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      DTI Study on Brain Structure and Cognitive Function in Patients with Chronic Mountain Sickness

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          Abstract

          In chronic mountain sickness (CMS) patients, the structure of the brain, memory and cognition are often irreversibly damaged by chronic hypoxia due to red blood cell overcompensation, elevated haemoglobin and blood stasis. In this study, we aimed to evaluate this damage using diffusion tensor imaging (DTI) and to study the correlations among the fractional anisotropy (FA),the apparent diffusion coefficient (ADC) value, the severity index of CMS and the simple Mental State Examination (MMSE) score in CMS patients. A total of 17 patients with CMS and 15 healthy controls were recruited for conventional brain magnetic resonance imaging (MRI) and DTI scans, and ADC images were reconstructed along with FA and FA colour maps. The FA and ADC values of the selected regions of interest (ROIs) were measured and compared. The FA and ADC values were also compared with the haemoglobin (Hb) and MMSE scores. CMS patients are prone to intracranial ischaemia, infarction and haemorrhage. Multiple structural changes occur in the brain of CMS patients, and these changes are related to the severity of the disease and cognitive function variation. The white matter fibre bundles of CMS patients showed no obvious damage, except in the ischaemic site.

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          High-altitude illness.

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            Consensus statement on chronic and subacute high altitude diseases.

            This is an international consensus statement of an ad hoc committee formed by the International Society for Mountain Medicine (ISMM) at the VI World Congress on Mountain Medicine and High Altitude Physiology (Xining, China; 2004) and represents the committee's interpretation of the current knowledge with regard to the most common chronic and subacute high altitude diseases. It has been developed by medical and scientific authorities from the committee experienced in the recognition and prevention of high altitude diseases and is based mainly on published, peer-reviewed articles. It is intended to include all legitimate criteria for choosing to use a specific method or procedure to diagnose or manage high altitude diseases. However, the ISMM recognizes that specific patient care decisions depend on the different geographic circumstances involved in the development of each chronic high altitude disease. These guidelines are established to inform the medical services on site who are directed to solve high altitude health problems about the definition, diagnosis, treatment, and prevention of the most common chronic high altitude diseases. The health problems associated with life at high altitude are well documented, but health policies and procedures often do not reflect current state-of-the-art knowledge. Most of the cases of high altitude diseases are preventable if on-site personnel identify the condition and implement appropriate care.
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              Hypobaric hypoxia-induced dendritic atrophy of hippocampal neurons is associated with cognitive impairment in adult rats.

              Simulated hypobaric hypoxia (HBH), resembling high altitude hypoxia severely affects the CNS and results in several physiological changes. The hippocampus is closely associated with learning and memory and an insult to this region affects cognition. Previous studies suggest that rapid or prolonged exposures to HBH are associated with psychomotor and cognitive impairments. The defense personnel, mountain climbers and rescue teams are exposed to such harsh environment and thus it demands a systematic study emphasizing the subtle effects of such extreme environments on cognitive function. Accordingly, this study evaluated the effect of hypobaric hypoxia on structural changes in the principal neurons of the hippocampus and learning in eight-arm radial maze. Adult male Wistar rats, subjected to simulated hypobaric hypoxia equivalent to an altitude of 6000 m for a period of 2 or 7 days, in a hypoxic chamber served as hypoxic group (HY). Rats housed in a similar chamber for the same period of time, without hypoxic exposure served as sham control (SC), while normal control (NC) group of rats were housed in standard laboratory conditions. The dendritic morphology of neurons in cornu ammonis region 1 (CA1) and cornu ammonis region 3 (CA3) was studied in Golgi-impregnated hippocampal sections. Exposure for 2 days to hypobaric hypoxia had minimal deleterious effects on the CA1 pyramidal neurons, while exposure for 7 days resulted in a significant decrease in the number of branching points, intersections and dendritic length. Unlike the CA1 pyramidal neurons, the CA3 neurons exhibited dendritic atrophy following both 2 and 7 days of hypoxic exposure. Further, hippocampal-dependent spatial learning was affected marginally following 2 day exposure, while 7 day exposure severely affected learning of the partially baited radial arm maze task. Our study suggests that dendritic atrophy in the hippocampus on exposure to HBH could be one of the bases for the cognitive deficits exhibited under such conditions.
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                Author and article information

                Contributors
                baohelen2@sina.com
                Journal
                Sci Rep
                Sci Rep
                Scientific Reports
                Nature Publishing Group UK (London )
                2045-2322
                18 December 2019
                18 December 2019
                2019
                : 9
                : 19334
                Affiliations
                GRID grid.459333.b, Department of Medical Imaging Center, Affiliated Hospital of Qinghai University, ; Xining, Qinghai China
                Author information
                http://orcid.org/0000-0003-2651-6120
                Article
                55498
                10.1038/s41598-019-55498-9
                6920146
                31852992
                410d4297-4feb-4916-a6a5-ee222558b6de
                © The Author(s) 2019

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 5 December 2018
                : 27 November 2019
                Funding
                Funded by: FundRef https://doi.org/10.13039/501100001809, National Natural Science Foundation of China (National Science Foundation of China);
                Award ID: 81060117
                Award Recipient :
                Categories
                Article
                Custom metadata
                © The Author(s) 2019

                Uncategorized
                neurological disorders,outcomes research
                Uncategorized
                neurological disorders, outcomes research

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