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Background: Cognitive impairment in adult moyamoya disease (MMD) is thought to be the result of ischemic stroke; however, the presence and extent of cognitive decline in asymptomatic patients is unclear. Methods: After classification using T2-weighted fluid attenuated inversion recovery (FLAIR) magnetic resonance imaging (MRI), a total of 19 MMD patients with a history of cerebral infarction, 21 asymptomatic MMD patients, and 20 healthy controls matched for age, sex, and years of education were prospectively included in this study. A detailed neuropsychological evaluation of two moyamoya subgroups and normal controls was conducted. Results: Asymptomatic patients showed varying degrees of decline in intelligence (Raven's Standard Progressive Matrices, P = 0.001), spatial imagination (mental rotation, P = 0.014), working memory (verbal working memory-backward digit span, P = 0.011), and computational ability (simple subtraction, P = 0.014; complex subtraction, P < 0.001) compared with normal controls. MMD patients with cerebral infarction had more severe impairment in complex arithmetic (P = 0.027) and word short-term memory (P = 0.01) than those without symptoms. Conclusion: In asymptomatic MMD patients, a variety of cognitive impairment precedes the onset of clinical symptoms such as cerebral infarction, which may be a long-term complication of conservative treatment.

A previous study has revealed sex-dependent neurofunctional predictors of visual word learning [C. Chen, G. Xue, Q. Dong, Z. Jin, T. Li, F. Xue, L. Zhao, Y. Guo, Sex determines the neurofunctional predictors of visual word learning, Neuropsychologia 45 (2007) 741-747]. The present study aimed to extend that study to investigate sex-dependent neurofunctional predictors of long-term maintenance. Twenty-three Chinese college students trained in the previous study were followed up twice: immediately (T1) and 6 months after the training (T2). At both T1 and T2, subjects were tested with the simultaneously presented same-different judgment task. Compared with the T1 performance, subjects (both males and females) showed a small but significant amount of forgetting (i.e., longer reaction times) at T2. Consistent with our hypothesis, males' performance at both T1 and T2 was predicted by the pre-training left-lateralized fusiform activation, whereas females' performance was predicted by symmetrical bilateral fusiform activation.