Improvement in cognitive function and cerebral perfusion after bur hole surgery in an adult with moyamoya disease

2011 ◽  
Vol 115 (2) ◽  
pp. 347-349 ◽  
Author(s):  
Lionel Calviere ◽  
Isabelle Catalaa ◽  
Fabienne Marlats ◽  
Anne-Christine Januel ◽  
Jacques Lagarrigue ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Cognitive Function ◽  
Mr Imaging ◽  
Cognitive Dysfunction ◽  
Moyamoya Disease ◽  
Cerebral Perfusion ◽  
Cerebral Hypoperfusion ◽  
Complete Regression ◽  
Cerebrovascular Reserve ◽  
Old West

Recent studies have suggested that cognitive impairment may be a common complication in adults with moyamoya disease (MMD). However, the mechanisms of cognitive dysfunction have not been clarified. Whether cognitive impairment may occur as a consequence of cerebral hypoperfusion and may improve after revascularization surgery has not been determined. A 39-year-old West Indian woman with subacute dysexecutive cognitive syndrome and no history of stroke was diagnosed with MMD. Magnetic resonance imaging showed an old, small cerebral infarction in the left frontal white matter and no evidence of recent cerebral ischemia. Perfusion MR imaging with acetazolamide challenge demonstrated a reduced cerebrovascular reserve in both frontal lobes. Revascularization with bur hole surgery was performed, which resulted in complete regression of initial cognitive impairment. Improvement in cognitive function correlated with the development of transdural collaterals on angiography and improvement in cerebral perfusion on MR imaging. This case suggests a relationship between cognitive dysfunction and cerebral hypoperfusion in MMD. Cognitive impairment may be potentially reversible after bur hole surgery and cerebral perfusion improvement.

scholarly journals Intradialytic Cerebral Hypoperfusion as Mechanism for Cognitive Impairment in Patients on Hemodialysis

2019 ◽  
Vol 30 (11) ◽  
pp. 2052-2058 ◽  
Author(s):  
Dawn F. Wolfgram
Keyword(s):  
Cognitive Impairment ◽  
Cerebral Perfusion ◽  
Ischemic Injury ◽  
Hemodialysis Patients ◽  
Cognitive Outcomes ◽  
Cerebral Injury ◽  
Cerebral Hypoperfusion ◽  
Increased Risk ◽  
Cerebral Ischemic Injury ◽  
Cerebral Ischemic

The high frequency of cognitive impairment in individuals on hemodialysis is well characterized. In-center hemodialysis patients are disproportionately affected by cognitive impairment compared with other dialysis populations, identifying hemodialysis itself as a possible factor. The pathophysiology of cognitive impairment has multiple components, but vascular-mediated cerebral injury appears to contribute based on studies demonstrating increased cerebral ischemic lesions and atrophy in brain imaging of patients on hemodialysis. Patients on hemodialysis may be at increased risk for cerebral ischemic injury disease due to vasculopathy associated with ESKD and from their comorbid diseases, such as hypertension and diabetes. This review focuses on the intradialytic cerebral hypoperfusion that can occur during routine hemodialysis due to the circulatory stress of hemodialysis. This includes a review of current methods used to monitor intradialytic cerebral perfusion and the structural and functional cognitive outcomes that have been associated with changes in intradialytic cerebral perfusion. Monitoring of intradialytic cerebral perfusion may become clinically relevant as nephrologists try to avoid the cognitive complications seen with hemodialysis. Identifying the appropriate methods to assess risk for cerebral ischemic injury and the relationship of intradialytic cerebral hypoperfusion to cognitive outcomes will help inform the decision to use intradialytic cerebral perfusion monitoring in the clinical setting as part of a strategy to prevent cognitive decline.

scholarly journals Study of cognitive functions in major idiopathic interstitial pneumonias

2020 ◽  
Vol 14 (1) ◽  
Author(s):  
Mohamed W. Zakaria ◽  
Reem I. El-Korashy ◽  
Mostafa O. Shaheen ◽  
Samah Selim ◽  
Kwashi J. Amum
Keyword(s):  
Cognitive Impairment ◽  
Cognitive Function ◽  
Cognitive Dysfunction ◽  
Mini Mental State Examination ◽  
Mmse Score ◽  
Control Group ◽  
Healthy Individuals ◽  
Co Morbidity ◽  
Impaired Lung Function ◽  
State Examination

