Relationship Between Imaging Markers Of Cerebral Small Vessel Disease And Cognitive Function In Adult Patients With Moyamoya Disease

Background: To investigate the relationship between imaging markers of cerebral small vessel disease(CSVD)and cognitive function of adult patients with moyamoya disease(MMD).Methods: 83 adult MMD patients(ischemic 56,hemorrhagic 24,asymptomatic 3)were recruited retrospectively.All the subjects had undergone brain magnetic resonance imaging(MRI)and extensive neuropsychological assessment.The markers were rated including lacunar infarction,white matter hyperintensity(WMH),cerebral microbleeds(CMBs)and enlargement of the perivascular space(EPVS).The correlation between the markers and various domains of cognitive function were analyzed with correlation analyses.Results: Linear regression analysis showed that lacunar infarction,WMH,CMBs,and EPVS were associated with low Mo CA score,memory loss and decreased speed of information processing.Lacunar infarction was associated with decreased executive function.After adjustment for gender,age,education,Body Mass Index(BMI)and classic vascular risk factors,lacunar infarction,WMH,CMBs and EPVS were associated with lower Mo CA scores and decreased speed of information processing;lacunar infarction,WMH and EPVS were associated with memory loss and lacunar infarction was associated with decreased executive function.After incorporating the above imaging markers into the CSVD scoring system,linear regression analysis revealed a negative correlation between the CSVD total score and all MMD cognitive impairment domains(all P < 0.05).After adjusting for the same factors,the total CSVD score was still associated with low Mo CA score(β-0.387,95% CI-0.522 ～-0.252,P<0.001),poor memory(β-0.194,95% CI-0.301 ～-0.087,P = 0.001)and decreased speed of information processing(β-0.181,95% CI-0.266 ～-0.096,P < 0.001).Among different clinical types,CSVD2(n = 19,33.9%)was the most common in patients with ischemic MMD,while CSVD4(n = 9,37.5%)was the most common in hemorrhagic type.In the cognitive domain,the memory(t=3.355,p=0.002)and Mo CA(t=2.323,p=0.025)of patients with cerebral hemorrhage were worse than those of patients with ischemia.Conclusions: There is a correlation between CSVD imaging markers and cognitive decline in adult MMD patients,especially the total CSVD burden is clearly associated with low Mo CA score,decreased information processing speed and memory loss,which can be used to easily assess cognitive function status in adult MMD patients.In addition,in adult MMD patients,early intervention should be done to avoid a significant loss of their cognitive function.