Cortical Thickness of Native Tibetans in the Qinghai-Tibetan Plateau

Investigating Sea-Level Brain Predictors for Acute Mountain Sickness: A Multimodal MRI Study before and after High-Altitude Exposure

BACKGROUND AND PURPOSE

Acute mountain sickness is a series of brain-centered symptoms that occur when rapidly ascending to high altitude. Predicting acute mountain sickness before high-altitude exposure is crucial for protecting susceptible individuals. The present study aimed to evaluate the feasibility of predicting acute mountain sickness after high-altitude exposure by using multimodal brain MR imaging features measured at sea level.

MATERIALS AND METHODS

We recruited 45 healthy sea-level residents who flew to the Qinghai-Tibet Plateau (3650 m). We conducted T1-weighted structural MR imaging, resting-state fMRI, and arterial spin-labeling perfusion MR imaging both at sea level and high altitude. Acute mountain sickness was diagnosed for 5 days using Lake Louise Scoring. Logistic regression with Least Absolute Shrinkage and Selection Operator logistic regression was performed for predicting acute mountain sickness using sea-level MR imaging features. We also validated the predictors by using MR images obtained at high altitude.

RESULTS

The incidence rate of acute mountain sickness was 80.0%. The model achieved an area under the receiver operating characteristic curve of 86.4% (sensitivity = 77.8%, specificity = 100.0%, and P < .001) in predicting acute mountain sickness At sea level, valid predictors included fractional amplitude of low-frequency fluctuations (fALFF) and degree centrality from resting-state fMRI, mainly distributed in the somatomotor network. We further learned that the acute mountain sickness group had lower levels of fALFF in the somatomotor network at high altitude, associated with smaller changes in CSF volume and higher Lake Louise Scoring, specifically relating to fatigue and clinical function.

CONCLUSIONS

Our study found that the somatomotor network function detected by sea-level resting-state fMRI was a crucial predictor for acute mountain sickness and further validated its pathophysiologic impact at high altitude. These findings show promise for pre-exposure prediction, particularly for individuals in need of rapid ascent, and they offer insight into the potential mechanism of acute mountain sickness.

The effects of long-term high-altitude exposure on cognition: A meta-analysis

Long-term high altitudes (HA) exposure's impact on cognition has yielded inconsistent findings in previous research. To address this, we conducted a meta-analysis of 49 studies (6191 individuals) to comprehensively evaluate this effect. Moderating factors such as cognitive task type, altitude (1500-2500 m, 2500-4000 m, and above 4000 m), residential type (chronic and lifelong), adaptation level and demographic factors were analyzed. Cognitive tasks were classified into eight categories: perceptual processes, psychomotor function, long-term memory, working memory, inhibitory control, problem-solving, language, and others. Results revealed a moderate negative effect of HA on cognitive performance (g = -.40, SE =.18, 95% CI = -.76 to -.05). Psychomotor function and long-term memory notably experience the most pronounced decline, while working memory and language skills show moderate decreases due to HA exposure. However, perceptual processes, inhibitory control, and problem-solving abilities remain unaffected. Moreover, residing at altitudes above 4000 m and being a HA immigrant are associated with significant cognitive impairment. In summary, our findings indicate a selective adaptation of cognitive performance to HA conditions.

Association of sugar-sweetened beverage consumption and sleep quality with anxiety symptoms: a cross-sectional study of Tibetan college students at high altitude

Background

Research on the association between sugar-sweetened beverages (SSBs) consumption and sleep quality with anxiety symptoms has been highly emphasized. However, past studies have focused on college students in plains areas, while fewer research studies have been conducted on Tibetan college students at high altitudes. Whether this association changes due to ethnicity or altitude is unclear. The present study will contribute to the prevention and intervention of depressive symptoms among Tibetan college students at high altitude.

Methods

A self-assessment questionnaire was administered to 3,026 university students (1,491 boys students, 49.27%) on SSBs consumption, sleep quality and anxiety symptoms status in the Tibetan Plateau, a high-altitude region of China. Logistic regression analysis and ordered logistic regression analysis in generalized linear model were used to analyze the association between SSBs consumption and sleep quality with anxiety symptoms.

