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Fronto-parietal and white matter haemodynamics predict cognitive outcome in children with moyamoya independent of stroke

Fronto-parietal and white matter haemodynamics predict cognitive outcome in children with moyamoya independent of stroke
Fronto-parietal and white matter haemodynamics predict cognitive outcome in children with moyamoya independent of stroke
Moyamoya disease is a major arteriopathy characterised by progressive steno-occlusion of the arteries of the circle of Willis. Studies in adults with moyamoya suggest an association between abnormal fronto-parietal and white matter regional haemodynamics and cognitive impairments, even in the absence of focal infarction. However, these associations have not been investigated in children with moyamoya. We examined the relationship between regional haemodynamics and ratings of intellectual ability and executive function, using hypercapnic challenge blood oxygen level–dependent magnetic resonance imaging of cerebrovascular reactivity in a consecutive cohort of children with confirmed moyamoya. Thirty children were included in the final analysis (mean age: 12.55 ± 3.03 years, 17 females, 15 idiopathic moyamoya and 15 syndromic moyamoya). Frontal haemodynamics were abnormal in all regardless of stroke history and comorbidity, but occipital lobe haemodynamics were also abnormal in children with syndromic moyamoya. Executive function deficits were noted in both idiopathic and syndromic moyamoya, whereas intellectual ability was impaired in syndromic moyamoya, even in the absence of stroke. Analysis of the relative effect of regional abnormal haemodynamics on cognitive outcomes demonstrated that executive dysfunction was predominantly explained by right parietal and white matter haemodynamics independent of stroke and comorbidity, while posterior circulation haemodynamics predicted intellectual ability. These results suggest that parietal and posterior haemodynamics play a compensatory role in overcoming frontal vulnerability and cognitive impairment.
BOLD MRI CVR, Cerebrovascular reactivity, Executive function, Moyamoya, Stroke
1868-4483
757-773
Choi, Eun Jung
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Westmacott, Robyn
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Kirkham, Fenella J.
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Robertson, Amanda
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Muthusami, Prakash
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Shroff, Manohar
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Moharir, Mahendranath
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Williams, Tricia
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Dirks, Peter
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MacGregor, Daune
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Slim, Mahmoud
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Pulcine, Elizabeth
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Bhathal, Ishvinder
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Kaseka, Matsanga Leyila
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Kassner, Andrea
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Logan, William
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deVeber, Gabrielle
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Dlamini, Nomazulu
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Choi, Eun Jung
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Westmacott, Robyn
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Kirkham, Fenella J.
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Robertson, Amanda
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Muthusami, Prakash
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Shroff, Manohar
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Moharir, Mahendranath
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Williams, Tricia
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Dirks, Peter
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MacGregor, Daune
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Slim, Mahmoud
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Pulcine, Elizabeth
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Bhathal, Ishvinder
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Kaseka, Matsanga Leyila
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Kassner, Andrea
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Logan, William
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deVeber, Gabrielle
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Dlamini, Nomazulu
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Choi, Eun Jung, Westmacott, Robyn, Kirkham, Fenella J., Robertson, Amanda, Muthusami, Prakash, Shroff, Manohar, Moharir, Mahendranath, Williams, Tricia, Dirks, Peter, MacGregor, Daune, Slim, Mahmoud, Pulcine, Elizabeth, Bhathal, Ishvinder, Kaseka, Matsanga Leyila, Kassner, Andrea, Logan, William, deVeber, Gabrielle and Dlamini, Nomazulu (2022) Fronto-parietal and white matter haemodynamics predict cognitive outcome in children with moyamoya independent of stroke. Translational Stroke Research, 13 (5), 757-773. (doi:10.1007/s12975-022-01003-w).

Record type: Article

Abstract

Moyamoya disease is a major arteriopathy characterised by progressive steno-occlusion of the arteries of the circle of Willis. Studies in adults with moyamoya suggest an association between abnormal fronto-parietal and white matter regional haemodynamics and cognitive impairments, even in the absence of focal infarction. However, these associations have not been investigated in children with moyamoya. We examined the relationship between regional haemodynamics and ratings of intellectual ability and executive function, using hypercapnic challenge blood oxygen level–dependent magnetic resonance imaging of cerebrovascular reactivity in a consecutive cohort of children with confirmed moyamoya. Thirty children were included in the final analysis (mean age: 12.55 ± 3.03 years, 17 females, 15 idiopathic moyamoya and 15 syndromic moyamoya). Frontal haemodynamics were abnormal in all regardless of stroke history and comorbidity, but occipital lobe haemodynamics were also abnormal in children with syndromic moyamoya. Executive function deficits were noted in both idiopathic and syndromic moyamoya, whereas intellectual ability was impaired in syndromic moyamoya, even in the absence of stroke. Analysis of the relative effect of regional abnormal haemodynamics on cognitive outcomes demonstrated that executive dysfunction was predominantly explained by right parietal and white matter haemodynamics independent of stroke and comorbidity, while posterior circulation haemodynamics predicted intellectual ability. These results suggest that parietal and posterior haemodynamics play a compensatory role in overcoming frontal vulnerability and cognitive impairment.

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e-pub ahead of print date: 25 March 2022
Published date: October 2022
Additional Information: Funding Information: We thank the Auxilium Foundation and Brain Canada for their support. Study funders were not involved in the study design, data analysis, or publication decisions. The findings are solely the responsibility of the authors and do not represent the Auxilium Foundation. Image processing and analysis was supported by the Stroke Imaging Laboratory for Children, The Hospital for Sick Children, Toronto. Publisher Copyright: © 2022, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
Keywords: BOLD MRI CVR, Cerebrovascular reactivity, Executive function, Moyamoya, Stroke

Identifiers

Local EPrints ID: 470208
URI: http://eprints.soton.ac.uk/id/eprint/470208
ISSN: 1868-4483
PURE UUID: 4af7c953-fcf6-4474-bb0e-2dfcb00540ee
ORCID for Fenella J. Kirkham: ORCID iD orcid.org/0000-0002-2443-7958

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Date deposited: 04 Oct 2022 16:49
Last modified: 05 Oct 2022 01:38

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Contributors

Author: Eun Jung Choi
Author: Robyn Westmacott
Author: Amanda Robertson
Author: Prakash Muthusami
Author: Manohar Shroff
Author: Mahendranath Moharir
Author: Tricia Williams
Author: Peter Dirks
Author: Daune MacGregor
Author: Mahmoud Slim
Author: Elizabeth Pulcine
Author: Ishvinder Bhathal
Author: Matsanga Leyila Kaseka
Author: Andrea Kassner
Author: William Logan
Author: Gabrielle deVeber
Author: Nomazulu Dlamini

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