Cognitive Deficits in Chronic Kidney Disease at Different Stages: The Role of Structural and Perfusion-Driven Functional Connectivity Changes

Motivation: Chronic kidney disease (CKD) can lead to cognitive impairment, but its underlying mechanisms remain unclear. Goal(s): This study investigates gray matter volume (GMV) and cerebral blood flow (CBF) changes across CKD stages, identifies co-altered brain regions, and examines abnormal seed-based functional connectivity (FC) correlations with MoCA scores. Approach: We recruited 208 participants (66 healthy controls, 70 CKD stages 1-3a, and 72 CKD stages 3b-5) for high-resolution T1-weighted imaging, arterial spin labeling, and functional MRI. Results: The CKD 3b-5 group exhibited reduced GMV and increased CBF in fusiform gyrus, decreased FC with cognitive-related regions, and negative correlations with MoCA scores. Impact: Alterations in brain structure and perfusion may contribute to reduced FC between the fusiform gyrus and cognitive-related regions, offering neuroimaging evidence for the neuropathological mechanisms of cognitive impairment in different stages of CKD.