Abstract Background Cognitive dysfunction in idiopathic interstitial pneumonia (IIP) is an important clinical co-morbidity that is associated with impaired lung function. The aim of the work is to assess cognitive function in major IIP and to find out the relation between cognitive dysfunction and the oxygenation parameters. Results Fifty individuals were involved in the study; 30 patients with major IIP and 20 healthy individuals. Patients with IIP had significantly lower mini mental state examination (MMSE) score compared to the control group (P < 0.001). Wechsler Deterioration Index (WDI) revealed that 33.3% (n = 10) of the patients with IIP had sure cognitive impairment and 26.6% (n = 8) had ongoing cognitive deterioration. Patients with idiopathic pulmonary fibrosis (IPF) had lower cognitive function than other IIP. Conclusion There is an impairment of cognitive function in patients with major IIP, particularly in IPF, as measured by WDI and MMSE. Further large studies are needed to assess the possible predictors of cognitive impairment and their effects on the patients’ outcome.

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

2015 ◽  
Vol 73 (2) ◽  
pp. 90-95 ◽  
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.

scholarly journals Combination of isoflurane and propofol, a means for general anesthesia in the orthopedic surgery of perioperative cerebral hypoperfusion rats to avoid cognitive impairment Anesthesia of perioperative cerebral hypoperfusion

2020 ◽  
Author(s):  
Xinyue Bu ◽  
Tang Li ◽  
Haiyun Wang ◽  
Zhengyuan Xia ◽  
Di Guo ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Cognitive Function ◽  
Er Stress ◽  
General Anesthesia ◽  
Underlying Mechanism ◽  
Cerebral Hypoperfusion ◽  
Nissl Staining ◽  
Aging Rats ◽  
Biochemical Analyses ◽  
Common Carotid Arteries

Abstract Background: Perioperative cerebral hypoperfusion often occurs. However, the underlying mechanism of cognitive impairment resulting when perioperative cerebral hypoperfusion occurs remain mostly to be determined. Anesthetic isoflurane induces neuronal injury via endoplasmic reticulum (ER) stress, whereas sub-anesthetic dose of propofol improves postoperative cognitive function. However, the effects of the combination of isoflurane plus propofol, which is a common combination of anesthesia for patient, on ER stress and the associated cognitive function remain unknown. Methods: We therefore set out to determine the effects of isoflurane plus propofol on the ER stress and cognitive function in the rats insulted by cerebral hypoperfusion. A ligation of bilateral common carotid arteries (CCA) surgery was adopted to prepare rats as cerebral hypoperfusion (CH) animal model. A second surgery, open reduction and internal fixation (ORIF), requiring general anesthesia, was operated 30 days later so that the effects of anesthetics on cognitive function of these CH rats could be assessed. The rats received isoflurane alone (1.9%), propofol alone (40 mg·kg -1 ·h -1 ) or a combination of isoflurane and propofol (1% and 20 mg·kg -1 ·h -1 or 1.4% and 10 mg·kg -1 ·h -1 ). Behavior studies (Fear Conditioning test), histological analyses (Nissl staining) and biochemical analyses (western blotting for the harvested rat brain tissues) were employed in the studies. Results: We found that the combination of 1% isoflurane plus 20 mg·kg -1 ·h -1 propol did not aggravate the cognitive impairment and the ER stress in aging rats with cerebral hypoperusion and being subjected to an ORIF surgery. Conclusions: These data suggest that ER stress contributes to the underlying mechanism of cognitive impairment and the combination of isoflurane and propofol did not aggravate the cognitive impairment and the ER stress in aging rats with cerebral hypoperfusion and being subjected to an ORIF surgery.