Results

The prevalence of anxiety symptoms among Tibetan college students at high altitude was 26.9%. SSBs consumption of ≤1 times/week, 2-5 times/week, and ≥ 6 times/week were 20.7, 28.1, and 45.7%, respectively, with statistically significant differences (χ2 value of 134.353, p < 0.001). Anxiety detection rates for Sleep quality of Good (PSQI ≤5), Moderate (PSQI 6-7), and Poor (PSQI >7) were 16.8, 19.8, and 32.0%, respectively, and the difference was also statistically significant (χ2 value was 73.761, p < 0.001). The ordered logistic regression analysis in the generalized linear model showed that, overall, the group of college students with SSBs ≤1 times/week and sleep quality of Good served as the reference group, and the group with SSBs ≥6 times/week and sleep quality of Poor (OR: 5.06, 95% CI: 3.75-6.83) had the highest risk of anxiety symptoms.

Conclusion

SSBs consumption and sleep quality were associated with anxiety symptoms, and there was an interaction effect. Effective control of SSBs consumption and improvement of sleep quality may be important factors in preventing and reducing the occurrence of anxiety symptoms.

Effects of long-term exposure to high altitude on brain structure in healthy people: an MRI-based systematic review and meta-analysis

Purpose

To conduct a systematic review and meta-analysis of observational studies of brain MRI, this paper assesses the effects of long-term exposure to high-altitude on brain structures in healthy people.

Methods

Observational studies related to high-altitude, brain and MRI were systematically searched based on data retrieved from PubMed, Embase and Cochrane Library. The timescale for collecting literature was from the establishment of the databases to 2023. NoteExpress 3.2 was used to manage the literature. Two investigators performed literature screening and data extraction based on inclusion criteria, exclusion criteria, and literature quality. The quality of the literature was assessed using the NOS Scale. Finally, meta-analysis of included studies was performed using Reviewer Manager 5.3.

Results

Initially, 3,626 articles were retrieved. After screening, 16 articles (n = 756 participants) were included in the systematic review, and meta-analysis was performed on 6 articles (n = 350 participants). The overall quality of the included articles was at medium level, with a mean NOS score of 5.62. The results of meta-analysis showed that the differences between the HA group and LA group were not statistically significant, in total GM volume (MD: -0.60, 95% CI: -16.78 to 15.58, P = 0.94), WM volume (MD: 3.05, 95% CI: -15.72 to 21.81, P = 0.75) and CSF volume (MD: 5.00, 95% CI: -11.10 to 21.09, P = 0.54).The differences between HA and LA in FA values of frontotemporal lobes were not statistically significant: right frontal lobe (MD: -0.02, 95% CI: -0.07 to 0.03, P = 0.38), left frontal lobe (MD: 0.01, 95% CI: -0.02 to 0.04, P = 0.65), right temporal lobe (MD: -0.00, 95% CI: -0.03 to 0.02, P = 0.78) and left temporal lobe (MD: -0.01, 95% CI: -0.04 to 0.02, P = 0.62). However, there were significant differences in GM volume, GM density and FA values in local brain regions between HA group and LA group.

Conclusion

Compared with LA area, there were no significant differences in total GM, WM and CSF volumes in healthy people living at high-altitude area for long-term, while there were significant differences in GM volume and FA values in local brain regions. Long-term exposure to high-altitude area caused the adaptive structural changes in local brain regions. Since heterogeneity existed between the studies, further studies are needed to uncover the effects of high-altitude on brain of healthy people.

Systematic review registration

https://www.crd.york.ac.uk/prospero/, identifier: CRD42023403491.

Genomic architecture underlying morphological and physiological adaptation to high elevation in a songbird

Organisms often acquire physiological and morphological modifications to conquer ecological challenges when colonizing new environments which lead to their adaptive evolution. However, deciphering the genomic mechanism of ecological adaptation is difficult because ecological environments are often too complex for straightforward interpretation. Thus, we examined the adaptation of a widespread songbird-the rufous-capped babbler (Cyanoderma ruficeps)-to a relatively simple system: distinct environments across elevational gradients on the mountainous island of Taiwan. We focused on the genomic sequences of 43 birds from five populations to show that the Taiwan group split from its sister group in mainland China around 1-2 million years ago (Ma) and colonized the montane habitats of Taiwan at least twice around 0.03-0.22 Ma. The montane and lowland Taiwan populations diverged with gene flow between them, suggesting strong selection associated with different elevations. We found that the montane babblers had smaller beaks than the lowland ones, consistent with Allen's rule, and identified candidate genes-COL9A1 and SOX11-underlying the beak size changes. We also found that altitudinally divergent mutations were mostly located in noncoding regions and tended to accumulate in chromosomal inversions and autosomes. The altitudinally divergent mutations might regulate genes related to haematopoietic, metabolic, immune, auditory and vision functions, as well as cerebrum morphology and plumage development. The results reveal the genomic bases of morphological and physiological adaptation in this species to the low temperature, hypoxia and high UV light environment at high elevation. These findings improve our understanding of how ecological adaptation drives population divergence from the perspective of genomic architecture.

