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Published on: April 23, 2021
White matter hyperintensities in cholinergic pathways correlates of cognitive impairment in moyamoya disease
Duo Xu1, Xinfeng Yu1, Junwen Hu2
1Department of Radiology, The 2nd Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Objective:
To investigate the effect of cholinergic pathways damage caused by white matter hyperintensities (WMHs) on cognitive function in moyamoya disease (MMD).
Methods:
We included 62 patients with MMD from a prospectively enrolled cohort. We evaluated the burden of cholinergic pathways damage caused by WMHs using the Cholinergic Pathways Hyperintensities Scale (CHIPS). Cognitive function was evaluated with the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA). Cognitive impairment was determined according to the cut-off of MMSE and education. Multivariate linear and logistic regression models were used to analyze whether CHIPS was independently associated with cognition. Receiver operating characteristic curve analysis was performed to identify the ability of CHIPS in discriminating cognitive impairment and normal cognition.
Results:
CHIPS was associated with both MMSE and MoCA (β = - 0.601 and β = - 0.672, both p < 0.001). After correcting age, sex, education, volumes of limbic areas, and other factors, CHIPS remained to be independently associated with both MMSE and MoCA (β = - 0.388 and β = - 0.334, both p < 0.001). In the logistic regression, only CHIPS was associated with cognitive impairment (odds ratio = 1.431, 95% confidence interval = 1.103 to 1.856, p = 0.007). The optimal cut-off of CHIPS score was 10, yielding a sensitivity of 87.5% and a specificity of 78.3% in identifying MMD patients with cognitive impairment.
Conclusions:
The damage of cholinergic pathways caused by WMHs plays an independent effect on cognition and CHIPS could be a useful method in identifying MMD patients likely to be cognitive impairment.
Clinical Relevance Statement:
This study shows that Cholinergic Pathways Hyperintensities Scale (CHIPS) could be a simple and reliable method in identifying cognitive impairment for patients with moyamoya disease. CHIPS could be helpful in clinical practice, such as guiding treatment decisions and predicting outcome.
Key Points:
• Cholinergic Pathways Hyperintensities Scale was significantly associated with cognitive screening tests in patients with moyamoya disease. • Cholinergic Pathways Hyperintensities Scale plays an independent effect on cognitive impairment in patients with moyamoya disease. • Cholinergic Pathways Hyperintensities Scale shows higher accuracy than education, volumes of limbic areas, and sex in identifying cognitive impairment in moyamoya disease.
Insights
Damage to cholinergic pathways from white matter hyperintensities significantly impacts cognitive function in moyamoya disease (MMD). The Cholinergic Pathways Hyperintensities Scale (CHIPS) effectively identifies MMD patients at risk for cognitive impairment.
Area of Science:
- Neuroscience
- Neurology
- Radiology
Background:
- White matter hyperintensities (WMHs) are common in moyamoya disease (MMD).
- WMHs can damage cholinergic pathways, potentially affecting cognition.
- The impact of WMH-induced cholinergic damage on MMD cognition requires further investigation.
Purpose of the Study:
- To investigate the association between WMH-induced cholinergic pathway damage and cognitive function in MMD patients.
- To evaluate the utility of the Cholinergic Pathways Hyperintensities Scale (CHIPS) in assessing cognitive impairment in MMD.
Main Methods:
- 62 MMD patients were assessed using the CHIPS for WMH burden in cholinergic pathways.
- Cognitive function was evaluated using the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA).
- Multivariate regression and ROC analysis were employed to determine CHIPS's association with and ability to predict cognitive impairment.
Main Results:
- CHIPS scores were significantly correlated with both MMSE and MoCA scores.
- CHIPS independently predicted cognitive function even after adjusting for confounding factors.
- CHIPS demonstrated high accuracy (87.5% sensitivity, 78.3% specificity) in identifying cognitive impairment in MMD patients.
Conclusions:
- WMH-induced damage to cholinergic pathways independently affects cognitive function in MMD.
- The CHIPS is a valuable tool for identifying MMD patients with cognitive impairment.
- CHIPS can aid in clinical decision-making and outcome prediction for MMD patients.
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