Neurocognitive and Radiological Assessments in Adult Moyamoya Undergoing Surgery (NRAAMUS)

Neurocognitive and Radiological Assessments in Adult Patients With Moyamoya Disease Undergoing Surgical Revascularization

Adult patients with moyamoya disease (MMD) are reported to suffer from considerable impairment of executive function/attention. Although reduced cerebrovascular reserve (CVR) in frontal areas has been detected by perfusion MRI and then confirmed to be associated with executive dysfunction in adult MMD, the structural and functional changes is still unclear with progression of executive dysfunction. Furthermore, it is very important to study the association between the neurocognitive and radiological improvement after surgical revascularization, so as to help detecting cerebral regions which are involved in executive deterioration or improvement after surgery. Then the investigators can determine whether these regions can be used as indicators to decide rational therapeutic schedule and timing of adult MMD with executive dysfunction.

Thus the aim of this study is to primarily find out the neuropsychological and radiological correlates in adult MMD, and then to quantitatively evaluate the effectiveness of surgical revascularization in prevention of executive dysfunction in adult MMD.

Study Overview

• Status: Unknown
• Conditions: Moyamoya Disease
• Intervention / Treatment: Procedure: Surgical Revascularization; Other: Conservative treatment

Detailed Description

Previous studies of adult moyamoya disease (MMD) have revealed that vascular cognitive impairment (VCI) is the consequence of ischemic damage to dynamic factors such as cerebral hypoperfusion, rather than to cerebral gray matter. However, it is still unclear which regions are affected by MMD and how these regions respond to the progressive cognitive decline. In other way, the investigators need to detect spatial patterns in the brain activity of MMD in order to understand its pathophysiological nature.

Surgical revascularization has been accepted as the only effective form of treatment in preventing future ischemic episodes. However, its effectiveness in cognitive protection is still unknown. Thus, the investigators determine to quantitatively evaluate cognitive and radiological outcomes in adult MMD postoperatively and during follow-ups.

• Study Type: Interventional
• Enrollment (Anticipated): 80
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Yu Lei, MD; Phone Number: +86 021 52889999; Email: piliyouxia_lei@126.com
• Study Contact Backup: Name: Yuxiang Gu, MD,PhD; Email: guyuxiang1972@126.com

Study Locations

• China
  • Shanghai
    • Shanghai, Shanghai, China, 200040
      • Recruiting
      • Department of Neurosurgery, Huashan Hospital
      • Contact: Yu Lei, MD; Phone Number: 862152889999; Email: 709586957@qq.com
      • Contact: Jiabin Su, MD; Phone Number: +8613621652533; Email: 36931280@qq.com
      • Sub-Investigator: Jiabin Su, MD

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 80 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Right-handed Chinese people aged over 18 years
• No evidence of recent or remote infarct in the cerebral cortical, basal ganglia, brainstem or cerebellum
• No evidence of recent or remote intracerebral hemorrhage
• Diagnosis confirmed by digital subtraction angiography (DSA) according to Suzuki scale
• No surgical intervention before recruitment
• Physically capable of cognitive testing
• Geographically accessible and reliable for follow-up.

Exclusion Criteria:

• Significant neurological diseases or psychiatric disorders that could affect cognition
• Other cerebrovascular diseases (such as atherosclerosis or vasculitides) likely to cause focal cerebral ischemia
• Concomitant cerebrovascular diseases (such as aneurysms or arteriovenous malformation) that need surgical intervention
• Severe systemic diseases
• Pregnant or perinatal stage women
• Any diseases likely to death within 2 yeas
• Taking drugs such as benzodiazepine clonazepam
• Any contraindications or allergy to aspirin
• Allergy to iodine or radiographic contrast media
• Past history of surgical revascularization
• Concurrent participation in any other experimental treatment trial
• Any condition that in the surgeon's judgment suggests the patient an unsuitable surgical candidate.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Non-Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: surgical revascularization; Patients will be assigned to either surgical or conservative treatment depending on their clinical symptoms and radiological assessment.	Procedure: Surgical Revascularization; Most patients in this group will be performed combined procedures of superficial temporal to middle cerebral artery bypass (STA-MCA) and encephalo-duro-myo-synangiosis (EDMS). Patients not suitable for combined procedures will be performed EDMS.
Experimental: conservative treatment; Normal conservative treatment without surgical intervention.	Other: Conservative treatment; Patients will be medically treated with antiplatelets, antiepileptics, antihypertensives and vasodilators depending on the presentation.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Neurocognitive outcomes at 3/6/12/24-month follow-up after surgical revascularization or conservative treatment.	Measure neurocognitive outcomes with a battery of neuropsychological tests covering global cognition, executive, memory, language, and visuospatial functions. It involves the Mini-mental state examination (MMSE), the Memory and Executive Screening test (MES), the Trail Making Test (TMT), the Auditory Verbal Learning Test (AVLT), the verbal fluency test (VFT), the Rey-Osterrieth complex figure test (CFT), etc.	2 years

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
The number of participants who suffer from all stroke or death during 30 days to 24 months		24 months
The number of participants who suffer from all kinds of adverse events related to surgery.		30 days
Postoperative neurocognitive outcomes before discharge.	Measure neurocognitive outcomes about 1 week after surgery according to participants' physical condition, using the tests mentioned in the primary outcome measurement.	average of 1 week after surgery
Postoperative radiological outcomes before discharge.	Measure cerebral perfusion simultaneously with neurocognitive testing, using the single photon emission computed tomography (SPECT).	average of 1 week after surgery
The changes from baseline in modified Rankin scale (mRS) and national institutes of health stroke scale (NIHSS).		at 7 days, 30 days, 3/6/12/24 months
The changes from baseline in single photon emission computed tomography (SPECT).		2 years
The changes from baseline in blood oxygen level-dependent functional magnetic resonance imaging (BOLD fMRI) during rest.	Data analysis techniques include amplitude of frequency fluctuation (ALFF), regional homogeneity (ReHo), independent component analysis (ICA), voxel-based morphometry analysis (VBM), etc.	2 years

Collaborators and Investigators

• Sponsor: Huashan Hospital
• Investigators: Study Chair: Yuxiang Gu, MD,PhD, Department of Neurosurgery, Huashan Hospital, Fudan University

Publications and helpful links

General Publications

• Su JB, Xi SD, Zhou SY, Zhang X, Jiang SH, Xu B, Chen L, Lei Y, Gao C, Gu YX. Microstructural damage pattern of vascular cognitive impairment: a comparison between moyamoya disease and cerebrovascular atherosclerotic disease. Neural Regen Res. 2019 May;14(5):858-867. doi: 10.4103/1673-5374.249234.

Study record dates

Study Major Dates

• Study Start: March 1, 2016
• Primary Completion (Anticipated): April 1, 2018
• Study Completion (Anticipated): May 1, 2018

Study Registration Dates

• First Submitted: November 19, 2014
• First Submitted That Met QC Criteria: November 27, 2014
• First Posted (Estimate): December 2, 2014

Study Record Updates

• Last Update Posted (Actual): August 22, 2017
• Last Update Submitted That Met QC Criteria: August 21, 2017
• Last Verified: August 1, 2017

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Cardiovascular Diseases; Vascular Diseases; Cerebrovascular Disorders; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Arterial Occlusive Diseases; Carotid Artery Diseases; Cerebral Arterial Diseases; Intracranial Arterial Diseases; Moyamoya Disease
• Other Study ID Numbers: VCI2014