目的:约30%的烟雾病(MMD)患儿的智力功能下降。记忆功能支撑着更高阶的大脑功能,但儿童MMD患者的智力功能与记忆之间的关系尚未得到很好的研究。本研究旨在探讨韦氏儿童智力量表(WISC)与本顿视力保持测验(BVRT)得分之间的相关性。可以对儿童进行的视觉记忆测试,在患有MMD的儿童中。在小儿MMD患者中,智力功能或记忆与局部脑血流量(rCBF)之间的关系也尚未得到很好的阐明。作者还研究了WISC或BVRT评分与不同大脑区域的rCBF之间的关联。
方法:在血管重建术前评估17例缺血性发作MMD患儿的WISC和BVRT评分以及rCBF。使用具有123I-碘苯丙胺的单光子发射CT来测量rCBF。采用Spearman相关系数和多元线性回归分析评价WISC与BVRT评分的关系。确定BVRT评分的截止值。计算敏感性和特异性以预测全面智商(FSIQ)>85或≤85。使用线性回归分析评估rCBF与WISC或BVRT评分之间的关联。
结果:BVRT得分与FSIQ和工作记忆指数(WMI)得分显着相关,处理速度指数,和WISC的言语理解指数(VCI)/言语智商(VIQ)。多元线性回归分析显示,BVRT的正确得分和错误得分与FSIQ相关。作为截止值,正确得分为5分和错误得分为8分,分别提供了FSIQ>85和≤85的最可靠预测因子.FSIQ与左右半球的rCBF呈正相关,左右神经节,左右丘脑,左右小脑,右大脑中动脉(MCA)区域,pons,还有Vermis.右半球WMI评分与rCBF呈正相关,右侧大脑前动脉区域,正确的MCA领土,右基底节,左右丘脑,左右小脑,pons,还有Vermis.
结论:BVRT得分与WISC指数得分有很好的相关性,提示BVRT可能有助于筛查MMD儿童的智力障碍。在MCA领土上,基底神经节,丘脑,小脑,pons,和Vermis,rCBF与WISC指数得分密切相关,提示相关脑区rCBF降低可能影响智力功能。
OBJECTIVE: Intellectual function declines in about 30% of children with moyamoya disease (MMD). Memory function underpins higher order brain function, but the relationship between intellectual function and memory in pediatric MMD patients has not been well studied. This study aimed to investigate correlations between scores on the Wechsler Intelligence Scale for Children (WISC) and the Benton Visual Retention Test (BVRT), a visual memory test that can be administered to children, in children with MMD. Relationships between intellectual function or memory and regional cerebral blood flow (rCBF) have also not been well clarified in pediatric MMD patients. The authors also investigated associations between WISC or BVRT scores and rCBF in various brain regions.
METHODS: WISC and BVRT scores and rCBF were assessed in 17 children with ischemic-onset MMD before revascularization. Single-photon emission CT with 123I-iodoamphetamine was used to measure rCBF. Relationships between WISC and BVRT scores were evaluated using Spearman\'s correlation coefficient and multivariate linear regression analysis. Cutoff values were identified for BVRT scores. Sensitivity and specificity were calculated to predict full-scale intelligence quotient (FSIQ) > 85 or ≤ 85. Associations between rCBF and WISC or BVRT scores were evaluated using linear regression analysis.
RESULTS: BVRT scores were significantly correlated with FSIQ and scores on the Working Memory Index (WMI), Processing Speed Index, and Verbal Comprehension Index (VCI)/Verbal Intelligence Quotient (VIQ) of WISC. Multivariate linear regression revealed that number correct score and number of errors score of BVRT were associated with FSIQ. As cutoff values, a number correct score of 5 and a number of errors score of 8 offered the most reliable predictors of FSIQ > 85 and ≤ 85, respectively. FSIQ correlated positively with rCBF in the right and left hemispheres, right and left ganglia, right and left thalamus, right and left cerebellum, right middle cerebral artery (MCA) territory, pons, and vermis. WMI score was positively associated with rCBF in the right hemisphere, right anterior cerebral artery territory, right MCA territory, right basal ganglia, right and left thalamus, right and left cerebellum, pons, and vermis.
CONCLUSIONS: BVRT score correlated well with WISC index scores, suggesting that BVRT may be helpful in screening for intellectual impairments in children with MMD. In the MCA territory, basal ganglia, thalamus, cerebellum, pons, and vermis, rCBF associated well with WISC index scores, suggesting that reduced rCBF in relevant brain regions may influence intellectual function.