{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T06:07:37Z","timestamp":1779084457570,"version":"3.51.4"},"reference-count":50,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T00:00:00Z","timestamp":1779062400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Nanshan People\u2019s Hospital, Shenzhen","award":["YN2022029"],"award-info":[{"award-number":["YN2022029"]}]},{"DOI":"10.13039\/501100003785","name":"Guangdong Provincial Medical Research Foundation","doi-asserted-by":"crossref","award":["A2023238"],"award-info":[{"award-number":["A2023238"]}],"id":[{"id":"10.13039\/501100003785","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Aging Neurosci."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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\u2019s 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      MoCA scores, used as a screening tool, indicated lower cognitive performance in patients with COPD than in healthy controls (25.03\u202f\u00b1\u202f3.13 vs. 27.13\u202f\u00b1\u202f2.32;\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt;\u202f0.001), with preliminary observations suggesting potential involvement in memory and visuospatial\/executive domains. These deficiencies were accompanied by cortical thinning in the right cuneus, temporal lobe, and supplementary motor area (SMA;\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.05), along with white matter disruption (lower FA, higher RD) in corresponding tracts (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.01). Graphical analysis showed decreased degree centrality of the left SMA (SMA_L\u2019DC,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.005) and decreased global network efficiency (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001). Notably, SMA_L\u2019DC was significantly associated with respiratory symptoms (SGRQ) and cognitive performance (MoCA). Using a cross-sectional mediation model, we found that the association between SGRQ and MoCA was significantly accounted for by SMA_L\u2019DC (path c:\n                      <jats:italic>\u03b2<\/jats:italic>\n                      =\u202f\u22120.302,\n                      <jats:italic>p<\/jats:italic>\n                      =\u202f0.019). Specifically, the results supported a statistical mediation model in which SMA_L\u2019DC was significantly associated with the pathway linking respiratory symptoms and cognitive function.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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\u2013brain axis hypothesis rather than definitive evidence of causation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fnagi.2026.1797616","type":"journal-article","created":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T05:40:50Z","timestamp":1779082850000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["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"],"prefix":"10.3389","volume":"18","author":[{"given":"Chunrong","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Radiology, Shenzhen Nanshan People\u2019s Hospital","place":["Shenzhen, Guangdong, China"]},{"name":"Department of Radiology, Affiliated Nanshan Hospital of Shenzhen University","place":["Shenzhen, Guangdong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shiwei","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Radiology, Shenzhen Nanshan People\u2019s Hospital","place":["Shenzhen, Guangdong, China"]},{"name":"Department of Radiology, Affiliated Nanshan Hospital of Shenzhen University","place":["Shenzhen, Guangdong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kun","family":"Zhao","sequence":"additional","affiliation":[{"name":"School of Artificial Intelligence, Beijing University of Posts and Telecommunications","place":["Beijing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yafeng","family":"Zhan","sequence":"additional","affiliation":[{"name":"School of Biomedical Engineering, Southern Medical University","place":["Guangzhou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yingwei","family":"Qiu","sequence":"additional","affiliation":[{"name":"Department of Radiology, Shenzhen Nanshan People\u2019s Hospital","place":["Shenzhen, Guangdong, China"]},{"name":"Department of Radiology, Affiliated Nanshan Hospital of Shenzhen University","place":["Shenzhen, Guangdong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kewen","family":"Peng","sequence":"additional","affiliation":[{"name":"Department of Radiology, Shenzhen Nanshan People\u2019s Hospital","place":["Shenzhen, Guangdong, China"]},{"name":"Department of Radiology, Affiliated Nanshan Hospital of Shenzhen University","place":["Shenzhen, Guangdong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xinyu","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Radiology, Shenzhen Nanshan People\u2019s Hospital","place":["Shenzhen, Guangdong, China"]},{"name":"Department of Radiology, Affiliated Nanshan Hospital of Shenzhen University","place":["Shenzhen, Guangdong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Su","family":"Lui","sequence":"additional","affiliation":[{"name":"Department of Radiology, Huaxi MR Research Center (HMRRC), Institute of Radiology and Medical Imaging, West China Hospital of Sichuan University","place":["Chengdu, Sichuan, China"]},{"name":"Psychoradiology Key Laboratory of Sichuan Province, West China Hospital of Sichuan University","place":["Chengdu, Sichuan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yong","family":"Liu","sequence":"additional","affiliation":[{"name":"School of Artificial Intelligence, Beijing University of Posts and Telecommunications","place":["Beijing, China"]},{"name":"School of Artificial Intelligence, University of Chinese Academy of Sciences & Brainnetome Center, Chinese Academy of Sciences","place":["Beijing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shijun","family":"Qiu","sequence":"additional","affiliation":[{"name":"Department of Radiology, First Affiliated Hospital of Guangzhou University of Chinese Medicine","place":["Guangzhou, Guangdong, China"]},{"name":"State Key Laboratory of Traditional Chinese Medicine Syndrome","place":["Guangzhou, Guangdong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,18]]},"reference":[{"key":"ref1","first-page":"63","article-title":"Guideline for the management of chronic obstructive pulmonary disease\u20142011 update","volume":"101","author":"Abdool-Gaffar","year":"2011","journal-title":"S. 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