Association of cognitive function with cerebral blood flow in children with moyamoya disease
Association of cognitive function with cerebral blood flow in children with moyamoya disease
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DOI：
10.3171/2019.7.peds19312
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发表时间：
2020-01-01
影响因子：
1.9
通讯作者：
Houkin, Kiyohiro
中科院分区：
文献类型：
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作者：
Kazumata, Ken;Tokairin, Kikutaro;Houkin, Kiyohiro
目的 主要大脑动脉闭塞性病变对烟雾病（MMD）儿童的认知影响尚不清楚。作者旨在调查无明显脑部病变的 MMD 儿科患者术前阶段的认知功能。 方法 在这项前瞻性、观察性、单中心研究中，纳入了 2012 年至 2018 年间在北海道大学医院诊断为 MMD 的 21 名儿童（平均年龄 10 +/- 3.0 岁，范围 5-14 岁）。在初次诊断时使用韦克斯勒儿童智力量表第四版对智力进行横断面评估。使用[I-123]N-异丙基对碘苯丙胺/SPECT测量rCBF。还检查了临床因素、疾病严重程度、局部脑血流量 (rCBF) 和智力测试分数之间的关联。 结果 无明显脑部病变的儿童的平均全量表智商 (FIQ) 为 101.8 +/- 12.5（范围 76-125）。观察到智力量表指数得分存在显着差异，最常见的是（42.9%）工作记忆指数（WMI）和言语理解指数（VCI；VCI - WMI > 11 分）之间的差异。与小脑 (77.8 +/- 6.8 ml/100 g/min) 相比，左侧和右侧内侧额叶皮质的区域 CBF 均显着降低 (左：61.3 +/- 5.3 ml/100 g/min，右 65.3 +/- 5.3 ml/100 g/min；p < 0.001)。左背外侧前额叶皮层 (DLPFC) 的 rCBF 与 FIQ (r = 0.46, p = 0.034)、知觉推理指数 (PRI; r = 0.44, p = 0.045) 和处理速度指数 (PSI; r = 0.44, p = 0.045) 显着相关。左侧内侧额叶皮层的 rCBF 与 PSI 之间存在关联（r = 0.49，p = 0.026）。发病年龄、家族史、缺血症状和血管造影严重程度与认知能力差无关。结论虽然MMD儿童的平均智力没有降低，但左侧DLPFC和内侧额叶皮层的rCBF减少与FIQ、PRI和PSI的相关性表明由于脑灌注不足导致的轻度认知功能障碍。
OBJECTIVE The cognitive effects of main cerebral artery occlusive lesions are unclear in children with moyamoya disease (MMD). The authors aimed to investigate cognitive function in the presurgical phase of pediatric patients with MMD with no apparent brain lesions.METHODS In this prospective, observational, single-center study, 21 children (mean age 10 +/- 3.0 years, range 5-14 years) diagnosed with MMD at Hokkaido University Hospital between 2012 and 2018 were enrolled. A cross-sectional evaluation of intellectual ability was performed using the Wechsler Intelligence Scale for Children-Fourth Edition at the initial diagnosis. rCBF was measured using [I-123] N-isopropyl p-iodoamphetamine/SPECT. The associations among clinical factors, disease severity, regional cerebral blood flow (rCBF), and intelligence test scores were also examined.RESULTS The mean full-scale intelligence quotient (FIQ) was 101.8 +/- 12.5 (range 76-125) in children with no apparent brain lesions. A significant difference in the intelligence scale index score was observed, most frequently (42.9%) between working memory index (WMI) and verbal comprehension index (VCI; VCI - WMI > 11 points). Regional CBF was significantly reduced both in the left and right medial frontal cortices (left: 61.3 +/- 5.3 ml/100 g/min, right 65.3 +/- 5.3 ml/100 g/min; p < 0.001) compared to the cerebellum (77.8 +/- 6.8 ml/100 g/min). There was a significant association of rCBF in the left dorsolateral prefrontal cortex (DLPFC) with FIQ (r = 0.46, p = 0.034), perceptual reasoning index (PRI; r = 0.44, p = 0.045), and processing speed index (PSI; r = 0.44, p = 0.045). There was an association between rCBF of the left medial frontal cortex and PSI (r = 0.49, p = 0.026). Age of onset, family history, ischemic symptoms, and angiographic severity were not associated with poor cognitive performance.CONCLUSIONS Although average intellectual ability was not reduced in children with MMD, the association of reduced rCBF in the left DLPFC and medial frontal cortex with FIQ, PRI, and PSI suggests mild cognitive dysfunction due to cerebral hypoperfusion.