Impairments in brain perfusion, executive control network, topological characteristics, and neurocognition in adult patients with asymptomatic Moyamoya disease

Abstract

Background Asymptomatic Moyamoya disease (MMD) impairs hemodynamic and cognitive function. The relationship between these changes, cerebral blood flow (CBF), and network connectivity remains largely unknown. The aim of this study was to increase understanding of the relationship between CBF, functional networks, and neurocognition in adults with asymptomatic MMD. We compared CBF and functional status in 26 patients with MMD and 20 healthy controls using arterial spin labeling and resting state functional magnetic resonance imaging sequences. At the same time, a detailed cognitive test was performed in 15 patients with no cerebral or lumen infarction who were selected by magnetic resonance imaging-T2 FLAIR screening. Results Compared to the controls, the patients showed varying degrees of decline in their computational ability (simple subtraction, p = 0.009; complex subtraction, p = 0.006) and short-term memory (p = 0.042). The asymptomatic MMD group also showed decreased CBF in the left anterior central and left inferior frontal gyri of the island flap with multiple node abnormalities in the brain network and reduced network connectivity. There was a significant association of these changes with cognitive decline in the MMD group. Conclusions In patients with asymptomatic MMD, disturbance of CBF and impaired brain network connections may be important causes of cognitive decline and appear before clinical symptoms. Clinical trial registration-URL: http://www.chictr.org.cn Unique identifier: ChiCTR1900023610

Application of DTI and fMRI in moyamoya disease

“…Similar finding has also been confirmed in other studies. He SH et al also found decreased activation in the posterior cingulate gyrus, the left superior parietal gyrus, and the left superior occipital gyrus in the right ECN (37). And they indicated that decreased computational ability in patients with MMD was associated with significant abnormalities in the CBF of the left inferior frontal gyrus.…”

“…Sakamoto et al found that DMN connectivity have changed in patients with MMD, their results showed highly disrupted patterns of ventral DMN connectivity, with a mixture of higher and lower functional connectivity in patients with low neuropsychologic scores compared with healthy controls (6). He et al (37) also found that there were significantly fewer functional connections in the brain in the asymptomatic MMD group than in the control group. Furthermore, a study designed by Lei (38) introduced a dynamic measurement of connectivity number entropy (CNE) to further explore the relationship between brain networks and vascular cognitive impairment (VCI) in patients with MMD, they found that only the ECN and DMN exhibited statistical CNE differences among the three groups (VCI, VCI with intact cognition, normal controls), implying their cognitive-related significance.…”

Cognitive Impairment in Primary and Secondary Headache Disorders

“…Although cognitive impairment in adults with MMA has long been assumed to be secondary to strokes, there is evidence for cognitive deficits (mostly in short-term memory and computation) in patients with asymptomatic MMA raising the hypothesis that cognitive deficits stem from chronic hypoperfusion [88,89]. In a case-control study of 26 patients with asymptomatic MMA and 20 controls of mean age 46 years, the MMA group had lower performance in terms of computational ability and short-term memory [90]. In a case-control study of 21 participants with asymptomatic MMA, 19 participants with MMA-related strokes, and 20 controls of mean age around 41 years, both groups MMA had worse performance than the control group in spatial imagination, working memory, computational ability, and short-term memory and the group with MMA-related strokes performed worse than the group with asymptomatic MMA in complex arithmetic and short-term memory [91].…”

Atrophy in subcortical gray matter in adult patients with moyamoya disease

“…With the enhanced awareness of physical examination and advances in noninvasive magnetic resonance methods, the early detection of asymptomatic patients with MMD who have not experienced CVAs is possible [5]. He et al [6] found that reduced brain network connectivity and cerebral hypoperfusion already existed in patients with asymptomatic MMD, suggesting that brain functions may not only be influenced by stroke or hemorrhages but also by hemodynamic changes, and abnormal cerebral blood flow and neurovascular coupling are crucial factors underlying the functional impairment in patients with normal cerebrovascular reserve. Chronic hemodynamic disturbance may also lead to regional decreases in cortical thickness [7], a reduction in the density of subcortical areas, and abnormalities in white matter [8] in patients with MMD, which might be other underlying causes of functional abnormalities.…”