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Frontal interhemispheric structural connectivity, attention, and executive function in children with perinatal stroke
Nicole Larsen1, Brandon T Craig1,2,3,4, Alicia J Hilderley1,2,3,4
1Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, Canada.
Insights
Perinatal stroke in children is linked to Attention Deficit/Hyperactivity Disorder (ADHD) and executive dysfunction. Diffusion imaging reveals altered frontal white matter microstructure, correlating with poorer cognitive and behavioral outcomes in affected children.
Area of Science:
- Neuroscience
- Pediatric Neurology
- Radiology
Background:
- Perinatal stroke impacts approximately 1 in 1000 births, frequently leading to cognitive impairments.
- Attention Deficit/Hyperactivity Disorder (ADHD) and executive dysfunction are significantly more common in children with perinatal stroke.
Purpose of the Study:
- To investigate the relationship between frontal white matter (WM) microstructure differences and cognitive impairments in children with perinatal stroke.
- To explore if diffusion imaging metrics of frontal WM can serve as biomarkers for cognitive and behavioral outcomes.
Main Methods:
- Used diffusion imaging and tractography to isolate and analyze the anterior forceps in 83 children (26 arterial ischemic stroke, 26 periventricular venous infarction, 31 controls).
- Quantified frontal WM microstructure using along-tract analyses.
- Correlated WM metrics with parent ratings of ADHD symptoms (ADHD-5) and executive functioning (BRIEF).
Main Results:
- Stroke groups exhibited altered frontal WM microstructure compared to controls.
- Differences in WM metrics were observed both near the lesion site and in remote areas, including the nonlesioned hemisphere.
- Higher white matter diffusivity values correlated with increased ADHD symptoms and poorer executive function.
Conclusions:
- Frontal white matter microstructure, as assessed by diffusion imaging and tractography, is altered in children with perinatal stroke.
- These microstructural changes are associated with significant cognitive and behavioral deficits, including ADHD and executive dysfunction.
- Frontal WM microstructure may serve as a valuable biomarker for understanding and potentially predicting cognitive and behavioral outcomes in perinatal stroke survivors.
Abstract:
Perinatal stroke affects ∼1 in 1000 births and concomitant cognitive impairments are common but poorly understood. Rates of Attention Deficit/Hyperactivity Disorder (ADHD) are increased 5-10× and executive dysfunction can be disabling. We used diffusion imaging to investigate whether stroke-related differences in frontal white matter (WM) relate to cognitive impairments. Anterior forceps were isolated using tractography and sampled along the tract. Resulting metrics quantified frontal WM microstructure. Associations between WM metrics and parent ratings of ADHD symptoms (ADHD-5 rating scale) and executive functioning (Behavior Rating Inventory of Executive Function (BRIEF)) were explored. Eighty-three children were recruited (arterial ischemic stroke [AIS] n = 26; periventricular venous infarction [PVI] n = 26; controls n = 31). WM metrics were altered for stroke groups compared to controls. Along-tract analyses showed differences in WM metrics in areas approximating the lesion as well as more remote differences at midline and in the nonlesioned hemisphere. WM metrics correlated with parental ratings of ADHD and executive function such that higher diffusivity values were associated with poorer function. These findings suggest that underlying microstructure of frontal white matter quantified via tractography may provide a relevant biomarker associated with cognition and behavior in children with perinatal stroke.
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