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Association Between Frontal Lobe Hemodynamics and Neurocognitive Dysfunction in Adults With Moyamoya Disease:
Sho Tsunoda1, Tomohiro Inoue1, Kazuhiro Ohwaki2
1Department of Neurosurgery, NTT Medical Center Tokyo, Shinagawa-ku, Tokyo, Japan.
Background:
Adult patients with moyamoya disease (MMD) may present with mild cognitive dysfunction, even those without evidence of conspicuous brain parenchymal damage. This cognitive dysfunction might be caused by local frontal lobe ischemia.
Objective:
To explore the relationship between frontal lobe hemodynamic insufficiency and cognitive dysfunction in patients with MMD.
Methods:
Thirty adult patients with MMD without conspicuous brain parenchymal damage were retrospectively examined. Patients with MMD with frontal lobe intracerebral steal phenomenon on single photon emission computed tomography were defined as group S (n = 13) and those without it were defined as group P (n = 17). A comparative group comprising patients with unruptured intracranial aneurysm was defined as group C (n = 30). The results of various cognitive and intelligence tests and a composite cognitive score were compared between groups.
Results:
The digit span test forward version ( P = .041), frontal assessment battery ( P = .022), and composite cognitive score ( P = .015) z-scores were significantly lower in group S than group C. Adjusting for sex and age, patients in group S had a significantly lower composite cognitive score compared with those in group C in multiple regression analysis ( P = .037). Executive dysfunction and working memory dysfunction may be involved in the cognitive decline observed in group S.
Conclusion:
Mild cognitive dysfunction in MMD was associated with frontal lobe hemodynamic insufficiency. Future studies should examine whether revascularization can improve cerebral hypoperfusion and neurocognitive function in these patients.
Insights
Moyamoya disease (MMD) patients with frontal lobe hemodynamic issues show mild cognitive dysfunction. This suggests frontal lobe ischemia contributes to cognitive decline in MMD, even without obvious brain damage.
Area of Science:
- Neurology
- Neuroscience
- Radiology
Background:
- Adults with moyamoya disease (MMD) can experience mild cognitive dysfunction, even without significant brain damage.
- This dysfunction may stem from localized frontal lobe ischemia.
Purpose of the Study:
- To investigate the link between frontal lobe hemodynamic insufficiency and cognitive deficits in MMD patients.
- To identify specific cognitive impairments associated with reduced blood flow in the frontal lobes of MMD patients.
Main Methods:
- Retrospective analysis of 30 adult MMD patients without apparent brain parenchymal damage.
- Classification of MMD patients into two groups: those with (group S) and without (group P) frontal lobe intracerebral steal phenomenon on SPECT.
- Comparison of cognitive test results and a composite cognitive score between MMD groups and a control group (group C) of patients with unruptured intracranial aneurysms.
Main Results:
- Group S (MMD with steal phenomenon) showed significantly lower scores on the digit span test forward, frontal assessment battery, and composite cognitive score compared to the control group (group C).
- Multiple regression analysis confirmed that patients in group S had a significantly lower composite cognitive score than group C, even after adjusting for sex and age.
- Executive dysfunction and working memory deficits were identified as potential contributors to cognitive decline in MMD patients with frontal lobe hemodynamic insufficiency.
Conclusions:
- Mild cognitive dysfunction in moyamoya disease is associated with frontal lobe hemodynamic insufficiency.
- Frontal lobe ischemia may underlie cognitive deficits observed in MMD patients.
- Further research is warranted to explore the potential of revascularization therapies to improve cerebral hypoperfusion and neurocognitive function in MMD.
