title: Executive dysfunction in adults with moyamoya disease is associated with increased diffusion in frontal white matter.
abstract: OBJECTIVE
  Alteration of the cerebrovascular reserve (CVR) in the frontal lobes has been associated with cognitive dysfunction in adults with moyamoya disease (MMD). Elevation of the apparent diffusion coefficient (ADC) in normal-appearing white matter on conventional MRI may occur as a consequence of chronic haemodynamic failure. In the present study, the authors examined the relation of ADC with CVR and cognitive dysfunction in adults with MMD.
  
  
  METHODS
  The authors measured ADC and CVR in the normal-appearing frontal white matter. CVR was calculated using dynamic susceptibility contrast-enhanced MRI and the acetazolamide challenge. A standardised and validated neuropsychological assessment test battery focusing on executive function was used.
  
  
  RESULTS
  14 patients, 9 women and 5 men (mean age 36.6±12.9 years), were included. The authors found executive dysfunction in 7 of 13 tested patients. ADC and CVR were negatively correlated (Spearman coefficient: -0.46; p=0.015). Elevation of ADC predicted executive dysfunction (area under receiver operating characteristic curve (95% CI): 0.85 (0.59 to 1.16); p=0.032).
  
  
  CONCLUSIONS
  Elevation of ADC in the normal-appearing frontal white matter of adults with MMD was associated with reduced CVR and executive dysfunction. This preliminary study suggests that measurement of ADC might be used to detect patients at risk for cerebral ischaemia and cognitive impairment.
authors.affiliation: Department of Vascular Neurology, University of Toulouse, Toulouse, France. liocalviere@free.fr
authors.forename: Lionel
authors.initials: L
authors.lastname: Calviere
authors.forename: Guillaume
authors.initials: G
authors.lastname: Ssi Yan Kai
authors.forename: Isabelle
authors.initials: I
authors.lastname: Catalaa
authors.forename: Fabienne
authors.initials: F
authors.lastname: Marlats
authors.forename: Fabrice
authors.initials: F
authors.lastname: Bonneville
authors.forename: V
authors.initials: V
authors.lastname: Larrue
mesh_terms: D000086:Acetazolamide; D000328:Adult; D003072:Cognition Disorders / Q000150:complications / Q000503:physiopathology*; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods / Q000523:psychology; D056344:Executive Function / Q000502:physiology*; D005260:Female; D005625:Frontal Lobe / Q000098:blood supply / Q000503:physiopathology*; D006801:Humans; D008297:Male; D009072:Moyamoya Disease / Q000503:physiopathology*; D009413:Nerve Fibers, Myelinated / Q000502:physiology*; D059906:Neuroimaging / Q000379:methods / Q000523:psychology*; D009483:Neuropsychological Tests / Q000706:statistics & numerical data; D055420:Perfusion Imaging / Q000379:methods / Q000523:psychology*
chemical_list: D000086:Acetazolamide