Brain Structural and Functional Alterations in Native Tibetans Living at High Altitude

Tibetans have adapted to high altitude environments. However, the genetic effects in their brains have not been identified. Twenty-five native Tibetans living in Lhasa (3650 m) were recruited for comparison with 20 Han immigrants who originated from lowlands and had been living in Lhasa for two years. The physiological characteristics, brain structure and neuronal spontaneous activity were investigated. Compared with Han immigrants, Tibetans showed higher peripheral oxygen saturation (SpO₂), and lower heart rate, red blood cell counts, hematocrit, and hemoglobin. Tibetans showed increased gray matter volume in the visual cortex, hippocampus, and rectus; increased the amplitudes of low-frequency fluctuations (ALFF) values in the left putamen and left fusiform gyrus; and decreased voxel-mirrored homotopic connectivity (VMHC) values in the precentral gyrus. Moreover, Tibetans have decreased functional connectivity (FC) between the left precentral gyrus and the frontal gyrusand right precuneus. In Tibetans and Han immigrants, hemoglobin and hematocrit were negatively correlated with total gray matter volume in males, SpO₂ was also positively correlated with ALFF in the left fusiform gyrus, while hemoglobin, and hematocrit were positively correlated with VMHC in the precentral gyrus and FC in the precentral gyrus with other brain regions, SpO₂ was also found to be negatively correlated with VMHC in the precentral gyrus, and hemoglobin and hematocrit were negatively correlated with ALFF in the left putamen and left fusiform gyrus. In summary, genetic mutations may result in modulation of some brain regions, which was further confirmed by the identification of correlations with hemoglobin and hematocrit in these regions.

Consistent differences in brain structure and functional connectivity in high-altitude native Tibetans and immigrants

It has been well-established that high-altitude (HA) environments affect the human brain; however, the differences in brain structural and functional networks between HA natives and acclimatized immigrants have not been well clarified. In this study, native HA Tibetans were recruited for comparison with Han immigrants (average of 2.3 ± 0.3 years at HA), with lowland residents recruited as controls. Cortical gray matter volume, thickness, and functional connectivity were investigated using magnetic resonance imaging data. In addition, reaction time and correct score in the visual movement task, hematology, and SpO₂ were measured. In both Tibetans and HA immigrants vs. lowlanders, decreased SpO₂, increased hematocrit and hemoglobin, and increased reaction time and correct score in the visual movement task were detected. In both Tibetans and HA immigrants vs. lowlanders, gray matter volumes and cortical thickness were increased in the left somatosensory and motor cortex, and functional connectivity was decreased in the visual, default mode, subcortical, somatosensory-motor, ventral attention, and subcortical networks. Furthermore, SpO₂ increased, hematocrit and hemoglobin decreased, and gray matter volumes and cortical thickness increased in the visual cortex, left motor cortex, and right auditory cortex in native Tibetans compared to immigrants. Movement time and correct score in task were positively correlated with the thickness of the visual cortex. In conclusion, brain structural and functional network difference in both Tibetan natives and HA immigrants were largely consistent, with native Tibetans only showing more intense brain modulation. Different populations acclimatized to HA develop similar brain mechanisms to cope with hostile HA environmental factors.

