Assessment Of Psychological And Cognitive Function In Adult Patients With Moyamoya Disease And Its Influencing Factors

Moyamoya disease（MMD）is a chronic ischemic cerebrovascular disease of unknown cause,characterized by gradual narrowing and even occlusion of the distal end of bilateral internal carotid arteries and/or initial segments of anterior and middle cerebral arteries,and compensatory dilation of the perforating artery of skull base.Although cognitive impairment is not a clinical symptom of moyamoya disease in the traditional sense,it has attracted more and more attention in recent years.Current studies on cognitive function of moyamoya disease have found that cognitive impairment caused by moyamoya disease can occur in different cognitive domains such as intelligence,executive function,information processing speed,memory and visual space.This study collected clinical information,imaging information and relatively complete functional states of each cognitive domain of adult moyamoya disease,hoping to further understand the overall cognitive status of moyamoya disease patients and the impact of different imaging manifestations on cognitive function.It can study the mechanism of cognitive dysfunction in patients with moyamoya disease without stroke.This study will gradually explore the cognitive and psychological state of adult MMD and the pathogenesis of patients without stroke from the above two aspects.Part 1:Assessment of psychological and cognitive function in adult patients with moyamoya disease and its influencing factorsObjective:To evaluate the overall cognitive status of adult patients with moyamoya disease and the effects of different imaging manifestations on their cognitive function.Methods:A total of 392 adult patients with moyamoya disease admitted to the Neurosurgery Department of the Fifth Medical Center of Chinese PLA General Hospital from December 2018 to December 2021 were prospectively and consecutively enrolled,and 82 healthy subjects matched in age,education level and gender during the same period were included as the control group.Clinical and imaging information of patients were collected,and comprehensive psychological status and cognitive function were evaluated for the case group（adult moyamoya disease）and the control group.Including Hamilton depression scale（HAMD）,daily living ability（ADL）scale,Montreal cognitive assessment（MoCA）scale,Chinese auditory word learning test（CAVLT）,connection test A,B（TMT A,B）,Boston naming test（BNT）,drawing clock test（CDT）.According to different imaging manifestations,patients with moyamoya disease were divided into three subgroups without stroke,cerebral infarction and cerebral hemorrhage,and the cognitive function differences among the three subgroups were analyzed and compared.According to MoCA scale score,all patients with Moyamoya disease were divided into cognitively normal group and cognitively impaired group.The risk factors of cognitive dysfunction in adult patients with moyamoya disease were analyzed by using multivariate Logistic regression analysis.Results:Of 392 patients,316（80.6%）had cognitive impairment（MoCA<26 points）.Compared with the control group,the information processing speed（TMTA）,executive function（TMTB）,memory function（CAVLT）,language expression ability（BNT）and visuospatial ability（CDT）of patients in the case group were decreased to varying degrees,with statistical significance（all P<0.001）.Comparison of cognitive function among patients without stroke,cerebral infarction and cerebral hemorrhage:there were statistically significant differences in MoCA scale score,TMTA,TMTB time,CAVLT,BNT and CDT scores among the three groups（all P<0.001）.Pairwise comparison showed that the cognitive domain scores of patients without stroke were superior to those of cerebral infarction and cerebral hemorrhage groups（all P<0.05）.There were no significant differences in cognitive domain scores between cerebral infarction group and cerebral hemorrhage group（all P>0.05）.Multivariate Logistic regression analysis showed that age,years of education,previous cerebral infarction and cerebral hemorrhage were independent risk factors for cognitive dysfunction.Conclusion:There are multiple cognitive impairment in adult patients with MMD.Stroke events have a significant impact on the cognitive function of patients with MMD.In addition to stroke events,age and years of education may also be influencing factors of cognitive impairment in patients with MMD.Part 2:Association of cognitive function and long-term hypoperfusion in non-stroke moyamoya disease patientsObjectives:The influence of long-term hypoperfusion on cognition is unclarified in MMD patients.This study aimed to investigate the changes of cognitive function in MMD patients without stroke and illustrate the relationship between cognitive impairment and hypoperfusion.Methods:We prospectively performed a structured battery of 7 neurocognitive tests on 115 MMD adult patients without stroke and 82 healthy controls matched for age,sex,degree of education.The hemodynamic assessment was measured by dynamic susceptibility contrast-enhanced MRI（DSC-MRI）.Best subsets regression（BSR）strategy was used to find the potential risk factors.Results:Global cognition（Montreal Cognitive Assessment,MoCA）,speed of information processing（Trail Making Test A,TMT-A）,executive function（Trail Making Test-B,TMT-B）,visuospatial function（Clock Drawing Test,CDT）,verbal memory（Chinese Auditory Verbal Learning Test,CAVLT）in MMD patients without stroke were significantly poorer than those in the healthy controls.The score of TMTB was significantly correlated with the CBF in the bilateral lateral frontal lobes,the centrum semiovale,and temporal lobes.The score of TMTA and CAVLT was significantly correlated with the CBF in the left centrum semiovale（L-CSO）and temporal lobes.According to the result of the BSR,age,education,white matter lesions,and hypoperfusion of the L-CSO were selected as potential risk factors of cognitive impairment.Conclusions:Long-term hypoperfusion leads to multiple cognitive domain impairment in MMD patients even without stroke.The perfusion of particular areas may help us evaluate the cognitive function of MMD patients and guide the therapeutic strategy.