Correlation between cognitive impairment and cerebral hemodynamic disturbances on perfusion magnetic resonance imaging in European adults with moyamoya disease

2010 ◽  
Vol 113 (4) ◽  
pp. 753-759 ◽  
Author(s):  
Lionel Calviere ◽  
Isabelle Catalaa ◽  
Fabienne Marlats ◽  
Alain Viguier ◽  
Fabrice Bonneville ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Moyamoya Disease ◽  
Cerebral Blood Volume ◽  
Mean Transit Time ◽  
Perfusion Magnetic Resonance Imaging ◽  
Cerebrovascular Reserve ◽  
Cerebral Hemodynamic ◽  
Perfusion Mr ◽  
Perfusion Mr Imaging ◽  
Relationship Of

Object Although cognitive impairment has been reported in adults with moyamoya disease (MMD), its relationship with cerebral hemodynamic disturbances has not been investigated. The aims of the present study were to confirm the presence of dysexecutive cognitive syndrome (DCS) in adults with MMD and to explore the relationship of DCS with frontal lobe perfusion as measured by perfusion MR imaging. Methods Cerebral blood volume (CBV) ratio and mean transit time delay were measured in frontal and temporoparietal regions using the cerebellum as a reference region in 10 European adults with MMD. In addition, the authors calculated the cerebrovascular reserve (CVR) using the CBV ratio and the acetazolamide challenge. All patients underwent a standardized neuropsychological assessment test battery. The authors defined DCS as an impairment shown on 3 tests or more of executive function. Results The authors found DCS in 6 patients. The frontal CVR was lower in patients with DCS than in patients without DCS (mean ± SD: −13.5 ± 13.2% and 20.3 ± 21.3%; p = 0.019, Mann-Whitney U-test). Other parameters of frontal perfusion and temporoparietal CVR were not correlated with DCS. Conclusions The authors' findings suggest that DCS is common in European adults with MMD and may be related to frontal perfusion impairment.

scholarly journals Different aspects of cognitive function in adult patients with moyamoya disease and its clinical subtypes

2020 ◽  
Vol 5 (1) ◽  
pp. 86-96 ◽  
Author(s):  
Zhiyong Shi ◽  
Yu-Jie Wen ◽  
Zheng Huang ◽  
Le-Bao Yu ◽  
Dong Zhang
Keyword(s):  
Cognitive Impairment ◽  
Cognitive Function ◽  
Moyamoya Disease ◽  
Performance Test ◽  
Pearson Correlation ◽  
Wisconsin Card Sorting Test ◽  
Adult Patients ◽  
Healthy Controls ◽  
Function Tests ◽  
Wide Range

ObjectiveAlthough a few reports suggested that cognitive function impairment could be found in adult patients with moyamoya disease (MMD), there were still many aspects that are unclear. The aim of our study was to assess the cognitive function of adult patients with MMD and its clinical subtypes.Methods49 patients with MMD and 23 healthy controls were asked to take cognitive function tests. Cognitive function tests included IQ, prospective memory (PM), immediate memory (IM), verbal fluency (VF), visual breadth, attention, retrospective memory (RM), Stroop test, Wisconsin Card Sorting Test, Trail-Making Test Part A (TMT-A) and Continuous Performance Test (CPT). Independent t-analysis, one-way analysis of variance and Pearson correlation were used to seek for differences between subgroups and the correlation between cognitive variables.ResultsCompared with healthy controls, adult patients with MMD had a comprehensive cognitive impairment, including IQ, PM, VF, attention, RM, Stroop, CPT and TMT-A, with more serious impairment in PM and attention. PM and RM were separated, indicating that they were independent of each other. Pattern of attention was significantly different from healthy controls. Female patients were better than male patients, where significant differences in PM, IM, Stroop and WCST could be found. The haemorrhagic patients exhibited poorer in the dimension of PM and RM than the ischaemic. The headache subtype exhibited poorer than healthy controls. PM, RM, attention and executive function were moderately correlated with each other.ConclusionsAdult patients with MMD had a wide range of cognitive impairment with more serious impairment in memory and attention. Differences in cognitive function existed between the different subtypes of adult MMD.