The human brain in a high altitude natural environment: A review

With the advancement of in vivo magnetic resonance imaging (MRI) technique, more detailed information about the human brain at high altitude (HA) has been revealed. The present review aimed to draw a conclusion regarding changes in the human brain in both unacclimatized and acclimatized states in a natural HA environment. Using multiple advanced analysis methods that based on MRI as well as electroencephalography, the modulations of brain gray and white matter morphology and the electrophysiological mechanisms underlying processing of cognitive activity have been explored in certain extent. The visual, motor and insular cortices are brain regions seen to be consistently affected in both HA immigrants and natives. Current findings regarding cortical electrophysiological and blood dynamic signals may be related to cardiovascular and respiratory regulations, and may clarify the mechanisms underlying some behaviors at HA. In general, in the past 10 years, researches on the brain at HA have gone beyond cognitive tests. Due to the sample size is not large enough, the current findings in HA brain are not very reliable, and thus much more researches are needed. Moreover, the histological and genetic bases of brain structures at HA are also needed to be elucidated.

Resting-State Neuronal Activity and Functional Connectivity Changes in the Visual Cortex after High Altitude Exposure: A Longitudinal Study

Damage to the visual cortex structures after high altitude exposure has been well clarified. However, changes in the neuronal activity and functional connectivity (FC) of the visual cortex after hypoxia/reoxygenation remain unclear. Twenty-three sea-level college students, who took part in 30 days of teaching at high altitude (4300 m), underwent routine blood tests, visual behavior tests, and magnetic resonance imaging scans before they went to high altitude (Test 1), 7 days after they returned to sea level (Test 2), as well as 3 months (Test 3) after they returned to sea level. In this study, we investigated the hematological parameters, behavioral data, and spontaneous brain activity. There were significant differences among the tests in hematological parameters and spontaneous brain activity. The hematocrit, hemoglobin concentration, and red blood cell count were significantly increased in Test 2 as compared with Tests 1 and 3. As compared with Test 1, Test 3 increased amplitudes of low-frequency fluctuations (ALFF) in the right calcarine gyrus; Tests 2 and 3 increased ALFF in the right supplementary motor cortex, increased regional homogeneity (ReHo) in the left lingual gyrus, increased the voxel-mirrored homotopic connectivity (VMHC) value in the motor cortex, and decreased FC between the left lingual gyrus and left postcentral gyrus. The color accuracy in the visual task was positively correlated with ALFF and ReHo in Test 2. Hypoxia/reoxygenation increased functional connection between the neurons within the visual cortex and the motor cortex but decreased connection between the visual cortex and motor cortex.

Study of Brain Structure and Function in Chronic Mountain Sickness Based on fMRI

Objective: Headache and memory impairment are the primary clinical symptoms of chronic mountain sickness (CMS). In this study, we used voxel-based morphometry (VBM) and the amplitude of the low-frequency fluctuation method (ALFF) based on blood oxygen level-dependent functional magnetic resonance imaging (BOLD-fMRI) to identify changes in the brain structure and function caused by CMS.

Materials and Methods: T1W anatomical images and a resting-state functional MRI (fMRI) of the whole brain were performed in 24 patients diagnosed with CMS and 25 normal controls matched for age, sex, years of education, and living altitude. MRI images were acquired, followed by VBM and ALFF data analyses.

Results: Compared with the control group, the CMS group had increased gray matter volume in the left cerebellum crus II area, left inferior temporal gyrus, right middle temporal gyrus, right insula, right caudate nucleus, and bilateral lentiform nucleus along with decreased gray matter volume in the left middle occipital gyrus and left middle temporal gyrus. White matter was decreased in the bilateral middle temporal gyrus and increased in the right Heschl's gyrus. Resting-state fMRI in patients with CMS showed increased spontaneous brain activity in the left supramarginal gyrus, left parahippocampal gyrus, and left middle temporal gyrus along with decreased spontaneous brain activity in the right cerebellum crus I area and right supplementary motor area.

Conclusion: Patients with CMS had differences in gray and white matter volume and abnormal spontaneous brain activity in multiple brain regions compared to the controls. This suggests that long-term chronic hypoxia may induce changes in brain structure and function, resulting in CMS.

