ORIGINAL RESEARCH article
Front. Aging Neurosci.
Sec. Alzheimer's Disease and Related Dementias
Gray-White Matter Covarying Impairment in the Anterior Cingulate Cortex Revealed by Multimodal Meta-Analysis of Post-Stroke Cognitive Impairment
ZiMeng Tang 1
Xin Tan 2
Longjian Huang 1
1. Youjiang Medical University for Nationalities, Baise, China
2. Yulin University, Yulin, China
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Abstract
Background: Post-stroke cognitive impairment (PSCI) involves complex interactions between gray matter (GM) and white matter (WM) pathology, yet their covarying patterns remain poorly characterized. Methods: We conducted a multimodal meta-analysis following PRISMA guidelines (PROSPERO registration number: CRD420251078162). Systematic literature searches identified 7 GM volume (GMV) studies (292 PSCI patients/231 controls) and 8 diffusion tensor imaging fractional anisotropy (DTI-FA) studies (339 PSCI patients/258 controls). Seed-based d Mapping with Permutation of Subject Images (SDM-PSI) was used for voxel-wise meta-analyses. Spatial integration identified GM-WM covarying pathology. Results: PSCI patients showed significant global GMV reduction versus controls (p=0.011). Family-wise error (FWE)-corrected analyses revealed GM atrophy in the right medial superior frontal gyrus (BA 10), right superior temporal gyrus/temporal pole (BA 38), and left orbital middle frontal gyrus (BA 47) (all p < 0.05, FWE-corrected). Concurrent GMV reduction and FA decrease occurred in the left anterior cingulate/paracingulate gyri (BA 11; p=0.043, uncorrected). Meta-regression demonstrated negative associations between age and GMV in BA 10 (p=0.006) and FA in the left cingulum bundle (p=0.021). Heterogeneity was low (I² < 50%) without publication bias. Conclusion: This study applied SDM-PSI multimodal meta-analysis to delineate characteristic neurostructural damage patterns in PSCI. Key findings encompass gray matter atrophy within frontotemporal cognitive hubs (FWE-corrected). Additionally, exploratory analyses at uncorrected thresholds suggested potential covarying GM-WM pathology in the left anterior cingulate/paracingulate gyri (BA 11) (at uncorrected thresholds). These findings elucidate PSCI pathogenesis and suggest potential anatomical targets for future research.
Summary
Keywords
anterior cingulate cortex, gray matter atrophy, Multimodal Meta-Analysis, post-stroke cognitive impairment, PSCI, white matter microstructure
Received
26 June 2025
Accepted
29 January 2026
Copyright
© 2026 Tang, Tan and Huang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Longjian Huang
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