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Published on: April 23, 2021
Intellectual ability and executive function in pediatric moyamoya vasculopathy
Tricia S Williams1, Robyn Westmacott, Nomazulu Dlamini
1Department of Psychology, The Hospital for Sick Children, University of Toronto, ON, Canada
Insights
Children with moyamoya vasculopathy experience significant intellectual and executive function deficits. Bilateral disease and stroke history worsen these neurocognitive challenges in pediatric patients.
Area of Science:
- Pediatric Neurology
- Neuroscience
- Cerebrovascular Disease
Background:
- Moyamoya vasculopathy involves progressive stenosis of cerebral arteries, leading to reduced blood flow and stroke risk.
- Understanding the neurocognitive impact in children is crucial for effective management.
Purpose of the Study:
- To assess intellectual and executive functioning in children with moyamoya vasculopathy.
- To determine how moyamoya type, stroke history, laterality, and disease duration affect cognitive abilities.
Main Methods:
- Thirty pediatric patients with moyamoya underwent cognitive assessments (Wechsler Intelligence Scales) before revascularization.
- Parent and teacher ratings (Behavior Rating Index of Executive Function) evaluated executive functions.
Main Results:
- Children with moyamoya showed significantly lower scores in intelligence and executive functioning compared to norms.
- Bilateral moyamoya with stroke history was associated with lower intellectual and verbal comprehension scores.
- Teacher-reported metacognitive executive function deficits were more pronounced in bilateral cases.
Conclusions:
- Moyamoya vasculopathy poses a risk for intellectual and executive dysfunction in children.
- Bilateral disease and a history of stroke exacerbate these neurocognitive impairments.
Aim:
Moyamoya vasculopathy is characterized by progressive stenosis of the major arteries of the Circle of Willis, resulting in compromised cerebral blood flow and increased risk of stroke. The objectives of the current study were to examine intellectual and executive functioning of children with moyamoya and to evaluate the impact of moyamoya type, stroke (clinical or silent), vasculopathy laterality, and disease duration on neurocognitive abilities.
Method:
Thirty pediatric participants (mean age 10 y 10 mo, SD 4 y; 18 females, 12 males) completed age-appropriate Wechsler Intelligence Scales before any therapeutic revascularization procedures. Reports of executive function were obtained from parents and teachers using the Behavior Rating Index of Executive Function.
Results:
Children with moyamoya scored significantly lower than the test standardization samples on all indices of intelligence and ratings of executive functioning (p<0.001). Patients did not differ by type of moyamoya or history of stroke. Patients with bilateral disease and stroke scored significantly lower than those with unilateral disease on measures of overall intellectual function (p=0.035) and verbal comprehension (p=0.04). Deficits in metacognitive executive functions were also more pronounced in bilateral patients according to teacher ratings.
Interpretation:
Children with moyamoya are at risk for intellectual and executive problems, exacerbated by bilateral disease and clinical stroke history.
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