Electrophysiological mechanisms underlying hypoxia-induced deficits in visual spatial and non-spatial discrimination

Impaired visual cognition in residents of hypoxic environment has been widely reported; however, the underlying electrophysiological mechanisms remain unclear. In this study, 23 college students underwent three sessions of a Clock task test before a 30-day high-altitude exposure (Test 1) and 1 week (Test 2) and 3 months (Test 3) after they returned to lowlands. The Clock task consists of a visual spatial angle and a visual non-spatial color discrimination subtask. Simultaneously, electroencephalography (EEG) was recorded during the Clock task. The behavioral results showed that, compared with Test 1, accuracy in Test 2 was significantly decreased in both the Angle and Color tasks, and reaction time (RT) was significantly increased in the Angle task. The event-related potentials results showed that, during both tasks amplitudes of the occipital N1 and P3 components during both tasks were significantly decreased in Test 2, compared with Test 1. Moreover, N1 amplitude was negatively correlated with RT and positively correlated with accuracy. Further time-frequency EEG analysis showed that theta power at occipital sites was significantly decreased in both tasks in Test 2, compared with Test 1, and was negatively correlated with RT in the Angle task. In Test 3, both the behavioral performance and EEG activity recovered to the baseline level in Test 1. These findings suggested that hypoxia impairs both visual spatial and visual non-spatial discriminations, and these impairments can recover after subjects return to lowlands. Inhibition of brain electrophysiological activity in the visual cortex may explain the deficits in visual cognition.

Cerebral regional and network characteristics in asthma patients: a resting-state fMRI study

Asthma is a serious health problem that involves not only the respiratory system but also the central nervous system. Previous studies identified either regional or network alterations in patients with asthma, but inconsistent results were obtained. A key question remains unclear: are the regional and neural network deficits related or are they two independent characteristics in asthma? Answering this question is the aim of this study. By collecting resting-state functional magnetic resonance imaging from 39 patients with asthma and 40 matched health controls, brain functional measures including regional activity (amplitude of low-frequency fluctuations) and neural network function (degree centrality (DC) and functional connectivity) were calculated to systematically characterize the functional alterations. Patients exhibited regional abnormities in the left angular gyrus, right precuneus, and inferior temporal gyrus within the default mode network. Network abnormalities involved both the sensorimotor network and visual network with key regions including the superior frontal gyrus and occipital lobes. Altered DC in the lingual gyrus was correlated with the degree of airway obstruction. This study elucidated different patterns of regional and network changes, thereby suggesting that the two parameters reflect different brain characteristics of asthma. These findings provide evidence for further understanding the potential cerebral alterations in the pathophysiology of asthma.

Abnormal brain activity in rats with sustained hypobaric hypoxia exposure: a resting-state functional magnetic resonance imaging study

Background:

Hypobaric hypoxia (HH) exposure at high altitudes can result in a decline in cognitive function, which may have a serious impact on the daily life of people who migrate to high altitudes. However, the specific HH-induced changes in brain function remain unclear. This study explored changes in brain activity in rats exposed to a sustained HH environment using functional magnetic resonance imaging (fMRI).

Methods:

Healthy male rats (8 weeks old) were randomly divided into a model group and a control group. A rat model of cognitive impairment induced by sustained HH exposure was established. The control and model groups completed training and testing in the Morris water maze (MWM). A two-sample t-test for between-group difference comparisons was performed. Repeated measures analyses of variance for within-group comparisons were performed and post-hoc comparisons were made using the Tukey test. Between-group differences in spontaneous brain activity were assessed using a voxel-wise analysis of resting-state fMRI (rs-fMRI), combined with analyses of the fractional amplitude of low frequency fluctuations (fALFF) in statistical parametric mapping.

Results:

In the MWM test, the escape latencies of the model group were significantly longer compared with those of the control group (control group vs. model group, day 1: 21.6 ± 3.3 s vs. 40.5 ± 3.4 s, t = –11.282; day 2: 13.5 ± 2.2 s vs. 28.7 ± 5.3 s, t = –7.492; day 3: 10.5 ± 2.8 s vs. 22.6 ± 6.1 s, t = –5.099; day 4: 9.7 ± 2.5 s vs. 18.6 ± 5.2 s, t = –4.363; day 5: 8.8 ± 2.7 s vs. 16.7 ± 5.0 s, t = –3.932; all P < 0.001). Within both groups, the escape latency at day 5 was significantly shorter than those at other time points (control group: F = 57.317, P < 0.001; model group: F = 50.718, P < 0.001). There was no within-group difference in average swimming speed (control group, F = 1.162, P = 0.956; model group, F = 0.091, P = 0.880). Within the model group, the time spent within the original platform quadrant was significantly shorter (control group vs. model group: 36.1 ± 5.7 s vs. 17.8 ± 4.3 s, t = 7.249, P < 0.001) and the frequency of crossing the original platform quadrant was significantly reduced (control group vs. model group: 6.4 ± 1.9 s vs. 2.0 ± 0.8 s, t = 6.037, P < 0.001) compared with the control group. In the rs-fMRI study, compared with the control group, rats in the model group showed widespread reductions in fALFF values throughout the brain.

