Cognitive characteristics and ischemic prognosis of quantitative white matter hyperintensities in adult moyamoya disease
Abstract Background White matter hyperintensities (WMHs) are associated with long-term stroke and cognitive decline in the elderly population but differ from the young and middle-aged populations, especially for those with moyamoya disease (MMD). The aim of this study was to modify the Fazekas grade...
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Nature Portfolio
2025-07-01
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| Series: | Communications Medicine |
| Online Access: | https://doi.org/10.1038/s43856-025-00990-9 |
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| author | Ziqi Liu Xiaokuan Hao Qi Duan Chaoran Shen Haojin Lyu Junze Zhang Jing Gu Shihao He Yanru Wang Xilong Wang Zhenyu Zhou Ning Ma Ran Duan Xinlin Zhou Xin Lou Rong Wang |
| author_facet | Ziqi Liu Xiaokuan Hao Qi Duan Chaoran Shen Haojin Lyu Junze Zhang Jing Gu Shihao He Yanru Wang Xilong Wang Zhenyu Zhou Ning Ma Ran Duan Xinlin Zhou Xin Lou Rong Wang |
| author_sort | Ziqi Liu |
| collection | DOAJ |
| description | Abstract Background White matter hyperintensities (WMHs) are associated with long-term stroke and cognitive decline in the elderly population but differ from the young and middle-aged populations, especially for those with moyamoya disease (MMD). The aim of this study was to modify the Fazekas grade and quantitatively analyze the effects of WMHs on multiple cognitive domains and 2-year clinical ischemic events in adult MMD patients. Methods Adult MMD patients and healthy controls were recruited for a comprehensive cognitive assessment. Among 151 adult MMD patients, the average age was 41.78 ± 10.59 years and the male-to-female ratio was 0.94. Adjusted quantitative whole-brain, periventricular (PVWMHs), and deep WMHs (DWMHs) were included in the proportional hazards model to explore their relationships with 2-year ischemic events. Linear regression analysis was used to evaluate the correlation between the WMH burden in different brain regions and various cognitive domains. Results MMD patients present decreases in intelligence (P = 0.000), spatial working memory (P = 0.011), verbal working memory 1 (P = 0.000) and 2 (P = 0.000), mental rotation (P = 0.008), and executive inhibition (P = 0.011). Quantitative whole-brain log10WMHs (adjusted HR = 6.757, P = 0.001) and log10PVWMHs (adjusted HR = 8.824, P = 0.000) are independently associated with future ischemic events. The area under curve (AUC) of the quantitative PVWMH for the prediction of 2-year ischemic events is 0.701, which is better than that of the Fazekas grade (AUC = 0.561) (P = 0.000). Conclusions PVWMHs have greater potential effects on verbal working memory, attention, and simple subtraction in adult MMD patients when compared with DWMHs. An increase in PVWMHs could be an indicator of future ischemic events in adults with MMD. Clinical registration Clinical registration no. ChiCTR2200058251 URL: https://www.chictr.org.cn/ . |
| format | Article |
| id | doaj-art-83dfd1099b8942b58479c63397e9e47d |
| institution | Kabale University |
| issn | 2730-664X |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Nature Portfolio |
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| series | Communications Medicine |
| spelling | doaj-art-83dfd1099b8942b58479c63397e9e47d2025-08-20T03:37:41ZengNature PortfolioCommunications Medicine2730-664X2025-07-01511910.1038/s43856-025-00990-9Cognitive characteristics and ischemic prognosis of quantitative white matter hyperintensities in adult moyamoya diseaseZiqi Liu0Xiaokuan Hao1Qi Duan2Chaoran Shen3Haojin Lyu4Junze Zhang5Jing Gu6Shihao He7Yanru Wang8Xilong Wang9Zhenyu Zhou10Ning Ma11Ran Duan12Xinlin Zhou13Xin Lou14Rong Wang15Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical UniversityDepartment of Neurosurgery, Beijing Tiantan Hospital, Capital Medical UniversityDepartment of Radiology, Chinese PLA General HospitalState Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal UniversityDepartment of