Enhanced local neural compensation accompanied by global functional decline in Binswanger's Disease with mild cognitive impairment: loss of whole-brain integration and dynamic flexibility in resting-state networks.

The neurobiological basis of cognitive impairment in Binswanger disease remains unclear. We compared 21 Binswanger disease patients with mild cognitive impairment (BD-MCI) and 21 without cognitive impairment (BD-C) using resting-state fMRI. No healthy control group was included. All participants completed cognitive assessments prior to scanning. Graph-theoretical and dynamic functional connectivity (dFC) analyses were performed, with most comparisons corrected for multiple comparisons (P FDR < 0.05). Group differences were characterized by significantly reduced global local efficiency in BD-MCI, suggesting widespread network disintegration. Regionally, nodal alterations were observed across frontoparietal, temporal, and subcortical regions, with increased degree centrality and nodal efficiency in bilateral inferior parietal lobule and superior parietal gyrus, but decreased clustering and efficiency in putamen, pallidum, and Heschl's gyrus(Cohen's d range: 0.63-1.45). dFC analysis revealed altered state frequency, mean dwell time, and total transitions between groups (FDR-corrected P < 0.05; Cohen's d range: 0.64-1.19), indicating disrupted temporal coordination and reduced dynamic flexibility. Collectively, these findings suggest that BD-MCI exhibits aberrant topological reorganization, characterized by impaired local information processing and altered temporal dynamics, which may reflect a reduced capacity for adaptive network reconfiguration. These preliminary findings provide potential neural correlates for early cognitive decline in Binswanger disease.