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Shanks HRC, Chen K, Reiman EM, Blennow K, Cummings JL, Massa SM, Longo FM, Börjesson-Hanson A, Windisch M, Schmitz TW. p75 neurotrophin receptor modulation in mild to moderate Alzheimer disease: a randomized, placebo-controlled phase 2a trial. Nat Med 2024; 30:1761-1770. [PMID: 38760589 PMCID: PMC11186782 DOI: 10.1038/s41591-024-02977-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 04/04/2024] [Indexed: 05/19/2024]
Abstract
p75 neurotrophin receptor (p75NTR) signaling pathways substantially overlap with degenerative networks active in Alzheimer disease (AD). Modulation of p75NTR with the first-in-class small molecule LM11A-31 mitigates amyloid-induced and pathological tau-induced synaptic loss in preclinical models. Here we conducted a 26-week randomized, placebo-controlled, double-blinded phase 2a safety and exploratory endpoint trial of LM11A-31 in 242 participants with mild to moderate AD with three arms: placebo, 200 mg LM11A-31 and 400 mg LM11A-31, administered twice daily by oral capsules. This trial met its primary endpoint of safety and tolerability. Within the prespecified secondary and exploratory outcome domains (structural magnetic resonance imaging, fluorodeoxyglucose positron-emission tomography and cerebrospinal fluid biomarkers), significant drug-placebo differences were found, consistent with the hypothesis that LM11A-31 slows progression of pathophysiological features of AD; no significant effect of active treatment was observed on cognitive tests. Together, these results suggest that targeting p75NTR with LM11A-31 warrants further investigation in larger-scale clinical trials of longer duration. EU Clinical Trials registration: 2015-005263-16 ; ClinicalTrials.gov registration: NCT03069014 .
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Grants
- R35 AG071476 NIA NIH HHS
- P30 AG072980 NIA NIH HHS
- SG-23-1038904 QC Alzheimer's Association
- 2022-00732 Vetenskapsrådet (Swedish Research Council)
- P20 GM109025 NIGMS NIH HHS
- R01 AG053798 NIA NIH HHS
- R35AG71476 U.S. Department of Health & Human Services | NIH | National Institute on Aging (U.S. National Institute on Aging)
- ZEN-21-848495 Alzheimer's Association
- R01 AG051596 NIA NIH HHS
- P20GM109025 U.S. Department of Health & Human Services | NIH | National Institute of General Medical Sciences (NIGMS)
- 453677 Gouvernement du Canada | Canadian Institutes of Health Research (Instituts de Recherche en Santé du Canada)
- P20 AG068053 NIA NIH HHS
- 2017-00915 Vetenskapsrådet (Swedish Research Council)
- U01 AG024904 NIA NIH HHS
- R01AG053798 U.S. Department of Health & Human Services | NIH | National Institute on Aging (U.S. National Institute on Aging)
- R25 AG083721-01 U.S. Department of Health & Human Services | NIH | National Institute on Aging (U.S. National Institute on Aging)
- R25 AG083721 NIA NIH HHS
- Jonathan and Joshua Memorial Foundation Government of Ontario
- U.S. Department of Health & Human Services | NIH | National Institute on Aging (U.S. National Institute on Aging)
- State of Arizona
- Alzheimer’s Association
- the Swedish state under the agreement between the Swedish government and the County Councils, the ALF-agreement (#ALFGBG-715986 and #ALFGBG-965240), the Swedish Alzheimer Foundation (#AF-930351, #AF-939721 and #AF-968270), Hjärnfonden, Sweden (#FO2017-0243 and #ALZ2022-0006), La Fondation Recherche Alzheimer (FRA), Paris, France, the Kirsten and Freddy Johansen Foundation, Copenhagen, Denmark, and Familjen Rönströms Stiftelse, Stockholm, Sweden.
- U.S. Department of Health & Human Services | NIH | National Institute of General Medical Sciences (NIGMS)
- Alzheimer’s Drug Discovery Foundation (ADDF)
- Ted and Maria Quirk Endowment; Joy Chambers-Grundy Endowment.
