title: Chronic ischemia alters brain microstructural integrity and cognitive performance in adult moyamoya disease.
abstract: OBJECTIVE
  The mechanisms underlying frontal lobe dysfunction in moyamoya disease (MMD) are unknown. We aimed to determine whether chronic ischemia induces subtle microstructural brain changes in adult MMD and evaluated the association of changes with neuropsychological performance.
  
  
  METHODS
  MRI, including 3-dimensional T1-weighted imaging and diffusion tensor imaging, was performed in 23 adult patients with MMD and 23 age-matched controls and gray matter density and major diffusion tensor imaging indices were compared between them; any alterations in the patients were tested for associations with age, ischemic symptoms, hemodynamic compromise, and neuropsychological performance.
  
  
  RESULTS
  Decrease in gray matter density, associated with hemodynamic compromise (P<0.05), was observed in the posterior cingulate cortex of patients with MMD. Widespread reduction in fractional anisotropy and increases in radial diffusivity and mean diffusivity in some areas were also observed in bilateral cerebral white matter. The fractional anisotropy (r=0.54; P<0.0001) and radial diffusivity (r=-0.41; P<0.01) of white matter significantly associated with gray matter density of the cingulate cortex. The mean fractional anisotropy of the white matter tracts of the lateral prefrontal, cingulate, and inferior parietal regions were significantly associated with processing speed, executive function/attention, and working memory.
  
  
  CONCLUSIONS
  In adult MMD, there were more white matter abnormalities than gray matter changes. Disruption of white matter may play a pivotal role in the development of cognitive dysfunction.
authors.affiliation: From the Departments of Neurosurgery (K.K., H.S., M.I., N.N., K.H.), Radiobiology and Medical Engineering (K.K.T.), and Psychiatry (H.N., I.K.), Hokkaido University Graduate School of Medicine, Sapporo, Japan. kazumata@med.hokudai.ac.jp.
authors.forename: Ken
authors.initials: K
authors.lastname: Kazumata
authors.affiliation: From the Departments of Neurosurgery (K.K., H.S., M.I., N.N., K.H.), Radiobiology and Medical Engineering (K.K.T.), and Psychiatry (H.N., I.K.), Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: Khin Khin
authors.initials: KK
authors.lastname: Tha
authors.affiliation: From the Departments of Neurosurgery (K.K., H.S., M.I., N.N., K.H.), Radiobiology and Medical Engineering (K.K.T.), and Psychiatry (H.N., I.K.), Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: Hisashi
authors.initials: H
authors.lastname: Narita
authors.affiliation: From the Departments of Neurosurgery (K.K., H.S., M.I., N.N., K.H.), Radiobiology and Medical Engineering (K.K.T.), and Psychiatry (H.N., I.K.), Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: Ichiro
authors.initials: I
authors.lastname: Kusumi
authors.affiliation: From the Departments of Neurosurgery (K.K., H.S., M.I., N.N., K.H.), Radiobiology and Medical Engineering (K.K.T.), and Psychiatry (H.N., I.K.), Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: Hideo
authors.initials: H
authors.lastname: Shichinohe
authors.affiliation: From the Departments of Neurosurgery (K.K., H.S., M.I., N.N., K.H.), Radiobiology and Medical Engineering (K.K.T.), and Psychiatry (H.N., I.K.), Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: Masaki
authors.initials: M
authors.lastname: Ito
authors.affiliation: From the Departments of Neurosurgery (K.K., H.S., M.I., N.N., K.H.), Radiobiology and Medical Engineering (K.K.T.), and Psychiatry (H.N., I.K.), Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Nakayama
authors.affiliation: From the Departments of Neurosurgery (K.K., H.S., M.I., N.N., K.H.), Radiobiology and Medical Engineering (K.K.T.), and Psychiatry (H.N., I.K.), Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: Kiyohiro
authors.initials: K
authors.lastname: Houkin
mesh_terms: D000328:Adult; D001921:Brain / Q000473:pathology; D002545:Brain Ischemia / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D002908:Chronic Disease; D003072:Cognition Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D056324:Diffusion Tensor Imaging / Q000639:trends; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009072:Moyamoya Disease / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D011446:Prospective Studies; D066127:White Matter / Q000473:pathology*; D055815:Young Adult
keywords: diffusion; ischemia; magnetic resonance imaging; moyamoya disease; white matter disease