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Updated: Jun 30, 2025
Evaluation of the Cognitive Performance of Hypertensive Patients with Silent Cerebrovascular Lesions
Published on: April 23, 2021
MRI hypoperfusion as a determinant of cognitive impairment in adults with Moyamoya angiopathy
Marine Giroud1, Mélanie Planton1,2, Jean Darcourt3
1Neurology Department, Toulouse University Hospital, Toulouse, France.
Introduction:
In Moyamoya angiopathy (MMA), mechanisms underlying cognitive impairment remain debated. We aimed to assess the association of cognitive impairment with the degree and the topography of cerebral hypoperfusion in MMA.
Methods:
A retrospective analysis of neuropsychological and perfusion MRI data from adults with MMA was performed. Ischemic and haemorrhagic lesion masks were created to account for cerebral lesions in the analysis of cerebral perfusion. Whole brain volume of hypoperfused parenchyma was outlined on perfusion maps using different Tmax thresholds from 4 to 12 s. Regional analysis produced mean Tmax values at different regions of interest. Analyses compared perfusion ratios in patients with and without cognitive impairment, with multivariable logistic regression analysis to identify predictive factors.
Results:
Cognitive impairment was found in 20/48 (41.7%) patients. Attention/processing speed and memory were equally impaired (24%) followed by executive domain (23%). After adjustment, especially for lesion volume, hypoperfused parenchyma volume outlined by Tmax > 4 s or Tmax > 5 s thresholds was an independent factor of cognitive impairment (OR for Tmax > 4 s = 1.06 [CI 95% 1.008-1.123]) as well as attention/processing speed (OR for Tmax > 4 s = 1.07 [CI 95% 1.003-1.133]) and executive domains (OR for Tmax > 5 s = 1.08 [CI 95% 1.004-1.158]). Regarding cognitive functions, patients with processing speed and flexibility impairment had higher frontal Tmax compared to other ROIs and to patients with normal test scores.
Discussion:
Cerebral hypoperfusion emerged as an independent factor of cognitive impairment in MMA particularly in attention/processing speed and executive domains, with a strong contribution of frontal areas.
Conclusion:
Considering this association, revascularization surgery could improve cognitive impairment.
Insights
Cerebral hypoperfusion is linked to cognitive impairment in Moyamoya angiopathy (MMA), especially affecting attention and executive functions. Addressing hypoperfusion may improve cognitive outcomes in MMA patients.
Area of Science:
- Neuroscience
- Radiology
- Neurology
Background:
- Moyamoya angiopathy (MMA) is a rare cerebrovascular disorder characterized by progressive stenosis of the internal carotid arteries.
- The mechanisms underlying cognitive impairment in MMA are not fully understood, prompting investigation into the role of cerebral blood flow.
- Cognitive deficits can significantly impact the quality of life for individuals with MMA.
Purpose of the Study:
- To investigate the association between the degree and location of cerebral hypoperfusion and cognitive impairment in adult patients with MMA.
- To identify specific patterns of hypoperfusion that correlate with particular cognitive deficits.
Main Methods:
- A retrospective analysis of neuropsychological assessments and perfusion MRI data from 48 adult MMA patients.
- Quantification of hypoperfused brain parenchyma volume using Tmax thresholds (4-12s) and regional analysis of Tmax values.
- Multivariable logistic regression was employed to identify independent predictors of cognitive impairment, adjusting for lesion volume.
Main Results:
- Cognitive impairment was present in 41.7% of patients, with attention/processing speed and memory domains most frequently affected.
- Hypoperfused brain parenchyma volume, particularly when defined by Tmax > 4s or Tmax > 5s, was an independent predictor of overall cognitive impairment.
- Impaired attention/processing speed and executive functions were significantly associated with hypoperfusion, with frontal areas showing higher Tmax values in affected patients.
Conclusions:
- Cerebral hypoperfusion is an independent factor contributing to cognitive impairment in Moyamoya angiopathy.
- Attention/processing speed and executive domains are particularly vulnerable to hypoperfusion, with a notable involvement of frontal brain regions.
- These findings suggest that interventions targeting cerebral hypoperfusion, such as revascularization surgery, may hold potential for improving cognitive function in MMA patients.
