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BACKGROUND Cognitive impairments are common in asthma, which is a serious global health problem characterized by chronic airway inflammation. However, the underlying neuromechanism is still unclear. PURPOSE/HYPOTHESIS To investigate the neuromechanism underlying cognitive impairments of asthma. We hypothesized that asthma patients exhibit altered white matter (WM) microstructures, which may contribute to their cognitive impairments. STUDY TYPE Case-control study. SUBJECTS 37 patients with asthma (14 male) and 31 healthy controls (10 male). FIELD STRENGTH/SEQUENCE Diffusion tensor imaging (DTI) covering the whole brain was acquired on a 3.0T scanner using a single-shot echo planar imaging sequence. ASSESSMENT A DTI with tract-based spatial statistics (TBSS) approach was used to investigate the whole-brain differences in the WM fractional anisotropy (FA) values. STATISTICAL TESTS Demographic and neuropsychological data were performed using two independent sample t-test or chi-square test or Mann-Whitney rank test. The relationship between cognitive impairments and WM abnormalities was studied using correlation analyses. RESULTS Impairments of language ability, executive function, and visual-spatial processing and widespread WM disruptions reflected by FA reduction were found in asthma patients. The executive function was related to left forceps major, cingulum, and right uncinate fasciculus, ILF (inferior longitudinal fasciculus) positively (P < 0.05). FA abnormalities were positively correlated with duration of asthma and asthma control test (ACT) scores. DATA CONCLUSION Asthma patients display multiple cognitive impairments and universally WM integrity disruptions, among which executive dysfunction closely correlates with WM abnormalities. LEVEL OF EVIDENCE 1 Technical Efficacy: Stage 5 J. Magn. Reson. Imaging 2018.

Background: Group cognitive behavior therapy (GCBT) is an effective treatment in improving self-management behaviors and quality of life for asthmatic patients. However, the mechanisms by which GCBT improves asthma-related clinical symptoms remain unknown. Previous studies have indicated that insula is an important region involved in the neuropathology of asthma. Therefore, we examined the possible alteration of functional connectivity (FC) in insula subregions after GCBT in asthmatic patients. Methods: Forty-two asthmatic patients and 60 healthy controls (HCs) received resting-state functional magnetic resonance imaging (rs-fMRI) scan and clinical assessments, 17 asthmatic patients completed GCBT treatment consisting of 8 sessions, and then received rs-fMRI scan and clinical assessments. Results: Asthmatic patients had greater left ventral anterior insula (vAI) FC with the left cerebellum posterior lobe, right middle temporal gyrus, and bilateral anterior cingulate cortex (ACC), but less FC with bilateral postcentral gyrus, bilateral occipital lobe, and left precentral gyrus compared with HCs. FC between left posterior insula and left medial frontal gyrus also increased in the patients. In addition, right vAI showed increased FC with right caudate and left putamen. FC between right dorsal anterior insula (dAI) and left calcarine however decreased. The increase in FC in insula subregions were significantly improved following GCBT. FC between the left vAI connectivity and left postcentral gyrus was positively correlated with the percentage of improvement in 17-items Hamilton depression rating scale scores, and FC between the right dAI and left calcarine was negatively associated with the improvement percentage in asthma control test scores. Conclusions: This study in the first time demonstrated that GCBT led to significant improvement of FC between insula subregions and other brain regions. Clinical Trial Registration: An investigation of therapeutic mechanism in asthmatic patients: based on the results of Group Cognitive Behavioral Therapy (Registration number: ChiCTR-COC-15007442) (http://www.chictr.org.cn/usercenter.aspx).

Objective. To explore the underlying mechanism of depression in asthmatic patients, the ReHo in the insula and its FC was used to probe the differences between depressed asthmatic (DA) and nondepressed asthmatic (NDA) patients. Methods. 18 DA patients, 24 NDA patients, and 60 healthy controls (HCs) received resting-state fMRI scan, severity of depression, and asthma control assessment. Results. DA patients showed increased FC between the left ventral anterior insula (vAI) and the left middle temporal gyrus compared with both NDA and HC groups. In addition, compared with HCs, the DA and NDA patients both exhibited increased FC between the left vAI and the right anterior cingulate cortex (ACC), decreased FC between the left vAI and the bilateral parietal lobe, and increased FC between the right vAI and the left putamen and the right caudate, respectively. Furthermore, the increased FC between the left vAI and the right ACC could differentiate HCs from both DA and NDA patients, and the increased FC between the right vAI and both the left putamen and the right caudate could separate NDA patients from HCs. Conclusions. This study confirmed that abnormal vAI FC may be involved in the neuropathology of depression in asthma. The increased FC between the left vAI and the left MTG could distinguish DA from the NDA and HC groups.