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White matter hyperintensities in cholinergic pathways correlates of cognitive impairment in moyamoya disease

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Abstract

Objective

To investigate the effect of cholinergic pathways damage caused by white matter hyperintensities (WMHs) on cognitive function in moyamoya disease (MMD).

Methods

We included 62 patients with MMD from a prospectively enrolled cohort. We evaluated the burden of cholinergic pathways damage caused by WMHs using the Cholinergic Pathways Hyperintensities Scale (CHIPS). Cognitive function was evaluated with the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA). Cognitive impairment was determined according to the cut-off of MMSE and education. Multivariate linear and logistic regression models were used to analyze whether CHIPS was independently associated with cognition. Receiver operating characteristic curve analysis was performed to identify the ability of CHIPS in discriminating cognitive impairment and normal cognition.

Results

CHIPS was associated with both MMSE and MoCA (β = − 0.601 and β = − 0.672, both p < 0.001). After correcting age, sex, education, volumes of limbic areas, and other factors, CHIPS remained to be independently associated with both MMSE and MoCA (β = − 0.388 and β = − 0.334, both p < 0.001). In the logistic regression, only CHIPS was associated with cognitive impairment (odds ratio = 1.431, 95% confidence interval = 1.103 to 1.856, p = 0.007). The optimal cut-off of CHIPS score was 10, yielding a sensitivity of 87.5% and a specificity of 78.3% in identifying MMD patients with cognitive impairment.

Conclusions

The damage of cholinergic pathways caused by WMHs plays an independent effect on cognition and CHIPS could be a useful method in identifying MMD patients likely to be cognitive impairment.

Clinical relevance statement

This study shows that Cholinergic Pathways Hyperintensities Scale (CHIPS) could be a simple and reliable method in identifying cognitive impairment for patients with moyamoya disease. CHIPS could be helpful in clinical practice, such as guiding treatment decisions and predicting outcome.

Key Points

• Cholinergic Pathways Hyperintensities Scale was significantly associated with cognitive screening tests in patients with moyamoya disease.

• Cholinergic Pathways Hyperintensities Scale plays an independent effect on cognitive impairment in patients with moyamoya disease.

• Cholinergic Pathways Hyperintensities Scale shows higher accuracy than education, volumes of limbic areas, and sex in identifying cognitive impairment in moyamoya disease.

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Abbreviations

CCH:

Chronic cerebral hypoperfusion

CHIPS:

Cholinergic Pathways Hyperintensities Scale

ICA:

Internal carotid arteries

MMD:

Moyamoya disease

MMSE:

Mini-Mental State Examination

MoCA:

Montreal Cognitive Assessment

mRS:

Modified Rankin Scale

ROC:

Receiver operating characteristic

WMHs:

White matter hyperintensities

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Funding

This study has received funding by the National Natural Science Foundation of China (No. 81901706, No. 82171271).

Author information

Author notes

  1. Duo Xu and Xinfeng Yu contributed equally.

Authors and Affiliations

  1. Department of Radiology, The 2nd Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China

    Duo Xu, Xinfeng Yu, Biao Jiang & Minming Zhang

  2. Department of Neurosurgery, The 2nd Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China

    Junwen Hu & Lin Wang

  3. Department of Radiology, UCSF, San Francisco, CA, USA

    Yannan Yu

Authors
  1. Duo Xu
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  2. Xinfeng Yu
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  3. Junwen Hu
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  4. Yannan Yu
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  5. Lin Wang
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  6. Biao Jiang
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  7. Minming Zhang
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Corresponding author

Correspondence to Minming Zhang.

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Guarantor

The scientific guarantor of this publication is Minming Zhang.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained. The study was approved by the Medical Ethics Committee of the Second Affiliated Hospital, Zhejiang University School of Medicine.

Study subjects or cohorts overlap

None.

Methodology

• prospective

• cross-sectional study

• performed at one institution

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Xu, D., Yu, X., Hu, J. et al. White matter hyperintensities in cholinergic pathways correlates of cognitive impairment in moyamoya disease. Eur Radiol (2023). https://doi.org/10.1007/s00330-023-10489-3

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  • DOI: https://doi.org/10.1007/s00330-023-10489-3

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