Predictors of preoperative cognitive dysfunction in adults with Moyamoya disease: a preliminary research

Abstract Objective To explore potential risk factors of preoperative cognitive dysfunction in adult patients with moyamoya disease (MMD) and discuss significance of moyamoya vessels. Methods The 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. Results In 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]). Conclusions Moyamoya 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.

Download Full-text

Haemodynamic analysis of adult patients with moyamoya disease: CT perfusion and DSA gradings

Stroke and Vascular Neurology ◽

10.1136/svn-2019-000317 ◽

2020 ◽

pp. svn-2019-000317

Author(s):

Zhiyong Shi ◽

Guofeng Ma ◽

Dong Zhang

Keyword(s):

Risk Factors ◽

Basal Ganglia ◽

Frontal Lobe ◽

Potential Risk ◽

Parietal Lobe ◽

Ct Perfusion ◽

Adult Patients ◽

Arterial Stenosis ◽

Significant Difference ◽

Potential Risk Factors

ObjectMoyamoya disease (MMD) is a common and chronic progressive stenotic-occlusive cerebrovascular disease in Eastern Asia. To evaluate the hemispheric haemodynamic status of adult patients with MMD, we explored the potential risk factors of hemispheric perfusion alterations with CT perfusion (CTP) and DSA.MethodsWe retrospectively reviewed 44 male and 44 female (176 hemispheres) adult patients with MMD who had both DSA and CTP. Data on cerebral blood perfusion (CBF), cerebral blood volume (CBV), mean transmit time (MTT), time to peak (TTP) of cerebral hemisphere and cerebellum were gathered and difference of relative haemodynamic parameters between different subgroups were assessed with independent sample t analysis, one-way analysis of variance and general linear regression analysis.ResultsParameters in regional CBF (rCBF) of frontal, temporal lobe and basal ganglia in female was more superior than male. rCBF, regional MTT (rMTT) and regional TTP (rTTP) in adult MMD patients with haemorrhage were superior than the ischaemic. With the increase of age, significant difference could be seen in rCBF and rCBV of thalamus. However, with progress of arterial stenosis, significant difference could only be obsevrved in rCBV, rMTT and rTTP, whereas rCBF had no significant difference. For increase of moyamoya vessels, significant decrease of rCBF could be seen in temporal and parietal lobe. With the increase of compensatory artery numbers, no significant difference could be seen in rCBF parameters (p>0.05).ConclusionsIn adult MMD patients, age, gender and clinical type were potential risk factors for the change of cerebral perfusion. When arterial stenosis is worsened, moyamoya vessels could alter perfusion of temporal and parietal lobe, but not frontal lobe. Extracranial/intracranial compensatory arteries could maintain microcirculation stability in frontal lobe and basal ganglia, indicating that the protection from extracranial compensatory arteries, a theoretic base for surgery treatment if necessary.

Download Full-text

Prolonged/delayed cerebral hyperperfusion in adult patients with moyamoya disease with RNF213 gene polymorphism c.14576G>A (rs112735431) after superficial temporal artery–middle cerebral artery anastomosis

Journal of Neurosurgery ◽

10.3171/2020.6.jns201037 ◽

2020 ◽

pp. 1-8

Author(s):

Ryosuke Tashiro ◽

Miki Fujimura ◽

Masahito Katsuki ◽

Taketo Nishizawa ◽

Yasutake Tomata ◽

...

Keyword(s):

