Functional reorganisation of lingual gyrus mediates cognitive impairment in COPD: a multimodal neuroimaging study

Background: COPD is a systemic disorder associated with cognitive impairment and affective dysfunction. However, the underlying neurobiological mechanisms remain unclear. This study examines brain reorganisation in patients with COPD and investigates potential neural mediators of cognitive and affective deficits. Methods: We enrolled 51 COPD patients and 50 age- and sex-matched healthy controls. All participants underwent high-resolution structural magnetic resonance imaging (MRI) and resting-state functional MRI. Comprehensive neuropsychological assessments for cognitive function (Montreal Cognitive Assessment (MoCA)) and affective symptoms (Beck Depression Inventory (BDI) and State-Trait Anxiety Inventory (STAI)) were conducted. Voxel-wise analyses compared grey matter volume, fractional amplitude of low-frequency fluctuations (fALFF) and functional connectivity strength between groups. Mediation analysis was performed to explore causal pathways linking COPD, brain alterations and cognitive-affective dysfunction. Results: COPD patients exhibited significant cognitive deficits (lower MoCA scores) compared with healthy controls, and greater affective symptom burden (higher BDI and STAI scores). Neuroimaging revealed no grey matter volume differences, but distinct functional abnormalities: increased fALFF in bilateral lingual gyri and decreased fALFF in the right inferior orbitofrontal and left middle occipital regions, alongside enhanced long-range functional connectivity strength in the right frontal and fusiform areas (cluster-level p