- San Francisco VA Health Care System
- National Institutes of Aging (NIA AD Pilot Trial 1R01AG051596) PharmatrophiX (Menlo Park, California)
- Alzheimer’s Society of Canada (176677)
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Affiliation(s)
- Hayley R C Shanks
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
- Robarts Research Institute, Western University, London, Ontario, Canada.
- Western Institute for Neuroscience, Western University, London, Ontario, Canada.
| | - Kewei Chen
- Banner Alzheimer's Institute, Phoenix, AZ, USA
- College of Medicine-Phoenix, University of Arizona, Phoenix, AZ, USA
- College of Health Solutions, Arizona State University, Downtown, Phoenix, AZ, USA
| | - Eric M Reiman
- Banner Alzheimer's Institute, Phoenix, AZ, USA
- College of Medicine-Phoenix, University of Arizona, Phoenix, AZ, USA
- Translational Genomics Research Institute, Phoenix, AZ, USA
- Arizona Alzheimer's Consortium, Phoenix, AZ, USA
- ASU-Banner Neurodegenerative Disease Research Center, Arizona State University, Tempe, AZ, USA
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Jeffrey L Cummings
- Chambers-Grundy Center for Transformative Neuroscience, Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas (UNLV), Las Vegas, NV, USA
| | - Stephen M Massa
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | | | - Anne Börjesson-Hanson
- Clinical Trials, Department of Aging, Karolinska University Hospital, Stockholm, Sweden
| | | | - Taylor W Schmitz
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
- Robarts Research Institute, Western University, London, Ontario, Canada.
- Western Institute for Neuroscience, Western University, London, Ontario, Canada.
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Kim D, Kim Y, Park J, Choi H, Ryu H, Loeser M, Seo K. Exploring the Relationship between Behavioral and Neurological Impairments Due to Mild Cognitive Impairment: Correlation Study between Virtual Kiosk Test and EEG-SSVEP. SENSORS (BASEL, SWITZERLAND) 2024; 24:3543. [PMID: 38894334 PMCID: PMC11175241 DOI: 10.3390/s24113543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 05/28/2024] [Accepted: 05/29/2024] [Indexed: 06/21/2024]
Abstract
Amnestic mild cognitive impairment (aMCI) is a transitional stage between normal aging and Alzheimer's disease, making early screening imperative for potential intervention and prevention of progression to Alzheimer's disease (AD). Therefore, there is a demand for research to identify effective and easy-to-use tools for aMCI screening. While behavioral tests in virtual reality environments have successfully captured behavioral features related to instrumental activities of daily living for aMCI screening, further investigations are necessary to establish connections between cognitive decline and neurological changes. Utilizing electroencephalography with steady-state visual evoked potentials, this study delved into the correlation between behavioral features recorded during virtual reality tests and neurological features obtained by measuring neural activity in the dorsal stream. As a result, this multimodal approach achieved an impressive screening accuracy of 98.38%.
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Affiliation(s)
- Dohyun Kim
- Department of Applied Artificial Intelligence, Seoul National University of Science and Technology, Seoul 01811, Republic of Korea; (D.K.); (Y.K.)
| | - Yuwon Kim
- Department of Applied Artificial Intelligence, Seoul National University of Science and Technology, Seoul 01811, Republic of Korea; (D.K.); (Y.K.)
| | - Jinseok Park
- Department of Neurology, College of Medicine, Hanyang University, Seoul 04763, Republic of Korea; (J.P.); (H.C.)
| | - Hojin Choi
- Department of Neurology, College of Medicine, Hanyang University, Seoul 04763, Republic of Korea; (J.P.); (H.C.)
| | - Hokyoung Ryu
- Graduate School of Technology and Innovation Management, Hanyang University, Seoul 04763, Republic of Korea;
| | - Martin Loeser
- Department of Computer Science, Electrical Engineering and Mechatronics, ZHAW Zurich University of Applied Sciences, 8401 Winterthur, Switzerland;
| | - Kyoungwon Seo
- Department of Applied Artificial Intelligence, Seoul National University of Science and Technology, Seoul 01811, Republic of Korea; (D.K.); (Y.K.)
