Declined connectivity of thalamus and dorsomedial prefrontal cortex in post-stroke cognitive impairment delineated by lesion network mapping

Abstract Post-stroke cognitive impairment (PSCI) is a common complication of stroke. Stroke events can often cause functional changes in distant brain regions beyond the lesion, which may be the underlying cause of PSCI. However, there are still no consistent imaging features with specificity for PSCI. In the present study, we utilized lesion network mapping analysis to address this question. The left thalamus was the only lesion of interest that we converged on, and it mapped the cognitive impairment circuit of PSCI. Patients with severe cognitive impairment had a higher proportion of lesions falling into the cognitive impairment circuit than those with mild cognitive impairment. From the perspectives of brain function, neurotransmitters and molecular genetics, we found that spatial regions of the circuit are strongly associated with memory-related functions. Interestingly, cognitive impairment circuit from PSCI do share high spatial similarity with published memory circuit. Besides, reduced functional connectivity in the left thalamus and left dorsomedial prefrontal cortex may be a crucial reason for cognitive decline in PSCI. Overall, our study identifies a cognitive impairment circuit in PSCI, which impairment may be an important mechanism for memory disorders in PSCI. Connectivity of left thalamus and dorsomedial prefrontal cortex is expected to serve as a biomarker and new target of neuromodulation therapy.