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Messimeris D, Bismuth H, Provost C, Emaer C, Mélé N, Kitenge R, Arlet JB, Joseph L, Ranque B, Bartolucci P, Narme P, Calvet D. Determinants of cognitive dysfunction in adults with sickle cell-related stroke or suspected neurological morbidity. Blood Adv 2024; 8:3993-4002. [PMID: 38815229 PMCID: PMC11339041 DOI: 10.1182/bloodadvances.2023010925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 04/30/2024] [Accepted: 05/25/2024] [Indexed: 06/01/2024] Open
Abstract
ABSTRACT The prognosis of sickle cell disease (SCD) in adults is determined primarily by damage to targeted organs such as the brain. Cognitive dysfunction in SCD is a common chronic neurological manifestation, but studies remain mostly descriptive in adults. The objective of this study was to better characterize the cognitive profile and the association between cognitive dysfunction and brain lesions. We included adult patients with SCD referred for a neurological assessment. An adapted battery of neuropsychological tests was used to assess cognitive deficits. Brain or arterial abnormalities were assessed using brain magnetic resonance imaging/magnetic resonance angiography and a cervical and transcranial Doppler ultrasound. The cognitive profile of 96 patients was characterized by deficits in processing speed (58%), short-term memory (34%), and working memory (24%). Brain infarcts were found in 56% of patients and intracranial vasculopathy in 49%. Twenty percent of patients had no brain abnormalities. Processing speed dysfunction was associated with territorial infarcts (odds ratio [OR], 3.1; P = .03) and education outside of France (OR, 4.7; P = .02). Short-term memory dysfunction was associated with territorial infarcts (OR, 3.4; P = .01) and a low educational level (OR, 8.2; P = .01). Working memory dysfunction was associated with a low educational level (OR, 4.3; P = .05) and vasculopathy (OR, 3.7; P = .03). Cognitive dysfunction appears to be a hallmark sign of SCD, particularly for adults with sickle cell-related stroke or suspected neurological morbidity. Assessment of such dysfunction could be used in longitudinal follow-up and clinical trials.
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Affiliation(s)
- Despina Messimeris
- Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Paris, France
- Neurology Department, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte Anne, Université Paris Cité, Paris, France
| | - Hugo Bismuth
- Neurology Department, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte Anne, Université Paris Cité, Paris, France
| | - Corentin Provost
- Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Paris, France
- Neuroradiology Department, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte Anne, Université Paris Cité, Paris, France
| | - Clémentine Emaer
- Neurology Department, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte Anne, Université Paris Cité, Paris, France
| | - Nicolas Mélé
- Neurology Department, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte Anne, Université Paris Cité, Paris, France
| | - Robert Kitenge
- Centre de formation et d’appui sanitaire, Centre hospitalier Monkole, Kinshasa, Democratic Republic of the Congo
| | - Jean-Benoit Arlet
- Internal Medicine Department, French National Sickle Cell Referral Center, Hôpital Européen Georges Pompidou, Assistance-Publique Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Laure Joseph
- France Centre de référence des syndromes drépanocytaires majeurs, service de biothérapie, Centre d'investigation clinique, Hôpital Universitaire Necker-Enfants Malades, Université Paris Cité, Paris, France
| | - Brigitte Ranque
- Internal Medicine Department, French National Sickle Cell Referral Center, Hôpital Européen Georges Pompidou, Assistance-Publique Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Pablo Bartolucci
- Referral Center for Sickle Cell Disease and Red Blood Cell Disorders, UMGGR, Paris Est Créteil University, IMRB, INSERM U955, Créteil, France
| | - Pauline Narme
- Laboratoire Mémoire Cerveau et Cognition, UR 7536, Institut de Psychologie, Université Paris Cité, Paris, France
| | - David Calvet
- Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Paris, France
- Neurology Department, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte Anne, Université Paris Cité, Paris, France
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Garelnabi M, Parinandi NL. Role of Traditional Stroke Risk Factors Aiding in Prediction of Infarcts in Adult Patients With Sickle Cell Disease. J Am Heart Assoc 2024; 13:e034798. [PMID: 38842295 PMCID: PMC11255737 DOI: 10.1161/jaha.124.034798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Accepted: 03/12/2024] [Indexed: 06/07/2024]
Affiliation(s)
- Mahdi Garelnabi
- Department of Biomedical and Nutritional Sciences, UMass Lowell Center for Population HealthUniversity of MassachusettsLowellMAUSA
| | - Narasimham L. Parinandi
- Division of Pulmonary, Critical Care and Sleep MedicineDavis Heart and Lung Research Institute, The Ohio State University College of MedicineColumbusOHUSA
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Hakami F, Alhazmi E, Busayli WM, Althurwi S, Darraj AM, Alamir MA, Hakami A, Othman RA, Moafa AI, Mahasi HA, Madkhali MA. Overview of the Association Between the Pathophysiology, Types, and Management of Sickle Cell Disease and Stroke. Cureus 2023; 15:e50577. [PMID: 38107212 PMCID: PMC10723021 DOI: 10.7759/cureus.50577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2023] [Indexed: 12/19/2023] Open
Abstract
Sickle cell disease (SCD) is a genetic blood disorder that affects hemoglobin and increases stroke risk, particularly in childhood. This review examines the pathophysiological association between SCD and stroke, the classification of stroke types, risk factors, diagnosis, management, prevention, and prognosis. A comprehensive literature search was conducted via PubMed, Scopus, and Cochrane databases. Relevant studies on SCD and stroke pathophysiology, classification, epidemiology, diagnosis, treatment, and prevention were identified. Sickle cell disease causes red blood cells to become rigid and sickle-shaped, obstructing blood vessels. Recurrent sickling alters cerebral blood flow and damages vessel walls, often leading to ischemic or hemorrhagic strokes (HS). These occur most frequently in childhood, with ischemic strokes (IS) being more common. Key risk factors include a prior transient ischemic attack (TIA), low hemoglobin, and a high leukocyte count. Neuroimaging is essential for diagnosis and determining stroke type. Primary prevention centers on blood transfusions and hydroxyurea for those at high risk. Acute treatment involves promptly restoring blood flow and managing complications. However, significant knowledge gaps remain regarding stroke mechanisms, optimizing screening protocols, and improving long-term outcomes. This review synthesizes current evidence on SCD and stroke to highlight opportunities for further research and standardizing care protocols across institutions. Ultimately, a holistic perspective is critical for mitigating the high risk of debilitating strokes in this vulnerable patient population.