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Hu Y, Zhu T, Zhang W. The characteristics of brain atrophy prior to the onset of Alzheimer's disease: a longitudinal study. Front Aging Neurosci 2024; 16:1344920. [PMID: 38863784 PMCID: PMC11165148 DOI: 10.3389/fnagi.2024.1344920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 05/02/2024] [Indexed: 06/13/2024] Open
Abstract
Objective We aimed to use the onset time of Alzheimer's disease (AD) as the reference time to longitudinally investigate the atrophic characteristics of brain structures prior to the onset of AD. Materials and methods A total of 328 participants from the ADNI database with clear onset of AD and structural imaging data were included in our study. The time before the onset of AD (abbreviated as BAD) was calculated. We investigated the longitudinal brain changes in 97 regions using multivariate linear mixed effects regression models. Results The average BAD was -28.15 months, with a range from -156 to 0 months. The 54 brain regions showed significant atrophy prior to the onset of AD, and these regions were mainly distributed in the frontal and temporal lobes. The parietal and occipital lobe exhibited relatively less atrophy than the other brain lobes. Sex, age, and magnetic field strength had greater direct impacts on structural indicators than APOE genotype and education. The analysis of interaction effects revealed that the APOE ε4 mutation carriers exhibited more severe structural changes in specific brain regions as the BAD increased. However, sex, age, and education had minimal regulatory influence on the structural changes associated with BAD. Conclusion Longitudinal analysis, with the onset time point of AD as the reference, can accurately describe the features of structural changes preceding the onset of AD and provide a comprehensive understanding of AD development.
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Affiliation(s)
- Ying Hu
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China
| | - Ting Zhu
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China
| | - Wei Zhang
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China
- Mental Health Center of West China Hospital, Sichuan University, Chengdu, China
- Med-X Center for Informatics, Sichuan University, Chengdu, China
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Huang Y, Shan Y, Qin W, Zhao G. Apolipoprotein E ε4 accelerates the longitudinal cerebral atrophy in open access series of imaging studies-3 elders without dementia at enrollment. Front Aging Neurosci 2023; 15:1158579. [PMID: 37323144 PMCID: PMC10265507 DOI: 10.3389/fnagi.2023.1158579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 05/03/2023] [Indexed: 06/17/2023] Open
Abstract
Introduction Early studies have reported that APOE is strongly associated with brain atrophy and cognitive decline among healthy elders and Alzheimer's disease (AD). However, previous research has not directly outlined the modulation of APOE on the trajectory of cerebral atrophy with aging during the conversion from cognitive normal (CN) to dementia (CN2D). Methods This study tried to elucidate this issue from a voxel-wise whole-brain perspective based on 416 qualified participants from a longitudinal OASIS-3 neuroimaging cohort. A voxel-wise linear mixed-effects model was applied for detecting cerebrum regions whose nonlinear atrophic trajectories were driven by AD conversion and to elucidate the effect of APOE variants on the cerebral atrophic trajectories during the process. Results We found that CN2D participants had faster quadratically accelerated atrophy in bilateral hippocampi than persistent CN. Moreover, APOE ε4 carriers had faster-accelerated atrophy in the left hippocampus than ε4 noncarriers in both CN2D and persistent CN, and CN2D ε4 carriers an noncarriers presented a faster atrophic speed than CN ε4 carriers. These findings could be replicated in a sub-sample with a tough match in demographic information. Discussion Our findings filled the gap that APOE ε4 accelerates hippocampal atrophy and the conversion from normal cognition to dementia.
