Cognitive Functioning and Brain Magnetic Resonance Imaging in Children With Sickle Cell Disease
Cognitive Functioning and Brain Magnetic Resonance Imaging in Children With Sickle Cell Disease
复制标题
镰状细胞病儿童的认知功能和脑磁共振成像
作者：
Armstrong Fd;R. J. Thompson;Winfred C. Wang;R. Zimmerman;C. Pegelow;Scott T. Miller;F. Moser;J. Bello;A. Hurtig;K. Vass
目标。脑磁共振成像(MRI)和神经心理学评估被用来确定6至12岁的镰状细胞病儿童的脑梗塞的神经放射学证据是否会导致认知和学习功能的损害。
方法与设计。对参加镰刀细胞病合作研究的儿童进行了脑MRI和神经心理学评估。对194名儿童进行了完整的研究，其中135名儿童患有HbSS。根据T2加权高信号图像提示脑梗塞的存在对磁共振成像进行分类，并根据脑血管意外(CVA)的临床病史进一步进行分类。MRI异常但无CVA临床病史者为无症状性脑梗塞。神经心理学评估包括对全球智力功能和特定学术和神经心理功能的评估。
结果。其中17.9%的患儿有中枢神经系统(CNS)异常(22.2%为HBS纯合子)，仅HbSS病患儿有CVA的临床病史(N=9，4.6%)。随后的分析只调查了患有糖化血红蛋白综合征的儿童。有CVA病史的儿童在大多数神经心理评估指标上的表现明显低于无症状性脑梗塞或无MRI异常的儿童。MRI上无症状脑梗塞的儿童在算术、词汇、视觉运动速度和协调性测试中的表现明显逊于无MRI异常的儿童。
结论。这些结果证实了仔细评估、教育规划和医疗干预对镰状细胞病儿童中枢神经系统相关并发症的重要性。
Objective. Brain magnetic resonance imaging (MRI) and neuropsychological evaluations were conducted to determine whether neuroradiographic evidence of infarct in children with sickle cell disease between ages 6 and 12 years would result in impairment in cognitive and academic functioning.
Method and Design. Children enrolled in the Cooperative Study of Sickle Cell Disease were evaluated with brain MRI and neuropsychological evaluation. Completed studies were obtained for 194 children, 135 with HbSS. MRIs were categorized according to the presence of T2-weighted, high-intensity images suggestive of infarct and were further categorized on the basis of a clinical history of cerebrovascular accident (CVA). An abnormal MRI but no clinical history of CVA was classified as a silent infarct. Neuropsychological evaluations included assessment of both global intellectual functioning and specific academic and neuropsychological functions.
Results. Central nervous system (CNS) abnormalities were identified on MRI in 17.9% of the children (22.2% of children homozygous for HbS), and a clinical history of CVA (N = 9, 4.6%) was identified in only children with HbSS disease. Subsequent analyses examined only children with HbSS. Children with a history of CVA performed significantly poorer than children with silent infarcts or no MRI abnormality on most neuropsychological evaluation measures. Children with silent infarcts on MRI performed significantly poorer than children with no MRI abnormality on tests of arithmetic, vocabulary, and visual motor speed and coordination.
Conclusions. These results substantiate the importance of careful evaluation, educational planning, and medical intervention for CNS-related complications in children with sickle cell disease.