Brain functional alterations associated with visuospatial working memory impairment in gouty arthritis patients

Gouty arthritis (GA) is a common inflammatory disease characterized by severe pain and hyperuricemia (HUA). To date, the interaction between GA and cognitive function has remained unclear. This study aimed to investigate the cognitive impairment and related brain function changes in GA patients.

A total of 21 male GA patients and 21 age-, gender-, and education-matched healthy controls (HC) were recruited. All participants underwent multimodal functional magnetic resonance imaging (fMRI) examinations and completed the Montreal Cognitive Assessment (MoCA) scale. We utilized supervised machine learning (ML) models based on whole-brain functional connectivity of resting-state fMRI (rs-fMRI) to distinguish GA patients from HC and exported the significantly neuroanatomical regions as functional connectivity matrices features. Meanwhile, task-state fMRI (ts-fMRI) performed during a mental rotation task (MRT) was used to investigate brain functional alterations associated with visuospatial working memory (VSWM) in GA patients.

GA patients performed worse on MoCA scores and MRT behavioral performance than the HC group (P<0.001). The support vector machine (SVM) model demonstrated superior classification performance (P<0.05) in rs-fMRI compared to other supervised learning models, with a classification accuracy of 77.78% and an area under the curve (AUC) of 0.7685. Functional connectivity with nodes in the cuneus, superior occipital gyrus, inferior parietal lobule, superior parietal gyrus, and middle frontal gyrus frequently appeared in the model's weight coefficient matrix. Compared to the HC group, GA patients showed abnormal activation in fMRI results during the MRT, especially in the left inferior parietal lobule and right hippocampus during the 100° rotation task (P<0.05).

This study comprehensively reveals VSWM impairment in GA patients and identifies the related brain activation differences in the frontoparietal network and diagnosis of cognitive impairment in GA patients and for further research on the underlying neural mechanisms.