Cognitive performance in patients with cerebral arteriovenous malformation

Area of Science:

• Neurology
• Neuroscience
• Neurosurgery

Background:

• Cerebral arteriovenous malformations (cAVMs) can progress and cause symptoms.
• Clinical studies often focus on ruptured cAVMs, overlooking pre-neurosurgical cognitive function.
• Neurocognitive deficits in cAVM patients are not well-characterized, particularly in unruptured cases.

Purpose of the Study:

• To investigate the neurocognitive function in patients with ruptured and unruptured cAVMs.
• To correlate neurocognitive deficits with Spetzler-Martin (SM) grade, flow status, and anatomical location.
• To highlight the potential impact of pre-existing cognitive alterations on quality of life.

Main Methods:

• A blinded, cross-sectional study involving 70 patients (ages 18-60) with cAVMs.
• Utilized the Brazilian Brief Neuropsychological Assessment Battery (Neupsilin) for evaluation.
• Assessed eight distinct neurocognitive domains.

Main Results:

• Over 70% of cAVM patients (50/70) exhibited neurocognitive deficits, irrespective of neurological symptoms.
• Temporal lobe cAVMs were linked to memory deficits.
• High-grade ruptured cAVMs correlated with working memory deficits, while low-grade ones showed executive function deficits.

Conclusions:

• Untreated cAVMs, both ruptured and unruptured, are associated with pre-existing neurocognitive deficits.
• Current disability scales in major trials (e.g., ARUBA) do not capture these cognitive alterations.
• Findings suggest cognitive deficits may predate interventions, questioning the impact of treatment on cognition.