Metabolic syndrome‐related cognitive impairment with white matter hyperintensities and functional network analysis

Abstract Objective This study aimed to explore the relationship between white matter hyperintensities (WMHs) and cognitive impairment related to metabolic syndrome (MetS) and the underlying neural network mechanisms. Methods This cross‐sectional study included 50 participants with MetS and WMHs (MetS‐WMHs), 45 with MetS without WMHs, and 50 control participants. All participants underwent resting‐state functional magnetic resonance imaging and a detailed cognitive evaluation. A graph theory analysis based on resting‐state functional magnetic resonance imaging was conducted to calculate functional network properties. A mediation analysis was conducted to determine the relationship between WMHs and MetS‐related cognitive impairment. Results Compared with the control group, the participants in the MetS‐WMHs group displayed lower global efficiency, local efficiency, and nodal efficiency, mainly located in the regions of the salience network. Furthermore, a significant correlation was observed between functional network efficiency and cognitive performance. Mediation analysis indicated that WMHs served as a mediating variable between MetS and cognitive decline, affecting attention/executive function, language, and global cognitive function. Conclusions WMHs mediated the association between MetS and cognitive function, with a decline in the efficiency of functional brain networks being a probable neural mechanism.