMSE scores improved, and NPI and CSDD scores decreased. Reduced BF functional connectivity in the left cerebellar lobule VI, post-treatment, was revealed by rs-fMRI. Compared with HCs, post-treatment AD patients showed lower BF functional connectivity in the right postcentral gyrus (PoG); pre-treatment patients exhibited higher BF functional connectivity in the left cerebellar lobule VI. Right PoG functional connectivity was negatively correlated with disease duration pre-treatment and positively correlated with MMSE post-treatment. Conclusions: Donepezil improved clinical symptoms in AD by modulating the BF\u2013PoG cholinergic pathway.<\/jats:p>","DOI":"10.31083\/jin50039","type":"journal-article","created":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T08:26:43Z","timestamp":1777451203000},"source":"Crossref","is-referenced-by-count":0,"title":["Functional Connectivity Alterations in the Cholinergic Neural Circuits of Patients With Alzheimer\u2019s Disease: A Donepezil Intervention Study Using Resting-State Functional Magnetic Resonance Imaging"],"prefix":"10.31083","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-6209-9224","authenticated-orcid":true,"given":"Yufei","family":"Guo","sequence":"first","affiliation":[{"name":"College of Integrated Traditional Chinese and Western Medicine Clinical Medicine, Zhejiang Chinese Medical University, 310051 Hangzhou, Zhejiang, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0776-1622","authenticated-orcid":true,"given":"Zhenzhong","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Neurology, Tongde Hospital of Zhejiang Province, 310012 Hangzhou, Zhejiang, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-1155-8330","authenticated-orcid":true,"given":"Bo","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine of Traditional Chinese Medicine, Tongde Hospital of Zhejiang Province, 310012 Hangzhou, Zhejiang, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4402-5096","authenticated-orcid":true,"given":"Hao","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Acupuncture, Tongde Hospital of Zhejiang Province, 310012 Hangzhou, Zhejiang, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8611-6084","authenticated-orcid":true,"given":"Fuquan","family":"Wei","sequence":"additional","affiliation":[{"name":"Department of Radiology, Tongde Hospital of Zhejiang Province, 310012 Hangzhou, Zhejiang, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1580-6942","authenticated-orcid":true,"given":"Xiaozheng","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Radiology, The Second Affiliated Hospital and Yuying Children\u2019s Hospital, Wenzhou Medical University, 325027 Wenzhou, Zhejiang, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5508-7455","authenticated-orcid":true,"given":"Zhongwei","family":"Guo","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Tongde Hospital of Zhejiang Province, 310012 Hangzhou, Zhejiang, China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"16242","published-online":{"date-parts":[[2026,4,21]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","unstructured":"Hampel H, Mesulam MM, Cuello AC, Farlow MR, Giacobini E, Grossberg GT, et al. 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