Association of cognitive function with cerebral blood flow in children with moyamoya disease

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OBJECTIVE

The cognitive effects of main cerebral artery occlusive lesions are unclear in children with moyamoya disease (MMD). The authors aimed to investigate cognitive function in the presurgical phase of pediatric patients with MMD with no apparent brain lesions.

METHODS

In this prospective, observational, single-center study, 21 children (mean age 10 ± 3.0 years, range 5–14 years) diagnosed with MMD at Hokkaido University Hospital between 2012 and 2018 were enrolled. A cross-sectional evaluation of intellectual ability was performed using the Wechsler Intelligence Scale for Children—Fourth Edition at the initial diagnosis. rCBF was measured using [123I] N-isopropyl p-iodoamphetamine/SPECT. The associations among clinical factors, disease severity, regional cerebral blood flow (rCBF), and intelligence test scores were also examined.

RESULTS

The mean full-scale intelligence quotient (FIQ) was 101.8 ± 12.5 (range 76–125) in children with no apparent brain lesions. A significant difference in the intelligence scale index score was observed, most frequently (42.9%) between working memory index (WMI) and verbal comprehension index (VCI; VCI − WMI > 11 points). Regional CBF was significantly reduced both in the left and right medial frontal cortices (left: 61.3 ± 5.3 ml/100 g/min, right 65.3 ± 5.3 ml/100 g/min; p < 0.001) compared to the cerebellum (77.8 ± 6.8 ml/100 g/min). There was a significant association of rCBF in the left dorsolateral prefrontal cortex (DLPFC) with FIQ (r = 0.46, p = 0.034), perceptual reasoning index (PRI; r = 0.44, p = 0.045), and processing speed index (PSI; r = 0.44, p = 0.045). There was an association between rCBF of the left medial frontal cortex and PSI (r = 0.49, p = 0.026). Age of onset, family history, ischemic symptoms, and angiographic severity were not associated with poor cognitive performance.

CONCLUSIONS

Although average intellectual ability was not reduced in children with MMD, the association of reduced rCBF in the left DLPFC and medial frontal cortex with FIQ, PRI, and PSI suggests mild cognitive dysfunction due to cerebral hypoperfusion.

ABBREVIATIONS 123I-IMP = [123I] N-isopropyl p-iodoamphetamine; ACA = anterior cerebral artery; ASL = arterial spin labeling; DLPFC = dorsolateral prefrontal cortex; FIQ = full-scale IQ; ICA = internal carotid artery; IQ = intelligence quotient; MCA = middle cerebral artery; MMD = moyamoya disease; MRA = MR angiography; PCA = posterior cerebral artery; PIQ = performance IQ; PRI = perceptual reasoning index; PSI = processing speed index; rCBF = regional cerebral blood flow; ROI = region of interest; TIA = transient ischemic attack; VCI = verbal comprehension index; VIQ = verbal IQ; WISC-IV = Wechsler Intelligence Scale for Children—Fourth Edition; WMI = working memory index.
Article Information

Contributor Notes

Correspondence Ken Kazumata: Hokkaido University Graduate School of Medicine, Sapporo, Japan. kazumata@med.hokudai.ac.jp.INCLUDE WHEN CITING Published online October 11, 2019; DOI: 10.3171/2019.7.PEDS19312.Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.
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