Association between White Matter Hyperintensities Burden and Cognitive Function in Adult Asymptomatic Moyamoya Disease

Abstract

Background and Purpose: White matter hyperintensities (WMH) caused by chronic cerebral hypoperfusion are common in Moyamoya disease (MMD) patients, but WMH burden with comprehensive cognition in adult asymptomatic MMD remains unknown. This study tried to investigate the association between the WMH burden and cognitive function in adult asymptomatic MMD. Methods: Sixty-four adult asymptomatic MMD patients without surgical revascularization were enrolled in this study and underwent a 3T MRI scan and complete cognitive tests from 2021 to 2022. WMH volume was extracted with brain anatomical analysis using the diffeomorphic deformation (BAAD) toolbox, which works on SPM 12 software. Multivariable linear regression analysis was performed to assess the association between WMH burden and cognitive function in asymptomatic MMD. Results: Firstly, our data showed that lower education levels and higher WMH burden were strongly related to global cognitive impairment after adjusting for other variables. Secondly, WMH severity was significantly associated with several domains of neurocognitive function, including memory, semantic memory, and executive function. Finally, when stratified by sex, the female participants with WMH severity had lower cognitive performance in all areas than male participants. Conclusions: These results suggest that WMH burden was highly correlated with global cognition, memory, semantic memory, and executive function in asymptomatic MMD. Especially in female participants, the relationship became more evident.

Neuropsychiatric Symptoms of Moyamoya Disease: Considerations for the Clinician

“… 43 , 44 However, even in the absence of stroke, increased burden of white matter hyperintensities caused by ischemic microvascular disease has been correlated with reductions in global cognition, memory, semantic memory, and executive function – particularly in adult women with MMD. 45 , 46 Perhaps not surprisingly, then, the particular pattern of neurocognitive impairment observed in MMD is reminiscent of vascular cognitive impairment due to diffuse small vessel disease. 31 Other studies have shown a lack of association between severity of infarcts and white matter disease and cognitive impairment.…”