High-field magnetic resonance imaging in patients with moyamoya disease

2001 ◽  
Vol 94 (2) ◽  
pp. 233-237 ◽  
Author(s):  
Atsuko Harada ◽  
Yukihiko Fujii ◽  
Yuichiro Yoneoka ◽  
Shigekazu Takeuchi ◽  
Ryuichi Tanaka ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Mr Imaging ◽  
Healthy Volunteers ◽  
Moyamoya Disease ◽  
Cerebral Circulation ◽  
High Field ◽  
Magnetic Resonance Images ◽  
Cerebral Hypoperfusion ◽  
Content Type ◽  
Fine Print

Object. The purpose of this study was to assess the utility of high-field magnetic resonance (MR) imaging as a quantitative tool for estimating cerebral circulation in patients with moyamoya disease. Methods. Eighteen patients with moyamoya disease who were scheduled to undergo revascularization surgery and 100 healthy volunteers were examined using T2-reversed MR imaging performed using a 3-tesla system. Ten of the 18 patients underwent a second study between 1 year and 3 years after revascularization. Magnetic resonance images obtained in the patients with moyamoya disease were statistically analyzed and compared with those obtained in healthy volunteers. The MR imaging findings were also correlated with results of single-photon emission computerized tomography and conventional cerebral angiography studies. Transverse lines in the white matter (medullary streaks) were observed in almost all persons. In healthy volunteers, the diameter sizes of the medullary streaks increased significantly with age (p < 0.001). Multiple logistic regression analysis revealed that age-adjusted medullary streak diameters were significantly larger in patients with moyamoya disease (p < 0.001). Diameter sizes also increased significantly with the increased severity of cerebral hypoperfusion (p < 0.001) and a higher angiographically determined stage of the disease (p < 0.001). Diameter sizes decreased significantly after surgery (p < 0.001). Conclusions. The increases in medullary streak diameters observed in patients with moyamoya disease appear to represent vessels dilated due to cerebral hypoperfusion. High-field T2-reversed MR imaging is useful in estimating cerebral circulation in patients with moyamoya disease.

scholarly journals Attenuating vascular stenosis-induced astrogliosis preserves white matter integrity and cognitive function

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Qian Liu ◽  
Mohammad Iqbal H. Bhuiyan ◽  
Ruijia Liu ◽  
Shanshan Song ◽  
Gulnaz Begum ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Cognitive Impairment ◽  
Cognitive Function ◽  
White Matter ◽  
Spatial Working Memory ◽  
Ex Vivo ◽  
Cerebral Hypoperfusion ◽  
Cellular Mechanisms ◽  
Bilateral Carotid

Abstract Background Chronic cerebral hypoperfusion (CCH) causes white matter damage and cognitive impairment, in which astrogliosis is the major pathology. However, underlying cellular mechanisms are not well defined. Activation of Na+/H+ exchanger-1 (NHE1) in reactive astrocytes causes astrocytic hypertrophy and swelling. In this study, we examined the role of NHE1 protein in astrogliosis, white matter demyelination, and cognitive function in a murine CCH model with bilateral carotid artery stenosis (BCAS). Methods Sham, BCAS, or BCAS mice receiving vehicle or a selective NHE1 inhibitor HOE642 were monitored for changes of the regional cerebral blood flow and behavioral performance for 28 days. Ex vivo MRI-DTI was subsequently conducted to detect brain injury and demyelination. Astrogliosis and demyelination were further examined by immunofluorescence staining. Astrocytic transcriptional profiles were analyzed with bulk RNA-sequencing and RT-qPCR. Results Chronic cerebral blood flow reduction and spatial working memory deficits were detected in the BCAS mice, along with significantly reduced mean fractional anisotropy (FA) values in the corpus callosum, external capsule, and hippocampus in MRI DTI analysis. Compared with the sham control mice, the BCAS mice displayed demyelination and axonal damage and increased GFAP+ astrocytes and Iba1+ microglia. Pharmacological inhibition of NHE1 protein with its inhibitor HOE642 prevented the BCAS-induced gliosis, damage of white matter tracts and hippocampus, and significantly improved cognitive performance. Transcriptome and immunostaining analysis further revealed that NHE1 inhibition specifically attenuated pro-inflammatory pathways and NADPH oxidase activation. Conclusion Our study demonstrates that NHE1 protein is involved in astrogliosis with pro-inflammatory transformation induced by CCH, and its blockade has potentials for reducing astrogliosis, demyelination, and cognitive impairment.

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