Int J Med Sci 2021; 18(13):2950-2956. doi:10.7150/ijms.60810 This issue

Research Paper

Distinct Patterns of Brain Atrophy associated with Mild Behavioral Impairment in Cognitively Normal Elderly Adults

Jun Shu, MD1*, Qiang Qiang, MD, Ph.D.1*, Yuning Yan, MD1, Yang Wen, MD2, Yiqing Ren, MD1, Wenshi Wei, MD, Ph.D.1✉, Li Zhang, MD, Ph.D.1✉

1. Department of Neurology, Huadong Hospital affiliated to Fudan University, No. 221, West Yan An Road, Shanghai, China.
2. Department of Neurology, The Third People's Hospital of Chengdu, China.
*These authors contributed equally to this work.

This is an open access article distributed under the terms of the Creative Commons Attribution License ( See for full terms and conditions.
Shu J, Qiang Q, Yan Y, Wen Y, Ren Y, Wei W, Zhang L. Distinct Patterns of Brain Atrophy associated with Mild Behavioral Impairment in Cognitively Normal Elderly Adults. Int J Med Sci 2021; 18(13):2950-2956. doi:10.7150/ijms.60810. Available from

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Graphic abstract

A cross-sectional study was conducted to evaluate patterns of gray matter changes in cognitively normal elderly adults with mild behavioral impairment (MBI). Sixteen MBI patients and 18 healthy controls were selected. All the participants underwent a neuropsychological assessment battery, including the Mini-mental State Examination (MMSE), Geriatric Depression Scale (GDS), Self-rating Anxiety Scale (SAS), and Chinese version of the mild behavioral impairment-checklist scale (MBI-C), and magnetic resonance imaging (MRI) scans. Imaging data was analyzed based on voxel-based morphometry (VBM). There was no significant difference in age, gender, MMSE score, total intracranial volume, white matter hyperdensity, gray matter volume, white matter volume between the two groups (p > 0.05). MBI group had shorter education years and higher MBI-C score, GDS and SAS scores than the normal control group (p < 0.05). For neuroimaging analysis, compared to the normal control group, the MBI group showed decreased volume in the left brainstem, right temporal transverse gyrus, left superior temporal gyrus, left inferior temporal gyrus, left middle temporal gyrus, right occipital pole, right thalamus, left precentral gyrus and left middle frontal gyrus(uncorrected p < 0.001). The grey matter regions correlated with the MBI-C score included the left postcentral gyrus, right exterior cerebellum, and left superior frontal gyrus. This suggests a link between MBI and decreased grey matter volume in cognitively normal elderly adults. Atrophy in the left frontal cortex and right thalamus in MBI patients is in line with frontal-subcortical circuit deficits, which have been linked to neuropsychiatric symptoms (NPS) in dementia. These initial results imply that MBI might be an early harbinger for subsequent cognitive decline and dementia.

Keywords: mild behavioral impairment, magnetic resonance imaging, voxel-based morphometry