Abstract TP409: Cognitive Function in Cerebral Arteriopathy: An Evaluation of the Effects of Blood Pressure and Body Mass Index

Abstract

Background: Cerebral arteriopathy (CA) is a major risk factor for childhood arterial ischemic stroke and is associated with significant cognitive impairments. Disease-related characteristics partially explain the variability observed in specific cognitive outcomes. Adult studies demonstrate an association between stroke risk factors such as increased body mass index (BMI) and blood pressure (BP) and cognitive function, suggesting a more diffuse mechanism of brain injury. We aimed to evaluate the association between BMI and BP with cognitive function in children with CA. Methods: We conducted a cross-sectional study in children with CA and no stroke, aged 5-18 years. Children were evaluated using Wechsler Intelligence Scale for Children (WISC), Adaptive Behaviour Assessment System (ABAS), Beery-Buktenica Developmental Test (BEERY) and Behaviour Assessment System for Children (BASC). Children with BMI≥85 th percentile were classified as overweight and those with systolic or diastolic BP≥90 th percentile were classified as prehypertensive/hypertensive (Pre-HTN). Results: Of 88 children with CA, 38 were included (63% female; median age:11.3 years). Pre-HTN and overweight were present in 26% and 29%, respectively. Significant negative correlations were found between BMI and working memory (R 2 =-0.5, p=0.01) and perceptual reasoning (R 2 =-0.4, p=0.04) of the WISC. Beery-perception scores correlated significantly with diastolic BP (R 2 =-0.5, p=0.02) and BMI (R 2 =-0.7, p=0.01). The social composite score of the ABAS correlated significantly with the BMI (R 2 =-0.7, p=0.04). Overweight children had significantly lower BEERY-motor scores (53.5±30.4 vs 84.8±17.8, p=0.03) and higher BASC-externalizing problems (58±11.4 vs 47.9±8.4, p=0.02) compared to children with normal weight. Hypertensive children displayed significantly lower BEERY-visual perception scores (63.5±26.2 vs 92.2±12.5, p=0.01). Conclusion: Increased BMI and BP may contribute to cognitive impairments observed in children with CA. We suggest that a more diffuse mechanism of brain injury is responsible for the specific cognitive impairments associated with increased BMI and BP. Larger controlled studies involving structural and perfusion imaging are needed.