Journal
TRANSLATIONAL STROKE RESEARCH
Volume 13, Issue 5, Pages 757-773Publisher
SPRINGER
DOI: 10.1007/s12975-022-01003-w
Keywords
Cerebrovascular reactivity; Moyamoya; Stroke; Executive function; BOLD MRI CVR
Categories
Funding
- Auxilium Foundation
- Brain Canada
- Stroke Imaging Laboratory for Children, The Hospital for Sick Children, Toronto
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This study examined the relationship between regional hemodynamics and cognitive functions in children with moyamoya disease. The results showed abnormal frontal hemodynamics in all cases, regardless of stroke history and comorbidity. Additionally, occipital lobe hemodynamics were also abnormal in children with syndromic moyamoya. Both idiopathic and syndromic moyamoya exhibited executive function deficits, while intellectual ability was impaired in syndromic moyamoya, even without stroke. The analysis revealed that right parietal and white matter hemodynamics explained executive dysfunction, while posterior circulation hemodynamics predicted intellectual ability, suggesting a compensatory role of parietal and posterior hemodynamics in overcoming frontal vulnerability and cognitive impairment.
Moyamoya disease is a major arteriopathy characterised by progressive steno-occlusion of the arteries of the circle of Willis. Studies in adults with moyamoya suggest an association between abnormal fronto-parietal and white matter regional haemodynamics and cognitive impairments, even in the absence of focal infarction. However, these associations have not been investigated in children with moyamoya. We examined the relationship between regional haemodynamics and ratings of intellectual ability and executive function, using hypercapnic challenge blood oxygen level-dependent magnetic resonance imaging of cerebrovascular reactivity in a consecutive cohort of children with confirmed moyamoya. Thirty children were included in the final analysis (mean age: 12.55 +/- 3.03 years, 17 females, 15 idiopathic moyamoya and 15 syndromic moyamoya). Frontal haemodynamics were abnormal in all regardless of stroke history and comorbidity, but occipital lobe haemodynamics were also abnormal in children with syndromic moyamoya. Executive function deficits were noted in both idiopathic and syndromic moyamoya, whereas intellectual ability was impaired in syndromic moyamoya, even in the absence of stroke. Analysis of the relative effect of regional abnormal haemodynamics on cognitive outcomes demonstrated that executive dysfunction was predominantly explained by right parietal and white matter haemodynamics independent of stroke and comorbidity, while posterior circulation haemodynamics predicted intellectual ability. These results suggest that parietal and posterior haemodynamics play a compensatory role in overcoming frontal vulnerability and cognitive impairment.
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