Differences in the Improvement of Neuroimaging Biomarkers between Two Pharmacological Regimens in Patients with Post-Stroke Cognitive Impairment
Bibliographic record
Abstract
This study aimed to compare the differential effects of two pharmacological regimens—the cholinesterase inhibitor donepezil and the cerebrovasodilator nicergoline—on neuroimaging biomarkers in patients with post-stroke cognitive impairment (PSCI) and to explore their relationship with cognitive improvement. A prospective, randomized, open-label, parallel-group controlled design was adopted. Ninety-six eligible PSCI patients were randomly assigned to the donepezil group (Group A, n=48) or the nicergoline group (Group B, n=48). Both groups received 24 weeks of target drug therapy on top of routine treatment. All patients underwent multimodal magnetic resonance imaging (MRI) before and after treatment, including 3D-T1-weighted imaging, diffusion tensor imaging, resting-state functional MRI, and 3D arterial spin labeling sequences, to assess brain structure, white-matter integrity, functional connectivity, and cerebral blood flow. Cognitive function was evaluated using the Montreal Cognitive Assessment and the Digit Symbol Substitution Test. The primary endpoint was between-group differences in neuroimaging metrics. Ninety-three patients completed the study. In terms of brain structure, the donepezil group showed significantly greater increases in bilateral hippocampal volume (e.g., left side from 2.85 to 3.02 cm³) compared with the nicergoline group (P<0.05). Regarding brain function, the donepezil group exhibited a more pronounced enhancement of default-mode network functional connectivity (P<0.05). However, in improving cerebral perfusion, the nicergoline group achieved a significantly larger elevation in whole-brain mean cerebral blood flow (from 46.1 to 52.3 ml/100g/min) than the donepezil group (P<0.01). Cognitive assessments revealed that the donepezil group had an advantage in global cognitive improvement, and its improvement in MoCA score was positively correlated with increased hippocampal volume (r=0.432); in the nicergoline group, improvement in processing speed was associated with increased cerebral blood flow (r=0.398). Safety profiles were similar between the two groups Donepezil and nicergoline demonstrate distinct targeting patterns in improving brain health in PSCI patients: donepezil preferentially promotes structural plasticity and functional integration of the memory-related limbic system, whereas nicergoline shows superior efficacy in enhancing whole-brain hemodynamic perfusion. These findings suggest that selecting individualized drug regimens based on multimodal neuroimaging characteristics holds potential clinical value.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".