Radiology, Chinese PLA General HospitalDepartment of Neurosurgery, Beijing Tiantan Hospital, Capital Medical UniversityDepartment of Neurosurgery, Beijing Tiantan Hospital, Capital Medical UniversityDepartment of Neurosurgery, Beijing Tiantan Hospital, Capital Medical UniversityDepartment of Neurosurgery, Beijing Tiantan Hospital, Capital Medical UniversityDepartment of Neurosurgery, Beijing Tiantan Hospital, Capital Medical UniversityDepartment of Neurosurgery, Beijing Tiantan Hospital, Capital Medical UniversityDepartment of Neurosurgery, Beijing Tiantan Hospital, Capital Medical UniversityDepartment of Neurosurgery, Peking University International HospitalState Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal UniversityDepartment of Radiology, Chinese PLA General HospitalDepartment of Neurosurgery, Beijing Tiantan Hospital, Capital Medical UniversityAbstract Background White matter hyperintensities (WMHs) are associated with long-term stroke and cognitive decline in the elderly population but differ from the young and middle-aged populations, especially for those with moyamoya disease (MMD). The aim of this study was to modify the Fazekas grade and quantitatively analyze the effects of WMHs on multiple cognitive domains and 2-year clinical ischemic events in adult MMD patients. Methods Adult MMD patients and healthy controls were recruited for a comprehensive cognitive assessment. Among 151 adult MMD patients, the average age was 41.78 ± 10.59 years and the male-to-female ratio was 0.94. Adjusted quantitative whole-brain, periventricular (PVWMHs), and deep WMHs (DWMHs) were included in the proportional hazards model to explore their relationships with 2-year ischemic events. Linear regression analysis was used to evaluate the correlation between the WMH burden in different brain regions and various cognitive domains. Results MMD patients present decreases in intelligence (P = 0.000), spatial working memory (P = 0.011), verbal working memory 1 (P = 0.000) and 2 (P = 0.000), mental rotation (P = 0.008), and executive inhibition (P = 0.011). Quantitative whole-brain log10WMHs (adjusted HR = 6.757, P = 0.001) and log10PVWMHs (adjusted HR = 8.824, P = 0.000) are independently associated with future ischemic events. The area under curve (AUC) of the quantitative PVWMH for the prediction of 2-year ischemic events is 0.701, which is better than that of the Fazekas grade (AUC = 0.561) (P = 0.000). Conclusions PVWMHs have greater potential effects on verbal working memory, attention, and simple subtraction in adult MMD patients when compared with DWMHs. An increase in PVWMHs could be an indicator of future ischemic events in adults with MMD. Clinical registration Clinical registration no. ChiCTR2200058251 URL: https://www.chictr.org.cn/ .https://doi.org/10.1038/s43856-025-00990-9 |
| spellingShingle | Ziqi Liu Xiaokuan Hao Qi Duan Chaoran Shen Haojin Lyu Junze Zhang Jing Gu Shihao He Yanru Wang Xilong Wang Zhenyu Zhou Ning Ma Ran Duan Xinlin Zhou Xin Lou Rong Wang Cognitive characteristics and ischemic prognosis of quantitative white matter hyperintensities in adult moyamoya disease Communications Medicine |
| title | Cognitive characteristics and ischemic prognosis of quantitative white matter hyperintensities in adult moyamoya disease |
| title_full | Cognitive characteristics and ischemic prognosis of quantitative white matter hyperintensities in adult moyamoya disease |
| title_fullStr | Cognitive characteristics and ischemic prognosis of quantitative white matter hyperintensities in adult moyamoya disease |
| title_full_unstemmed | Cognitive characteristics and ischemic prognosis of quantitative white matter hyperintensities in adult moyamoya disease |
| title_short | Cognitive characteristics and ischemic prognosis of quantitative white matter hyperintensities in adult moyamoya disease |
| title_sort | cognitive characteristics and ischemic prognosis of quantitative white matter hyperintensities in adult moyamoya disease |
| url | https://doi.org/10.1038/s43856-025-00990-9 |
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