Genetic Analysis ◽

Gene Polymorphism ◽

Intracerebral Hemorrhage ◽

Middle Cerebral Artery ◽

Moyamoya Disease ◽

Cerebral Artery ◽

Superficial Temporal Artery ◽

Temporal Artery ◽

Adult Patients ◽

Cerebral Hyperperfusion

OBJECTIVESuperficial temporal artery–middle cerebral artery (STA-MCA) anastomosis is the standard surgical management for moyamoya disease (MMD), whereas cerebral hyperperfusion (CHP) is one of the potential complications of this procedure that can result in delayed intracerebral hemorrhage and/or neurological deterioration. Recent advances in perioperative management in the early postoperative period have significantly reduced the risk of CHP syndrome, but delayed intracerebral hemorrhage and prolonged/delayed CHP are still major clinical issues. The clinical implication of RNF213 gene polymorphism c.14576G>A (rs112735431), a susceptibility variant for MMD, includes early disease onset and a more severe form of MMD, but its significance in perioperative pathology is unknown. Thus, the authors investigated the role of RNF213 polymorphism in perioperative hemodynamics after STA-MCA anastomosis for MMD.METHODSAmong 96 consecutive adult patients with MMD comprising 105 hemispheres who underwent serial quantitative cerebral blood flow (CBF) analysis by N-isopropyl-p-[123I]iodoamphetamine SPECT after STA-MCA anastomosis, 66 patients consented to genetic analysis of RNF213. Patients were routinely maintained under strict blood pressure control during and after surgery. The local CBF values were quantified at the vascular territory supplied by the bypass on postoperative days (PODs) 1 and 7. The authors defined the radiological CHP phenomenon as a local CBF increase of more than 150% compared with the preoperative values, and then they investigated the correlation between RNF213 polymorphism and the development of CHP.RESULTSCHP at POD 1 was observed in 23 hemispheres (23/73 hemispheres [31.5%]), and its incidence was not statistically different between groups (15/41 [36.6%] in RNF213-mutant group vs 8/32 [25.0%] in RNF213–wild type (WT) group; p = 0.321). CHP on POD 7, which is a relatively late period of the CHP phenomenon in MMD, was evident in 9 patients (9/73 hemispheres [12.3%]) after STA-MCA anastomosis. This prolonged/delayed CHP was exclusively observed in the RNF213-mutant group (9/41 [22.0%] in the RNF213-mutant group vs 0/32 [0.0%] in the RNF213-WT group; p = 0.004). Multivariate analysis revealed that RNF213 polymorphism was significantly associated with CBF increase on POD 7 (OR 5.47, 95% CI 1.06–28.35; p = 0.043).CONCLUSIONSProlonged/delayed CHP after revascularization surgery was exclusively found in the RNF213-mutant group. Although the exact mechanism underlying the contribution of RNF213 polymorphism to the prolonged/delayed CBF increase in patients with MMD is unclear, the current study suggests that genetic analysis of RNF213 is useful for predicting the perioperative pathology of patients with MMD.

Download Full-text

Reasons for Tooth Extractions and Related Risk Factors in Adult Patients: A Cohort Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17072575 ◽

2020 ◽

Vol 17 (7) ◽

pp. 2575

Author(s):

Pier Carmine Passarelli ◽

Stefano Pagnoni ◽

Giovan Battista Piccirillo ◽

Viviana Desantis ◽

Michele Benegiamo ◽

...

Keyword(s):

Risk Factors ◽

Periodontal Disease ◽

Smoking Habit ◽

Extraction Process ◽

Adult Patients ◽

Diabetic Patients ◽

Related Risk ◽

Potential Risk Factors ◽

Practice Methods ◽

Tooth Extractions

Background: The aim of this study was to evaluate oral status, the reasons for tooth extractions and related risk factors in adult patients attending a hospital dental practice. Methods: 120 consecutive patients ranging from 23 to 91 years in age (mean age of 63.3 ± 15.8) having a total of 554 teeth extracted were included. Surveys about general health status were conducted and potential risk factors such as smoking, diabetes and age were investigated. Results: a total of 1795 teeth were missing after extraction procedures and the mean number of remaining teeth after the extraction process was 16.8 ± 9.1 per patient. Caries (52.2%) was the most common reason for extraction along with periodontal disease (35.7%). Males were more prone to extractions, with 394 of the teeth extracted out of the total of 554 (71.1%). Male sex (β = 2.89; 95% CI 1.26, 4.53; p = 0.001) and smoking habit (β = 2.95; 95% CI 1.12, 4.79; p = 0.002) were related to a higher number of teeth extracted. Age (β = −0.24; 95% CI −0.31, −0.16; p < 0.001) and diabetes (β = −4.47; 95% CI −7.61, −1.33; p = 0.006) were related to a higher number of missing teeth at evaluation time. Moreover, periodontal disease was more common as a reason of extraction among diabetic patients than among non-diabetic ones (p = 0.04). Conclusions: caries and periodontal disease were the most common causes of extraction in a relatively old study population: further screening strategies might be required for the early interception of caries and periodontal disease.

Download Full-text

Looking Beyond the Surface of Adult Moyamoya Disease: Brain Magnetic Resonance Imaging Microstructural Changes and Cognitive Dysfunction

World Neurosurgery ◽

10.1016/j.wneu.2015.05.001 ◽

2015 ◽

Vol 84 (1) ◽

pp. 18-20

Author(s):

Youssef J. Hamade ◽

Rami James N. Aoun ◽

Samer G. Zammar ◽

Stacie E. DeMent ◽

Naresh P. Patel ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Cognitive Dysfunction ◽

Moyamoya Disease ◽

Brain Magnetic Resonance Imaging ◽

Resonance Imaging ◽

Microstructural Changes ◽

Adult Moyamoya Disease

Download Full-text

Evaluation of the effects of group psychotherapy on cognitive function in patients with multiple sclerosis with cognitive dysfunction and depression

Arquivos de Neuro-Psiquiatria ◽

10.1590/0004-282x20140144 ◽

2015 ◽

Vol 73 (2) ◽

pp. 90-95 ◽

Cited By ~ 3

Author(s):

Emine Bilgi ◽

Hasan Hüseyin Özdemir ◽

Ayhan Bingol ◽

Serpil Bulut

Keyword(s):

Multiple Sclerosis ◽

Cognitive Impairment ◽

Cognitive Function ◽

Group Psychotherapy ◽

Cognitive Dysfunction ◽

Beck Depression Inventory ◽

Neuropsychological Tests ◽

Depression Severity ◽

Group Members ◽

Repeatable Battery

Objective This study will evaluate how decreasing depression severity via group psychotherapy affects the cognitive function of patients with multiple sclerosis (MS) who are also diagnosed with depression and cognitive dysfunction. Method MS patients completed the Brief Repeatable Battery of Neuropsychological Tests and Beck Depression Inventory (BDI). The group members diagnosed with depression and cognitive dysfunction underwent group psychotherapy for 3 months. Upon completion of psychotherapy, both tests were readministered. Results Depression and cognitive dysfunction were comorbid in 15 (13.9%) of patients. Although improvement was detected at the end of the 3-month group psychotherapy intervention, it was limited to the BDI and the Paced Auditory Test. Conclusion Group psychotherapy might decrease cognitive impairment in MS patients.

