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Executive dysfunction in adults with moyamoya disease is associated with increased diffusion in frontal white matter
  1. Lionel Calviere1,
  2. Guillaume Ssi Yan Kai2,
  3. Isabelle Catalaa2,
  4. Fabienne Marlats1,
  5. Fabrice Bonneville2,
  6. V Larrue1
  1. 1Department of Vascular Neurology, University of Toulouse, France
  2. 2Department of Neuroradiology, University of Toulouse, France
  1. Correspondence to Dr Lionel Calviere, Department of Vascular Neurology, University of Toulouse, Toulouse 31059, France; liocalviere{at}


Background and purpose 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).

Conclusion 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.

  • Diffusion
  • dysexecutive syndrome
  • moyamoya disease
  • cerebrovascular disease
  • subarachnoid haemorrhage
  • stroke
  • ultrasound
  • cerebral blood flow
  • neuroradiology

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  • Competing interests None.

  • Ethics approval This study was approved by the medical institutional review board of “Centre Hospitalo-Universitaire” of Toulouse and the local ethics committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The data of the study are eventually accessible by contacting the principal author.