Abstract
ObjectiveTo explore potential risk factors of preoperative cognitive dysfunction in adult patients with moyamoya disease (MMD) and discuss significance of moyamoya vessels.MethodsThe author reviewed adult MMD patients harboring no parenchymal infarction or hemorrhage underwent a standardized neuropsychological assessment test battery from December 2018 to May 2019. The authors defined patients with cognitive dysfunction as cognitive impairment shown on 3 or more neuropsychological tests. According to the presence of cerebral angiography, arterial stenosis, moyamoya vessels, and compensatory arteries were conducted. Univariate and multivariate analyses were performed to identify predictors for cognitive dysfunction before surgery. Subgroup analyses by onset type and Suzuki stage were carried out to identify specific predictors for preoperative cognitive dysfunction.ResultsIn total, 29 of 92 (31.52%) patients had cognitive dysfunction. Multivariate analysis showed that moyamoya vessels generating from left hemisphere was recognized as independent predictor for cognitive dysfunction (P = 0.025, OR [95%CI], 0.085 [0.012–0.874]). For patients in left ICA-moyamoya subgroup, 19 of 45 (42.22%) cases with sparse moyamoya vessels had cognitive dysfunction (P = 0.031), while 22 (91.67%) of patients with dense moyamoya vessels had normal cognition (P = 0.004). Moyamoya vessels arising from ophthalmic artery had no significant association with cognitive dysfunction (P = 0.111). Multivariate analysis found that moyamoya vessels originating from left ICA was recognized as independent predictors for preoperative cognitive dysfunction (P = 0.048, OR [95%CI], 0.394 [0.132–0.926]).ConclusionsMoyamoya vessels arising from left hemisphere was a risk factor for the preoperative cognitive dysfunction in adult patients with MMD, with the denser moyamoya vessels, the less cognitive dysfunction. The current study offers a new perspective of moyamoya vessels and supporting data for choosing MMD candidates on cerebral revascularization.
Highlights
Moyamoya disease (MMD) was a relatively rare cerebrovascular disease with unknown etiology, characterized by progressive stenosis of internal carotid artery (ICA) termination and the formation of smoke-like vessels at the base of brain [1,2,3]
There was no significant difference in age, gender, education time, clinical type, and Suzuki stage of bilateral hemisphere between patients with normal cognition and patients with cognitive dysfunction (P > 0.05), except Suzuki stage II in left hemisphere (P = 0.021) (Table 2)
Multivariate analysis was conducted with factors with the aforementioned significance, and moyamoya vessels originating from left ICA was recognized as independent predictors for preoperative cognitive dysfunction (P = 0.048, OR [95%confidence interval (CI)], 0.394 [0.132–0.926]), especially for cases with dense moyamoya vasculature (P = 0.038, OR [95%CI], 0.159[0.004–0.860]) (Table 4)
Summary
Moyamoya disease (MMD) was a relatively rare cerebrovascular disease with unknown etiology, characterized by progressive stenosis of internal carotid artery (ICA) termination and the formation of smoke-like vessels at the base of brain [1,2,3]. Previous literature reported that cognitive function of adult patients with MMD were often impaired due to insufficient cerebral blood flow perfusion and hypoxia [6,7,8,9,10]. Digital subtraction angiography (DSA) was a useful tool for estimation of brain collateral circulation, which had never been used to evaluate cognitive impairment in adult patients with MMD in previous literature. The keynote of this research was to study potential risk factors of preoperative cognitive dysfunction in adult patients with MMD based on DSA findings, and discuss significance of moyamoya vessels
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