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. 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 chronic obstructive pulmonary disease 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 to healthy controls, the patient group showed increased Toro's Gyrification Index in the bilateral superior temporal gyrus and right anterior cingulate cortex, and decreased Toro's Gyrification Index in the bilateral lingual gyri ( P < .05). In the patient group, the Toro's Gyrification Index in the left superior temporal gyrus was negatively correlated with abstract thinking ( r = –0.522, P < .001) and attention scores ( r = –0.377, P = .01), and in the right superior temporal gyrus with orientation score ( r = –0.360, P = .02). A regression model combining Toro's Gyrification Index in the left superior temporal and right lingual gyri explained 43% of the variance in the abstract thinking score ( F = 9.73, P < .001). The Global Initiative for Chronic Obstructive Lung Disease stage significantly predicted the right superior temporal gyrus Toro's Gyrification Index ( F = 15.08, P < .001), with higher values observed in patients with disease stages 3 and 4 than stages 1 and 2 ( F = 4.74, P = .005). ‌ Conclusions Chronic obstructive pulmonary disease is associated with region-specific, bidirectional cortical gyrification changes that are closely linked to cognitive impairment and disease severity. Hypergyrification in the superior temporal and lingual gyri might reflect compensatory neural plasticity mechanisms, suggesting these patterns could serve as novel neuroimaging biomarkers for evaluating neurodegenerative changes in chronic obstructive pulmonary disease.