Regional gray matter atrophy mediates white matter hyperintensity-induced cognitive decline following carbon monoxide poisoning

Motivation: To reveal the underlying neuroimaging pathology mechanisms of cognitive impairment in patients with delayed neurologic sequelae (DNS) following carbon monoxide (CO) poisoning. Goal(s): To investigate the relationship among white matter hyperintensities (WMH), gray matter (GM) volume and cortical thickness alteration, and cognitive impairment severities in patients with DNS following CO poisoning. Approach: Clinical retrospective observational studyResults: The DNS patients with dementia (DNS-D) group showed more severe GM atrophy and higher WMH load than those with mild cognitive impairment (DNS-MCI) group. Reduced GM volume in 16 subregions of the bilateral prefrontal, left occipital, bilateral temporal, and cerebellar regions mediated the WMH-induced cognitive decline. Impact: Using the neuroimaging methods to explore the pathophysiological mechanism of DNS with cognitive impairment could provide a theoretical basis for exploring new therapeutic approaches. Our results provide preliminary evidence that the role of regional GM atrophy in WMH-induced cognitive decline.