Bidirectional cortical gyrification alterations in chronic obstructive pulmonary disease: links to cognitive impairment and global initiative for chronic obstructive lung disease staging

PURPOSE: Cognitive impairment is a common but poorly understood comorbidity in chronic obstructive pulmonary disease (COPD). Although gray matter abnormalities have been observed in this population, the contribution of cortical gyrification-a structural feature linked to cognitive development and brain plasticity-remains unclear. This study aimed to characterize region-specific cortical gyrification alterations and examine their associations with domain-specific cognitive function and disease severity. METHODS: We enrolled 59 patients with stable COPD and 49 healthy controls who underwent pulmonary function testing, Montreal Cognitive Assessment, and high-resolution T1WI. The Toro's Gyrification Index quantified cortical gyrification. Group comparisons, partial correlations, and multiple linear regression analyses were conducted with adjustments for age, sex, and total intracranial volume. RESULTS: Compared with healthy controls, the patient group showed increased Toro's Gyrification Index in the bilateral superior temporal gyrus and left insula, and decreased values in the bilateral lingual gyri (P < .05). In the patient group, Toro's Gyrification Index in the left superior temporal gyrus was negatively correlated with abstract thinking (r = - .46, P = .003) and attention scores (r = - .39, P = .01). A regression model incorporating Toro's Gyrification Index in the left superior temporal and right lingual gyri explained 31% of the variance in abstract thinking score (F = 3.68, P = .004). The Global Initiative for Chronic Obstructive Lung Disease stage significantly predicted the right superior temporal gyrus Toro's Gyrification Index (F = 3.98, P = .002), with higher values observed in patients with disease stages 3 and 4 than stages 1 and 2 (F = 4.74, P = .005). CONCLUSIONS: COPD is associated with region-specific, bidirectional cortical gyrification changes that are closely linked to cognitive impairment and disease severity. These findings suggest that gyrification-based metrics may offer a novel neuroimaging perspective for understanding brain reorganization in COPD. CLINICAL TRIAL NUMBER: Not applicable.