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Affiliation(s)
- Yuda Huang
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Yongzhi Shan
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Wen Qin
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Guoguang Zhao
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
- Clinical Research Center for Epilepsy Capital Medical University, Beijing, China
- Beijing Municipal Geriatric Medical Research Center, Beijing, China
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Lin YR, Chi CH, Chang YL. Differential decay of gist and detail memory in older adults with amnestic mild cognitive impairment. Cortex 2023; 164:112-128. [PMID: 37207409 DOI: 10.1016/j.cortex.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 02/19/2023] [Accepted: 04/11/2023] [Indexed: 05/21/2023]
Abstract
Amnestic mild cognitive impairment (aMCI) has been identified as a risk factor for dementia due to Alzheimer's disease. The medial temporal structures, which are crucial for memory processing, are the earliest affected regions in the brains of patients with aMCI, and episodic memory performance has been identified as a reliable way to discriminate between patients with aMCI and cognitively normal older adults. However, whether the detail and gist memory of patients with aMCI and cognitively normal older adults decay differently remains unclear. In this study, we hypothesized that detail and gist memory would be retrieved differentially, with a larger group performance gap in detail memory than in gist memory. In addition, we explored whether an increasing group performance gap between detail memory and gist memory groups would be observed over a 14-day period. Furthermore, we hypothesized that unisensory (audio-only) and multisensory (audiovisual) encoding would lead to differences in retrievals, with the multisensory condition reducing between and within-group performance gaps observed under the unisensory condition. The analyses conducted were analyses of covariance controlling for age, sex, and education and correlational analyses to examine behavioral performance and the association between behavioral data and brain variables. Compared with cognitively normal older adults, the patients with aMCI performed poorly on both detail and gist memory tests, and this performance gap persisted over time. Moreover, the memory performance of the patients with aMCI was enhanced by the provision of multisensory information, and bimodal input was significantly associated with medial temporal structure variables. Overall, our findings suggest that detail and gist memory decay differently, with a longer lasting group gap in gist memory than in detail memory. Multisensory encoding effectively reduced or overcame the between- and within-group gaps between time intervals, especially for gist memory, compared with unisensory encoding.
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Affiliation(s)
- Yu-Ruei Lin
- Department of Psychology, College of Science, National Taiwan University, Taipei, Taiwan
| | - Chia-Hsing Chi
- Department of Psychology, College of Science, National Taiwan University, Taipei, Taiwan
| | - Yu-Ling Chang
- Department of Psychology, College of Science, National Taiwan University, Taipei, Taiwan; Department of Neurology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan; Neurobiology and Cognitive Science Center, National Taiwan University, Taipei, Taiwan; Center for Artificial Intelligence and Advanced Robotics, National Taiwan University, Taipei, Taiwan.
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Segobin S, Ambler M, Laniepce A, Platel H, Chételat G, Groussard M, Pitel AL. Korsakoff's Syndrome and Alzheimer's Disease-Commonalities and Specificities of Volumetric Brain Alterations within Papez Circuit. J Clin Med 2023; 12:jcm12093147. [PMID: 37176588 PMCID: PMC10179200 DOI: 10.3390/jcm12093147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/11/2023] [Accepted: 04/18/2023] [Indexed: 05/15/2023] Open
Abstract
Background: Alzheimer's disease (AD) and Korsakoff's syndrome (KS) are two major neurocognitive disorders characterized by amnesia but AD is degenerative while KS is not. The objective is to compare regional volume deficits within the Papez circuit in AD and KS, considering AD progression. Methods: 18 KS patients, 40 AD patients (20 with Moderate AD (MAD) matched on global cognitive deficits with KS patients and 20 with Severe AD (SAD)), and 70 healthy controls underwent structural MRI. Volumes of the hippocampi, thalami, cingulate gyri, mammillary bodies (MB) and mammillothalamic tracts (MTT) were extracted. Results: For the cingulate gyri, and anterior thalamic nuclei, all patient groups were affected compared to controls but did not differ between each other. Smaller volumes were observed in all patient groups compared to controls in the mediodorsal thalamic nuclei and MB, but these regions were more severely damaged in KS than AD. MTT volumes were damaged in KS only. Hippocampi were affected in all patient groups but more severely in the SAD than in the KS and MAD. Conclusions: There are commonalities in the pattern of volume deficits in KS and AD within the Papez circuit with the anterior thalamic nuclei, cingulate cortex and hippocampus (in MAD only) being damaged to the same extent. The specificity of KS relies on the alteration of the MTT and the severity of the MB shrinkage. Further comparative studies including other imaging modalities and a neuropsychological assessment are required.
