Xiaoyuan Huang ¹ Lu Jin ² TENGWU CHANG ³ Jian Liu ^4* Yuan Qu ^5* Jin Yong Li ¹ Wenju Bai ¹ CHUZHONG LI ^6* Jichao Wang ^3*

• ¹ Graduate School, Xinjiang Medical University, Ürümqi, China
• ² Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, Beijing Municipality, China
• ³ Department of Neurosurgery, People's Hospital of Xinjiang Uygur Autonomous Region, Ürümqi, Xinjiang Uyghur Region, China
• ⁴ Department of Orthopaedics, People's Hospital of Xinjiang Uygur Autonomous Region, Ürümqi, Xinjiang Uyghur Region, China
• ⁵ Radiographic Image Center, People's Hospital of Xinjiang Uygur Autonomous Region, Ürümqi, Xinjiang Uyghur Region, China
• ⁶ Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, Beijing Municipality, China

Cognitive impairment is a frequent clinical symptom of non-communicating hydrocephalus (NCH) involving multiple domains, including executive function, working memory, visual-spatial function, language, and attention. Functional magnetic resonance imaging (fMRI) can be used to obtain information on functional activity in local brain areas and functional connectivity (FC) across multiple brain regions. However, studies on the associated cognitive impairment are limited; further, the pathophysiological mechanisms of NCH with cognitive impairment remain unclear. Here, we aimed to explore alterations in regional neural activity and FC, as well as the mechanisms of cognitive impairment, in patients with NCH. Methods: Overall, 16 patients with NCH and 25 demographically matched healthy controls (HCs) were assessed using the Mini-Mental State Examination (MMSE) and fMRI. Changes in regional homogeneity (ReHo), degree centrality (DC), and region of interest-based FC were analyzed in both groups. The relationship between fMRI metrics (ReHo, DC, and FC) and MMSE scores in patients with NCH was also investigated. Results and Discussion: Compared with the HC group, the NCH group exhibited significantly lower ReHo values in the left precentral and postcentral gyri, and significantly higher ReHo values in the left medial prefrontal cortex (MPFC). The NCH group also showed significantly higher DC values in the bilateral MPFC compared with the HC group. Regarding seed-based FC, the MPFC showed reduced FC values in the right superior parietal and postcentral gyrus in the NCH group compared with those in the HC group. Moreover, within the NCH group, MMSE scores were significantly negatively correlated with the ReHo value in the left MPFC and the DC value in the bilateral MPFC, whereas MMSE scores were significantly positively correlated with FC values. To conclude, regional neural activity and FC are altered in patients with NCH and are correlated with cognitive impairment. These results advance our understanding of the pathophysiological mechanisms underlying the association between NCH and cognitive impairment.