The impact of lesion size on executive function performance in children and adolescents after pediatric stroke
Kathrin Kollndorfer1, Florian PhS Fischmeister2, Astrid Novak3
1Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Developmental and Interventional Imaging (DIN) Lab, Vienna, Austria; Department of Pediatrics and Adolescent Medicine, Medical University Vienna, Vienna, Austria.
Insights
Childhood arterial ischemic stroke (AIS) can impact executive functions. Lesion size may affect cognitive outcomes, but sustained attention performance appears to mediate this relationship, potentially explaining prior research inconsistencies.
Area of Science:
- Pediatric Neurology
- Neuropsychology
- Childhood Stroke Research
Background:
- Childhood arterial ischemic stroke (AIS) frequently leads to cognitive deficits, particularly in executive functions.
- Factors like lesion location, size, and age at stroke influence cognitive outcomes, though lesion size's impact remains debated.
Purpose of the Study:
- To investigate the specific impact of lesion size on executive performance in children with AIS.
- To clarify the relationship between lesion size and cognitive outcomes using direct testing and parental reports.
Main Methods:
- Compared executive functioning in 14 children post-AIS with 14 age- and sex-matched healthy controls.
- Utilized direct cognitive testing and parental rating scales to assess executive performance.
- Analyzed correlations between lesion size, cognitive test results, and parental ratings.
Main Results:
- Children with AIS showed poorer executive functioning than controls, generally within normal limits.
- Lesion size correlated with sustained attention and some parental executive function ratings.
- After controlling for sustained attention, lesion size no longer correlated with parental ratings.
Conclusions:
- Sustained attention performance mediates the link between lesion size and parental executive function ratings in childhood AIS.
- This mediating role of sustained attention may explain inconsistent findings in previous studies on lesion size and cognitive outcomes.
Abstract:
Cognitive deficits after childhood arterial ischemic stroke (AIS) can be observed in more than half the affected children, especially in executive functions. Previous research revealed some main factors that influence cognitive outcome after childhood AIS, including lesion location, lesion size, and age at stroke. However, the importance of lesion size particularly has been discussed controversially. Thus, the present study takes a closer look at the impact of lesion size on executive performance in children who suffered an AIS using both direct cognitive testing and parental ratings. The study sample comprised 14 patients after childhood AIS (mean age 12.71, 5 female) and 14 age- and sex-matched healthy controls (mean age 11.00, 6 female). Results of cognitive testing revealed that the patient group performed poorer in executive functioning compared to controls, but mostly within the normal range. Lesion size correlated with sustained attention performance and some of the parental rating scales. However, if these correlations were controlled for sustained attention, lesion size was no longer correlated with any parental rating scale. The results of the present study suggest that sustained attention performance mediates the correlation between parental ratings of executive functions and lesion size. This confounding factor may explain inconsistent results of the relationship between lesion size and cognitive outcome in previous research.
