Cerebral small vessel disease moderates the association between executive dysfunction and spontaneous neural activity...

The loss of an only child represents a profound psychological trauma that is a significant risk factor for adverse mental health outcomes, including post-traumatic stress disorder (PTSD) and executive dysfunction. Research indicates that cerebral small vessel disease (CSVD) shares partial pathophysiological mechanisms with PTSD and may directly contribute to cognitive impairment through multiple pathways. Therefore, CSVD could serve as a pivotal entry point for understanding the neural mechanisms underlying executive dysfunction in parents who have lost their only child.

We utilized resting-state fMRI in a cross-sectional design, comparing 39 individuals with executive dysfunction with 115 matched trauma-exposed controls without executive dysfunction. We quantified spontaneous neural activity via fractional amplitude of low-frequency fluctuations (fALFF), regional homogeneity (ReHo), and ALFF, while CSVD burden was assessed. Moderation analysis was used to identify the moderating role of CSVD on executive dysfunction-related neural alterations in adults who lost their only child.

Individuals with executive dysfunction exhibited decreased fALFF in the left superior frontal gyrus (SFG) and reduced ReHo in the right medial SFG, alongside elevated ALFF and fALFF in the superior temporal gyrus (STG). fALFF in the left SFG demonstrated higher diagnostic accuracy for detecting executive dysfunction. Crucially, moderation analysis revealed that higher CSVD burden was associated with a greater reduction in fALFF in the left SFG, among individuals in the executive dysfunction group.

Executive dysfunction subjects demonstrated abnormal spontaneous activity in SFG and STG. The moderation analysis suggested that CSVD burden may be associated with a greater reduction in executive dysfunction-related frontal hypoactivity, supporting the construction of a "vascular-neuro-cognitive" triad model.