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Affiliation(s)
- Shailendra Segobin
- Normandie Univ, UNICAEN, PSL Université Paris, EPHE, INSERM, U1077, CHU de Caen, Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine (NIMH), 14000 Caen, France
| | - Melanie Ambler
- Normandie Univ, UNICAEN, PSL Université Paris, EPHE, INSERM, U1077, CHU de Caen, Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine (NIMH), 14000 Caen, France
| | - Alice Laniepce
- Normandie Univ, UNICAEN, PSL Université Paris, EPHE, INSERM, U1077, CHU de Caen, Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine (NIMH), 14000 Caen, France
- Normandie Univ, UNIROUEN, CRFDP (EA 7475), 76821 Rouen, France
- Normandie Univ, UNICAEN, INSERM, PhIND "Physiopathology and Imaging of Neurological Disorders", Institut Blood and Brain @ Caen-Normandie, Cyceron, 14000 Caen, France
| | - Hervé Platel
- Normandie Univ, UNICAEN, PSL Université Paris, EPHE, INSERM, U1077, CHU de Caen, Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine (NIMH), 14000 Caen, France
| | - Gael Chételat
- Normandie Univ, UNICAEN, INSERM, PhIND "Physiopathology and Imaging of Neurological Disorders", Institut Blood and Brain @ Caen-Normandie, Cyceron, 14000 Caen, France
| | - Mathilde Groussard
- Normandie Univ, UNICAEN, PSL Université Paris, EPHE, INSERM, U1077, CHU de Caen, Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine (NIMH), 14000 Caen, France
| | - Anne-Lise Pitel
- Normandie Univ, UNICAEN, INSERM, PhIND "Physiopathology and Imaging of Neurological Disorders", Institut Blood and Brain @ Caen-Normandie, Cyceron, 14000 Caen, France
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Dong H, Guo L, Yang H, Zhu W, Liu F, Xie Y, Zhang Y, Xue K, Li Q, Liang M, Zhang N, Qin W. Association between gray matter atrophy, cerebral hypoperfusion, and cognitive impairment in Alzheimer's disease. Front Aging Neurosci 2023; 15:1129051. [PMID: 37091519 PMCID: PMC10117777 DOI: 10.3389/fnagi.2023.1129051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 03/15/2023] [Indexed: 04/25/2023] Open
Abstract
Background Alzheimer's disease (AD) is one of the most severe neurodegenerative diseases leading to dementia in the elderly. Cerebral atrophy and hypoperfusion are two important pathophysiological characteristics. However, it is still unknown about the area-specific causal pathways between regional gray matter atrophy, cerebral hypoperfusion, and cognitive impairment in AD patients. Method Forty-two qualified AD patients and 49 healthy controls (HC) were recruited in this study. First, we explored voxel-wise inter-group differences in gray matter volume (GMV) and arterial spin labeling (ASL) -derived cerebral blood flow (CBF). Then we explored the voxel-wise associations between GMV and Mini-Mental State Examination (MMSE) score, GMV and CBF, and CBF and MMSE to identify brain targets contributing to cognitive impairment in AD patients. Finally, a mediation analysis was applied to test the causal pathways among atrophied GMV, hypoperfusion, and cognitive impairment in AD. Results Voxel-wise permutation test identified that the left middle temporal gyrus (MTG) had both decreased GMV and CBF in the AD. Moreover, the GMV of this region was positively correlated with MMSE and its CBF, and CBF of this region was also positively correlated with MMSE in AD (p < 0.05, corrected). Finally, mediation analysis revealed that gray matter atrophy of left MTG drives cognitive impairment of AD via the mediation of CBF (proportion of mediation = 55.82%, β = 0.242, 95% confidence interval by bias-corrected and accelerated bootstrap: 0.082 to 0.530). Conclusion Our findings indicated suggested that left MTG is an important hub linking gray matter atrophy, hypoperfusion, and cognitive impairment for AD, and might be a potential treatment target for AD.
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Affiliation(s)
- Haoyang Dong
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, China
| | - Lining Guo
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, China
| | - Hailei Yang
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, China
| | - Wenshuang Zhu
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, China
| | - Fang Liu
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China
| | - Yingying Xie
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, China
| | - Yu Zhang
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, China
| | - Kaizhong Xue
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, China
| | - Qiang Li
- Technical College for the Deaf, Tianjin University of Technology, Tianjin, China
| | - Meng Liang
- School of Medical Imaging, Tianjin Medical University, Tianjin, China
| | - Nan Zhang
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China
- *Correspondence: Nan Zhang,
| | - Wen Qin
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, China
- Wen Qin,
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