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Affiliation(s)
- Faisal Hakami
- Medicine, Faculty of Medicine, Jazan University, Jazan, SAU
| | - Essam Alhazmi
- Medicine, Faculty of Medicine, Jazan University, Jazan, SAU
| | - Wafa M Busayli
- Medicine, Faculty of Medicine, Jazan University, Jazan, SAU
| | | | | | | | - Alyaj Hakami
- Medicine, Faculty of Medicine, Jazan University, Jazan, SAU
| | - Renad A Othman
- Medicine, Faculty of Medicine, Jazan University, Jazan, SAU
| | - Amal I Moafa
- Medicine, Faculty of Medicine, Jazan University, Jazan, SAU
| | | | - Mohammed Ali Madkhali
- Internal Medicine, and Hematology and Oncology, Faculty of Medicine, Jazan University, Jazan, SAU
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Hamdule S, Kirkham FJ. Brain Volumes and Cognition in Patients with Sickle Cell Anaemia: A Systematic Review and Meta-Analysis. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1360. [PMID: 37628359 PMCID: PMC10453222 DOI: 10.3390/children10081360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/28/2023] [Accepted: 08/04/2023] [Indexed: 08/27/2023]
Abstract
Cognitive decline is a major problem in paediatric and adult patients with sickle cell anaemia (SCA) and affects the quality of life. Multiple studies investigating the association between quantitative and qualitative neuroimaging findings and cognition have had mixed results. Hence, the aetiology of cognitive decline in this population is not clearly understood. Several studies have established cerebral atrophy in SCA children as well as adults, but the relationship between cognition and brain volumes remains unclear. The purpose of this systematic review was therefore to evaluate the literature on regional brain volumes and their association with cognitive outcomes. We also meta-analysed studies which compared regional brain volumes between patients and controls. Studies report that patients with SCA tend to have lower grey matter volumes, including total subcortical volumes in childhood as compared to controls, which stabilise in young adulthood and may be subjected to decline with age in older adulthood. White matter volumes remain stable in children but are subjected to reduced volumes in young adulthood. Age and haemoglobin are better predictors of cognitive outcomes as compared to regional brain volumes.
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Affiliation(s)
- Shifa Hamdule
- Developmental Neurosciences Section, UCL Great Ormond Street Institute of Child Health, London WC1N 1EH, UK;
| | - Fenella J. Kirkham
- Developmental Neurosciences Section, UCL Great Ormond Street Institute of Child Health, London WC1N 1EH, UK;
- Clinical and Experimental Sciences, University of Southampton, Southampton SO16 6YD, UK
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Early Strokes Are Associated with More Global Cognitive Deficits in Adults with Sickle Cell Disease. J Clin Med 2023; 12:jcm12041615. [PMID: 36836150 PMCID: PMC9967394 DOI: 10.3390/jcm12041615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 02/10/2023] [Accepted: 02/13/2023] [Indexed: 02/22/2023] Open
Abstract
This study sought to link neurocognitive profiles in sickle cell disease (SCD) patients with clinical characteristics. We conducted a prospective cohort study of adults with SCD who underwent comprehensive neuropsychological assessment at the UMGGR clinic at Henri Mondor Hospital, Créteil (France). A cluster analysis was performed based on neuropsychological testing scores. The association between clusters and clinical profiles was assessed. Between 2017 and 2021, 79 patients with a mean age of 36 [range 19-65] years were included. On principal component analysis, a 5-factor model presented the best fit (Bartlett's sphericity test [χ2 (171) = 1345; p < 0.001]), explaining 72% of the variance. The factors represent distinct cognitive domains and anatomical regions. On hierarchical classification, three clusters emerged. Cluster 1 (n = 24) presented deficits in all five factors compared to Cluster 3 (n = 33). Cluster 2 (n = 22) had deficits in all factors, but to a lesser extent than Cluster 1. MoCA scores mirrored the severity of these cognitive deficits. Age, genotype and stroke prevalence did not differ significantly between clusters. However, the time of first stroke occurrence differed significantly between Cluster 1 and 2-3: 78% of strokes occurred during childhood, whereas 80% and 83% occurred during adulthood in Clusters 2 and 3, respectively. Educational attainment was also reduced in Cluster 1. SCD patients with childhood stroke seem to be at increased risk of a global cognitive deficit profile. In addition to existing methods of primary and secondary stroke prevention, early neurorehabilitation should be prioritized in order to reduce the long-term cognitive morbidity of SCD.
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