Abstract
Moyamoya angiopathy (MMA) related cerebral perfusion deficits or infarctions might influence quality of life (QoL). This study examines preoperative QoL in adult patients with MMA and correlates these with findings obtained via diagnostic imaging. Sixty-seven adult Moyamoya patients underwent preoperative neuropsychological testing including questionnaires to determine QoL, as well as psychiatric and depressive symptoms. The results were checked for correlation with territorial hypoperfusions seen in H215O PET with acetazolamide (ACZ) challenge (cerebrovascular reserve) and infarction patterns observed in MRI. Each vascular territory was analyzed separately and correlated with QoL. Physical role function was restricted in 41.0% of cases and emotional role function in 34.4% of cases (SF-36). Obsessive–compulsive disorder (39.3%) (SCL-90-R), psychoticism (34.4%) (SCL-90-R), and depression (32.7%) (BDI-II) were also very common. Psychoticism was significantly more frequent in cases where perfusion deficits in PET CT were observed in both MCA territories (left p = 0.0124, right p = 0.0145) and infarctions in MRI were present in the right MCA territory (p = 0.0232). Depression was significantly associated with infarctions in the right MCA territory (SCL-90-R p = 0.0174, BDI-II p = 0.0246). Women were affected more frequently by depression (BDI-II, p = 0.0234). Physical role function impairment was significantly associated with perfusion deficits in the left MCA territory (p = 0.0178) and infarctions in the right MCA territory (p = 0.0428). MMA leads to impairments in different areas of QoL. Approximately one-third of all adult MMA patients suffered from depression, with women being most affected. In addition to depression, presence of executive dysfunctions and mental disorders such as psychoticism, obsessive–compulsive disorder, and impaired physical and emotional role function affected QoL. These patients showed significantly more often infarctions and perfusion deficits in the right MCA territory. Long-term studies with follow-up results are necessary to clarify a possible beneficial impact of early surgical revascularization on QoL and depression in adult MMA patients.
Highlights
Moyamoya angiopathy (MMA) is a chronic and occasionally progressive steno-occlusive disease
Our results suggest an association with the occurrence of depression in adult MMA patients with a compromised right nondominant hemisphere in the middle cerebral artery (MCA) territory
We evaluated the preoperative neuropsychological outcomes with assessment of quality of life (QoL), depression, and the presence of dysexecutive cognitive syndrome (DCS) in 67 adult patients with MMA and determined possible associations with infarctions seen in MRI and perfusion deficits in H215O PET
Summary
Moyamoya angiopathy (MMA) is a chronic and occasionally progressive steno-occlusive disease. It is primarily observed in the anterior circulation, but the posterior circulation may be involved. It is characterized by a fine collateral network, akin to a puff of smoke in angiography [29]. While the prevalence of mental disorders such as depression and QoL has been well studied for stroke survivors in general [4, 15], little information is available on the prevalence of neuropsychological disorders in MMA and their relation to stroke burden in MRI and perfusion deficits in PET
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