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Association between Cognitive Decline and Altered Cerebral Perfusion in Adults with Moyamoya Disease after
Yiwen Bao1, Fei Yu2, Liang Wei3
1Department of Neurology, Tongji University, School Med, East Hospital, Shanghai, China, 1132885600@qq.com.
Introduction:
Certain studies have observed that patients with moyamoya disease (MMD) have cognitive decline after revascularization. Thus, this study analyzed the relationship between cognitive decline and altered cerebral perfusion after revascularization.
Methods:
Here, 313 adult patients with MMD underwent single unilateral revascularization. First, cognitive function was scored using a Mini-Mental Scale (MMSE) and Montreal cognitive function scale (MoCA) before and 3 months after the operation (superficial temporal artery-middle cerebral artery anastomosis with encephalo-myo-synangiosis). Then, computed tomography perfusion was performed before and 1 week after the operation to assess the cerebral perfusion.
Results:
Our data showed that cognitive function decreased in 55 cases (17.6%) after revascularization. Furthermore, the incidence of cerebral hyperperfusion (CHP) was significantly higher in the cognitive decline group (49/55) than in the cognitive nondecline group (89.1% vs. 5.4%, p < 0.001). Results also showed that although all 55 patients had postoperative cognitive decline, 47 experienced relative cerebral blood flow (CBF) decrease at a relatively distant area of the anastomosis compared with that before the operation, which was significantly higher than in patients without cognitive decline (85.5% vs. 1.94%, p < 0.001). In addition, 41 patients had a simultaneous occurrence of local CHP and paradoxical CBF decrease at a relatively distant anastomosis area, which indicated the incident of watershed shift (WS). As observed, WS occurred in 74.5% of patients with cognitive decline, significantly higher than in patients without cognitive decline (74.5% vs. 0%, p < 0.0001). Through multiple logistic regression analysis, WS was also observed to be a strong independent risk factor for predicting postoperative cognitive decline 3 months after revascularization (odds ratio 17.780, 95% confidence interval 1.668-18.564; p = 0.017).
Conclusion:
Therefore, cognitive decline in patients with MMD after revascularization is related to WS, leading to an uneven distribution of CBF.
Insights
Cognitive decline in moyamoya disease (MMD) patients after revascularization is linked to watershed shift (WS), an uneven distribution of cerebral blood flow (CBF). This finding highlights WS as a key predictor of post-operative cognitive impairment in MMD.
Area of Science:
- Neuroscience
- Neurosurgery
- Radiology
Background:
- Moyamoya disease (MMD) is a rare cerebrovascular disorder characterized by progressive stenosis of intracranial arteries.
- Revascularization surgery is performed to improve cerebral blood flow (CBF) in MMD patients, but cognitive decline can occur postoperatively.
Purpose of the Study:
- To investigate the relationship between cognitive decline and altered cerebral perfusion following revascularization in adult moyamoya disease patients.
- To identify predictors of postoperative cognitive decline after unilateral revascularization in MMD.
Main Methods:
- 313 adult MMD patients underwent unilateral revascularization (superficial temporal artery-middle cerebral artery anastomosis with encephalo-myo-synangiosis).
- Cognitive function was assessed using MMSE and MoCA before and 3 months post-operation.
- Computed tomography perfusion (CTP) was performed before and 1 week post-operation to evaluate cerebral perfusion, including cerebral hyperperfusion (CHP) and relative CBF changes.
Main Results:
- Cognitive decline was observed in 17.6% of patients post-revascularization.
- Cerebral hyperperfusion (CHP) and watershed shift (WS), characterized by paradoxical CBF decrease in distant areas, were significantly more prevalent in patients with cognitive decline.
- WS was identified as a strong independent risk factor for predicting 3-month postoperative cognitive decline (OR 17.780, p = 0.017).
Conclusions:
- Postoperative cognitive decline in MMD patients after revascularization is associated with watershed shift (WS).
- WS leads to an uneven distribution of cerebral blood flow (CBF), contributing to cognitive impairment.
- Identifying WS is crucial for predicting and potentially mitigating cognitive decline following revascularization in MMD.
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