title: Executive function and diffusion in frontal white matter of adults with moyamoya disease.
abstract: BACKGROUND
  Cognitive impairment is a frequent complication of moyamoya disease (MMD) in adults. Chronic hypoperfusion in frontal lobes can lead to subtle brain injury, resulting in cognitive dysfunctions. Apparent diffusion coefficient (ADC) in normal-appearing white matter on conventional magnetic resonance imaging correlates with cerebral hemodynamics in the frontal lobe.
  
  
  OBJECTIVE
  The purpose of this study was to examine the relationship of ADC with executive function in patients with MMD.
  
  
  METHODS
  Thirty-one patients (25 women and 6 men; mean age, 32.6 ± 10.4 years) were included in this study. Executive function was evaluated by the Frontal Assessment Battery (FAB) at 21.5 ± 7.5 years after disease onset. ADC was measured in the normal-appearing frontal white matter.
  
  
  RESULTS
  ADC was statistically related to the occurrence of executive dysfunction in multivariate analysis (P = .0179). Total FAB score and ADC were negatively correlated (r(2) = .22; P = .0072; Spearman correlation coefficient, -.41; P = .024). Elevated ADC predicted executive dysfunction (area under the receiver operating characteristic curve, .73; 95% confidence interval, .55-.91; P = .029).
  
  
  CONCLUSIONS
  The association of ADC with executive function might suggest that ADC is useful in screening for executive dysfunction during follow-up in the outpatient setting.
authors.affiliation: Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. Electronic address: nakamizo@ns.med.kyushu-u.ac.jp.
authors.forename: Akira
authors.initials: A
authors.lastname: Nakamizo
authors.affiliation: Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Kikkawa
authors.affiliation: Department of Clinical radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors.forename: Akio
authors.initials: A
authors.lastname: Hiwatashi
authors.affiliation: Department of Neurosurgery, Saga University, Saga, Japan.
authors.forename: Toshio
authors.initials: T
authors.lastname: Matsushima
authors.affiliation: Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors.forename: Tomio
authors.initials: T
authors.lastname: Sasaki
mesh_terms: D000328:Adult; D019540:Area Under Curve; D002560:Cerebrovascular Circulation; D003072:Cognition Disorders / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology / Q000523:psychology; D038524:Diffusion Magnetic Resonance Imaging; D056344:Executive Function; D005260:Female; D005625:Frontal Lobe / Q000098:blood supply*; D006801:Humans; D016014:Linear Models; D008297:Male; D009072:Moyamoya Disease / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology; D015999:Multivariate Analysis; D009460:Neurologic Examination; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D055815:Young Adult
keywords: Moyamoya disease; diffusion magnetic resonance imaging; executive function; frontal assessment battery; revascularization