Conclusions:

The abnormalities in spontaneous brain activity indicated by the fALFF measurements may reflect changes in brain function after HH exposure. This widespread abnormal brain activity may help to explain and to provide new insights into the mechanism underlying the impairment of brain function under sustained exposure to high altitudes.

Neural network correlates of high-altitude adaptive genetic variants in Tibetans: A pilot, exploratory study

Although substantial progress has been made in the identification of genetic substrates underlying physiology, neuropsychology, and brain organization, the genotype–phenotype associations remain largely unknown in the context of high‐altitude (HA) adaptation. Here, we related HA adaptive genetic variants in three gene loci (EGLN1, EPAS1, and PPARA) to interindividual variance in a set of physiological characteristics, neuropsychological tests, and topological attributes of large‐scale structural and functional brain networks in 135 indigenous Tibetan highlanders. Analyses of individual HA adaptive single‐nucleotide polymorphisms (SNPs) revealed that specific SNPs selectively modulated physiological characteristics (erythrocyte level, ratio between forced expiratory volume in the first second to forced vital capacity, arterial oxygen saturation, and heart rate) and structural network centrality (the left anterior orbital gyrus) with no effects on neuropsychology or functional brain networks. Further analyses of genetic adaptive scores, which summarized the overall degree of genetic adaptation to HA, revealed significant correlations only with structural brain networks with respect to local interconnectivity of the whole networks, intermodule communication between the right frontal and parietal module and the left occipital module, nodal centrality in several frontal regions, and connectivity strength of a subnetwork predominantly involving in intramodule edges in the right temporal and occipital module. Moreover, the associations were dependent on gene loci, weight types, or topological scales. Together, these findings shed new light on genotype–phenotype interactions under HA hypoxia and have important implications for developing new strategies to optimize organism and tissue responses to chronic hypoxia induced by extreme environments or diseases.

Regional cerebral blood flow in natives at high altitude: An arterial spin labeled MRI study

BACKGROUND

It is known that a neurologic sequence occurs at high altitudes (HA); hence, cerebral blood flow (CBF) might vary by altitude.

PURPOSE

To use arterial spin labeled (ASL) MRI to evaluate absolute CBF differences between subjects who live at HA and lowlands.

STUDY TYPE

Cohort prospective trial.

POPULATION

In all, 64 HA Tibetans, 19 lowland Tibetans, and 25 lowland Han subjects.

FIELD STRENGTH/SEQUENCE

CBF was measured with the pulsed ASL sequence at 3T.

ASSESSMENT

CBF was correlated with abode altitude in HA Tibetans; CBF differences among HA Tibetans, lowland Tibetans, and lowland Han subjects was assessed.

STATISTICAL TESTS

Pearson correlation assessed the correlation. Independent t-tests analyzed group differences.

RESULTS

In HA Tibetans, CBF decreased with altitude in the bilateral anterior and posterior cingulate gyri, fusiform gyrus, cerebellar tonsil and cortices, and thalamus as well as left middle and inferior temporal gyri and right insula (P < 0.05); HA Tibetans (vs. lowland Tibetans) had lower CBF in the left hemisphere (precuneus, anterior cingulate gyrus, fusiform gyrus, and lingual gyrus) and right hemisphere (superior parietal lobule, precuneus, posterior cingulate gyrus, and cerebellar tonsil), while they had higher CBF in the left inferior parietal lobule, lentiform nucleus, and inferior frontal gyrus (P < 0.05). The overlapping regions, in which CBF in HA Tibetans correlated with altitude and decreased (vs. lowland Tibetans), were selected for region of interest analysis, and the results showed lower CBF in HA Tibetans than lowland Han subjects (P < 0.05).

DATA CONCLUSION

HA adaptation in Tibetans is associated with a decrease of regional CBF.

LEVEL OF EVIDENCE

2 Technical Efficacy: Stage 4 J. Magn. Reson. Imaging 2018.