Altered connectivity patterns among resting state networks in patients with ischemic white matter lesions

White matter lesions (WMLs) have been associated with cognitive and motor decline. Resting state networks (RSNs) are spatially coherent patterns in the human brain and their interactions sustain our daily function. Therefore, investigating the altered intra- and inter-network connectivity among the RSNs may help to understand the association of WMLs with impaired cognitive and motor function. Here, we assessed alterations in functional connectivity patterns based on six well-defined RSNs-the default mode network (DMN), dorsal attention network (DAN), frontal-parietal control network (FPCN), auditory network (AN), sensory motor network (SMN) and visual network (VN)-in 15 patients with ischemic WMLs and 15 controls. In the patients, Spearman's correlation analysis was further performed between these alterations and cognitive test scores, including Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) scores. Our results showed wide alterations of inter-network connectivity mainly involving the SMN, DMN, FPCN and DAN, and some alterations correlated with cognitive test scores in the patients. The reduced functional connectivities in the SMN-AN, SMN-VN, FPCN-AN, DAN-VN pairs may account for the cognitive and motor decline in patients with ischemic WMLs, while the increased functional connectivities in the DMN-AN, DMN-FPCN and DAN-FPCN pairs may reflect a functional network reorganization after damage to white matter. It is unexpected that altered intra-network connectivities were found within the AN and VN, which may explain the impairments in verbal fluency and information retrieval associated with WMLs. This study highlights the importance of functional connectivity in understanding how WMLs influence cognitive and behavior dysfunction.