Neurology Department, Toulouse University Hospital, Toulouse, France.
ToNIC, Toulouse NeuroImaging Center, Toulouse University, Toulouse, France.
Eur Stroke J. 2024 Sep;9(3):732-742. doi: 10.1177/23969873241240829. Epub 2024 Mar 19.
In Moyamoya angiopathy (MMA), mechanisms underlying cognitive impairment remain debated. We aimed to assess the association of cognitive impairment with the degree and the topography of cerebral hypoperfusion in MMA.
A retrospective analysis of neuropsychological and perfusion MRI data from adults with MMA was performed. Ischemic and haemorrhagic lesion masks were created to account for cerebral lesions in the analysis of cerebral perfusion. Whole brain volume of hypoperfused parenchyma was outlined on perfusion maps using different Tmax thresholds from 4 to 12 s. Regional analysis produced mean Tmax values at different regions of interest. Analyses compared perfusion ratios in patients with and without cognitive impairment, with multivariable logistic regression analysis to identify predictive factors.
Cognitive impairment was found in 20/48 (41.7%) patients. Attention/processing speed and memory were equally impaired (24%) followed by executive domain (23%). After adjustment, especially for lesion volume, hypoperfused parenchyma volume outlined by Tmax > 4 s or Tmax > 5 s thresholds was an independent factor of cognitive impairment (OR for Tmax > 4 s = 1.06 [CI 95% 1.008-1.123]) as well as attention/processing speed (OR for Tmax > 4 s = 1.07 [CI 95% 1.003-1.133]) and executive domains (OR for Tmax > 5 s = 1.08 [CI 95% 1.004-1.158]). Regarding cognitive functions, patients with processing speed and flexibility impairment had higher frontal Tmax compared to other ROIs and to patients with normal test scores.
Cerebral hypoperfusion emerged as an independent factor of cognitive impairment in MMA particularly in attention/processing speed and executive domains, with a strong contribution of frontal areas.
Considering this association, revascularization surgery could improve cognitive impairment.
在烟雾病（Moyamoya angiopathy，MMA）中，认知障碍的发病机制仍存在争议。本研究旨在评估认知障碍与 MMA 患者脑灌注不足的程度和分布之间的关系。
对成人 MMA 患者的神经心理学和灌注 MRI 数据进行回顾性分析。通过创建缺血性和出血性病变掩模来分析脑灌注，以考虑脑损伤。使用 Tmax 阈值为 4-12 秒的灌注图勾画脑灌注不足的实质全脑容积。在不同感兴趣区（ROI）进行区域分析，得出 Tmax 值的平均值。比较认知障碍患者和无认知障碍患者的灌注比值，采用多变量逻辑回归分析确定预测因素。
20/48（41.7%）名患者存在认知障碍。注意力/处理速度和记忆力同样受损（24%），其次是执行功能域（23%）。经过调整，特别是考虑到病变体积后，Tmax＞4s 或 Tmax＞5s 阈值勾画的低灌注实质体积是认知障碍的独立因素（Tmax＞4s 的 OR=1.06[95%CI 1.008-1.123]），以及注意力/处理速度（Tmax＞4s 的 OR=1.07[95%CI 1.003-1.133]）和执行功能域（Tmax＞5s 的 OR=1.08[95%CI 1.004-1.158]）。对于认知功能，处理速度和灵活性受损的患者额叶 Tmax 值高于其他 ROI 和测试结果正常的患者。
脑灌注不足是 MMA 认知障碍的独立因素，尤其是在注意力/处理速度和执行功能域，额叶区域有很强的影响。
考虑到这种关联，血管重建手术可能会改善认知障碍。
