Does the Suzuki stage and symptom-related variables correlate with the neuropsychologic status?

Abstract

Objective: Because of repeated ischemic insults such as transient ischemic attack and/or cerebral infarction, intellectual development is impaired in a certain subgroup in pediatric age groups at the time of diagnosis. Several studies reported intellectual problems of pediatric moyamoya disease (MMD) patients. The purpose of this study was to evaluate the change of intellectual and neuropsychological profiles according to the angiographic alteration and symptom variables.Methods: During the period from 2008 to 2009, presurgical neuropsychological assessments were done on forty-six children with neuroradiologically confirmed MMD. And also, thirty-four children in non-clinical normal control group, who were participating in separate studies that were conducted at the Department of Clinical psychology. Neuropsychological assessments included the intelligence, memory, attention, and executive function. Intelligence was evaluated with the Korean Wechsler Intelligence Scale for Children-Third Edition (K-WISC-Ⅲ). Memory was evaluated with the Rey-Kim Memory Test for children, which provides general memory quotient with the results from Auditory Verbal Learning test and Complex Figure Test. Measures of Attention were obtained using Attention-Deficit Hyperactivity Disorder Diagnostic System. Executive Function was measured with Wisconsin Card Sorting Test.Results: Normal control group showed better intelligence, memory and executive function than MMD patients (p-value < 0.05). However, attention such as inattention and impulsivity are no significant differences between two groups. In regards to Intelligence, the group classification by Suzuki stage in left sided hemisphere showed relatively more group differences. According to Matsushima classification, the Moyamoya group showed significant differences in Perceptual organization and Attention & Concentration amongst FSIQ, PIQ, and composite subtests in right sided hemisphere. Suzuki stage right 2 group demonstrated significantly higher MQ than Suzuki stage right 3 and 4, while the memory quotient of the group right 3 was higher than that of group right 4 but not to the significant level. With Executive Function, Suzuki stage left 1 group demonstrated better performances than Suzuki stage left 3 group in the rates of total errors and conceptualization.Conclusion: Neuropsychological profiles showed that the classification by Suzuki stage is more sensitive to the decline of left hemisphere dominant functions and the Matsushima classification to the decline of right hemisphere dominant functions. In terms of symptom classification, the Moyamoya group with TIA maintained significantly better overall cognitive functions than the group with infarct with less attention problems.