Download Full-text

Evaluation of the Potential Risk Factors for Drug-Induced Anaphylaxis in Adult Patients

International Archives of Allergy and Immunology ◽

10.1159/000494130 ◽

2018 ◽

Vol 178 (2) ◽

pp. 167-176 ◽

Cited By ~ 4

Author(s):

Semra Demir ◽

Fusun Erdenen ◽

Asli Gelincik ◽

Derya Unal ◽

Muge Olgac ◽

...

Keyword(s):

Risk Factors ◽

Potential Risk ◽

Adult Patients ◽

Drug Induced ◽

Potential Risk Factors

Download Full-text

Assessment of Single-Barrel Superficial Temporal Artery-Middle Cerebral Artery Bypass in Treatment for Adult Patients with Ischemic-Type Moyamoya Disease

Medical Science Monitor ◽

10.12659/msm.910252 ◽

2018 ◽

Vol 24 ◽

pp. 7469-7474

Author(s):

Xiaoyang Tao ◽

Yin Liu ◽

Jun Chen ◽

Li Xu ◽

Zhijie Zhou ◽

...

Keyword(s):

Middle Cerebral Artery ◽

Moyamoya Disease ◽

Cerebral Artery ◽

Artery Bypass ◽

Superficial Temporal Artery ◽

Temporal Artery ◽

Adult Patients

Download Full-text

Human cerebral collateral arteriole function in subjects with normal cognition, mild cognitive impairment, and dementia

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.00206.2018 ◽

2018 ◽

Vol 315 (2) ◽

pp. H284-H290 ◽

Cited By ~ 4

Author(s):

Raymond Q. Migrino ◽

Seth Truran ◽

Nina Karamanova ◽

Geidy E. Serrano ◽

Calvin Madrigal ◽

...

Keyword(s):

Smooth Muscle ◽

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Endothelial Function ◽

Palmitic Acid ◽

Cognitive Dysfunction ◽

Collateral Circulation ◽

Dependent Function ◽

Β Amyloid ◽

Normal Cognition

Clinical and preclinical studies have suggested a link between cardiovascular disease and dementia disorders, but the role of the collateral brain circulation in cognitive dysfunction remains unknown. We aimed to test the hypothesis that leptomeningeal arteriole (LMA) function and response to metabolic stressors differ among subjects with dementia, mild cognitive impairment (MCI), and normal cognition (CN). After rapid autopsy, LMAs were isolated from subjects with CN ( n = 10), MCI ( n = 12), or dementia [ n = 42, Alzheimer’s disease (AD), vascular dementia (VaD), or other dementia], and endothelial and smooth muscle-dependent function were measured at baseline and after exposure to β-amyloid (2 μM), palmitic acid (150 μM), or medin (5 μM) and compared. There were no differences among the groups in baseline endothelial function (maximum dilation to acetylcholine, CN: 74.1 ± 9.7%, MCI: 67.1 ± 4.8%, AD: 74.7 ± 2.8%, VaD: 72.0 ± 5.3%, and other dementia: 68.0 ± 8.0%) and smooth muscle-dependent function (CN: 93.4 ± 3.0%, MCI: 83.3 ± 4.1%, AD: 91.8 ± 1.7%, VaD: 91.7 ± 2.4%, and other dementia: 87.9 ± 4.9%). There was no correlation between last cognitive function score and baseline endothelial or smooth muscle-dependent function. LMA endothelial function and, to a lesser extent, smooth muscle-dependent function were impaired posttreatment with β-amyloid, palmitic acid, and medin. Posttreatment LMA responses were not different between subjects with CN/MCI vs. dementia. Baseline responses and impaired vasoreactivity after treatment with metabolic stressors did not differ among subjects with CN, MCI, and dementia. The results suggest that the cognitive dysfunction in dementia disorders is not attributable to differences in baseline brain collateral circulation function but may be influenced by exposure of the vasculature to metabolic stressors. NEW & NOTEWORTHY Here, we present novel findings that brain collateral arteriole function did not differ among subjects with normal cognition, mild cognitive impairment, and dementia (Alzheimer’s disease and vascular dementia). Although arteriole function was impaired by vascular stressors (β-amyloid, palmitic acid, and medin), responses did not differ between those with or without dementia. The cognitive dysfunction in dementia disorders is not attributable to differences in baseline brain collateral circulation function but may be influenced by vascular exposure to metabolic stressors.

Download Full-text