Associations Between White-Matter Functional Network Reorganization and Cognitive Impairment in Patients with Presbycusis

Presbycusis, a bilateral, symmetric, and progressive neural hearing loss, is closely associated with cognitive decline, yet its underlying white-matter (WM) network mechanisms remain unclear. Using resting-state functional magnetic resonance imaging (rs-fMRI), this study investigated WM functional network reorganization and its relationship with cognitive performance in 81 patients with presbycusis and 77 healthy controls. Patients exhibited significant WM functional connectivity (FC) alterations, characterized by decreased intra-network functional integrity within the left corticospinal tract (CST) and reduced inter-network FC between the body of the corpus callosum (BCC) and the bilateral posterior limbs of the internal capsule (PLIC) as well as the left medial lemniscus (ML). These disrupted FC patterns were significantly correlated with global cognitive impairment, attentional deficits, and poorer auditory verbal memory. Furthermore, a support vector machine (SVM) classifier with a radial basis function (RBF) kernel, implemented with a nested feature selection and repeated 5-fold cross-validation scheme, achieved stable discriminative performance (accuracy = 60.65%, AUC = 0.64, precision = 61.70%, sensitivity = 62.62%). These findings indicate that reorganization of WM functional networks is associated with cognitive impairment in presbycusis, suggesting that WM FC metrics may serve as potential imaging indicators to assist in the clinical assessment of cognitive risk, offering preliminary network-level evidence consistent with the auditory deprivation hypothesis.