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García M, Amayra I, Pérez M, Salgueiro M, Martínez O, López-Paz JF, Allen PA. Cognition in Chiari Malformation Type I: an Update of a Systematic Review. Neuropsychol Rev 2023:10.1007/s11065-023-09622-2. [PMID: 37798373 DOI: 10.1007/s11065-023-09622-2] [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: 03/31/2023] [Accepted: 09/26/2023] [Indexed: 10/07/2023]
Abstract
Chiari malformation has been classified as a group of posterior cranial fossa disorders characterized by hindbrain herniation. Chiari malformation type I (CM-I) is the most common subtype, ranging from asymptomatic patients to those with severe disorders. Research about clinical manifestations or medical treatments is still growing, but cognitive functioning has been less explored. The aim of this systematic review is to update the literature search about cognitive deficits in CM-I patients. A literature search was performed through the following electronic databases: MEDLINE, PsychINFO, Pubmed, Cochrane Library, Scopus, and Web of Science. The date last searched was February 1, 2023. The inclusion criteria were as follows: (a) include pediatric or adult participants with a CM-I diagnosis, (b) include cognitive or neuropsychological assessment with standardized tests, (c) be published in English or Spanish, and (d) be empirical studies. Articles that did not report empirical data, textbooks and conference abstracts were excluded. After the screening, twenty-eight articles were included in this systematic review. From those, twenty-one articles were focused on adult samples and seven included pediatric patients. There is a great heterogeneity in the recruited samples, followed methodology and administered neurocognitive protocols. Cognitive functioning appears to be affected in CM-I patients, at least some aspects of attention, executive functions, visuospatial abilities, episodic memory, or processing speed. However, these results require careful interpretation due to the methodological limitations of the studies. Although it is difficult to draw a clear profile of cognitive deficits related to CM-I, the literature suggests that cognitive dysfunction may be a symptom of CM-I. This suggest that clinicians should include cognitive assessment in their diagnostic procedures used for CM-I. In summary, further research is needed to determine a well-defined cognitive profile related to CM-I, favoring a multidisciplinary approach of this disorder.
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Affiliation(s)
- Maitane García
- Department of Psychology, Faculty of Health Sciences, Neuro-E-Motion Research Team, University of Deusto, Bilbao, Spain.
| | - Imanol Amayra
- Department of Psychology, Faculty of Health Sciences, Neuro-E-Motion Research Team, University of Deusto, Bilbao, Spain
| | - Manuel Pérez
- Department of Psychology, Faculty of Health Sciences, Neuro-E-Motion Research Team, University of Deusto, Bilbao, Spain
- Faculty of Health Sciences, Isabel I University, Burgos, Spain
| | - Monika Salgueiro
- Department of Clinical and Health Psychology, and Research Methodology, Faculty of Psychology, University of the Basque Country, Donostia, Spain
| | - Oscar Martínez
- Department of Psychology, Faculty of Health Sciences, Neuro-E-Motion Research Team, University of Deusto, Bilbao, Spain
| | - Juan Francisco López-Paz
- Department of Psychology, Faculty of Health Sciences, Neuro-E-Motion Research Team, University of Deusto, Bilbao, Spain
| | - Philip A Allen
- Conquer Chiari Research Center, Department of Psychology, University of Akron, Akron, OH, USA
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Balasa A, Bala A, Olejnik A, Marchel A, Kunert P. Pain-depression relationship, quality of life and acceptance of illness among patients with Chiari malformation type I: A cross-sectional study. Medicine (Baltimore) 2023; 102:e33738. [PMID: 37335726 DOI: 10.1097/md.0000000000033738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2023] Open
Abstract
Chiari malformation type I (CM-I) is a congenital anomaly of the hindbrain. The most common symptoms include suboccipital tussive headache, dizziness and neck pain. Recently there has been growing interest in the psychological and psychiatric aspects of functioning in patients with CM-I, which have a significant effect on treatment outcomes and quality of life (QoL). The aim of the study was to assess the severity of depressive symptoms and the QoL in patients with CM-I and to identify the main factors responsible for these phenomena. A total of 178 people participated in the study and were divided into 3 groups: patients with CM-I who had undergone surgery (n = 59); patients with CM-I who had not undergone surgery (n = 63); and healthy volunteers (n = 56). Psychological evaluation included a set of questionnaires: the Beck Depression Inventory II, the World Health Organization shortened version of the WHOQOL-100 quality of life questionnaire, the Acceptance of Illness Scale and the Beliefs about Pain Control Questionnaire. Results showed that the control group participants obtained significantly better results than both groups of CM-I patients in terms of all indicators of QoL, symptoms of depression, acceptance of illness, pain level (average and present) and perceived influence of doctors regarding coping with pain. Patients with CM-I (operated and non-operated) obtained similar results in most of the questionnaires and the QoL indices correlated significantly with the majority of the analyzed variables. Moreover, CM-I patients with higher depression scores described their pain as more severe and had a stronger belief that pain levels were not influenced by them but only by doctors, or that it could be controlled randomly; they were also less willing to accept their illness. CM-I symptoms affect the mood and QoL of patients. Psychological and psychiatric care should be the golden standard in managing this clinical group.
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Affiliation(s)
- Artur Balasa
- Department of Neurosurgery, Medical University of Warsaw, Warsaw, Poland
| | | | | | - Andrzej Marchel
- Department of Neurosurgery, Medical University of Warsaw, Warsaw, Poland
| | - Przemysław Kunert
- Department of Neurosurgery, Medical University of Warsaw, Warsaw, Poland
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Yılmaz Y, Karademir M, Caygın T, Yağcıoğlu OK, Özüm Ü, Kuğu N. Executive Functions, Intellectual Capacity, and Psychiatric Disorders in Adults with Type 1 Chiari Malformation. World Neurosurg 2022; 168:e607-e612. [DOI: 10.1016/j.wneu.2022.10.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 10/17/2022] [Indexed: 11/08/2022]
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Seaman SC, Streese CD, Manzel K, Kamm J, Menezes AH, Tranel D, Dlouhy BJ. Cognitive and Psychological Functioning in Chiari Malformation Type I Before and After Surgical Decompression - A Prospective Cohort Study. Neurosurgery 2021; 89:1087-1096. [PMID: 34662899 DOI: 10.1093/neuros/nyab353] [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: 01/19/2021] [Accepted: 07/31/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Chiari Malformation Type I (CM-I) is defined as cerebellar tonsil displacement more than 5 mm below the foramen magnum. This displacement can alter cerebrospinal fluid flow at the cervicomedullary junction resulting in Valsalva-induced headaches and syringomyelia and compress the brainstem resulting in bulbar symptoms. However, little is known about cognitive and psychological changes in CM-I. OBJECTIVE To prospectively assess cognitive and psychological performance in CM-I and determine whether changes occur after surgical decompression. METHODS Blinded evaluators assessed symptomatic CM-I patients ages ≥18 with a battery of neuropsychological and psychological tests. Testing was conducted preoperatively and 6 to 18 mo postoperatively. Data were converted to Z-scores based on normative data, and t-tests were used to analyze pre-post changes. RESULTS A total of 26 patients were included, with 19 completing both pre- and post-op cognitive assessments. All patients had resolution of Valsalva-induced headaches and there was improvement in swallowing dysfunction (P < .0001), ataxia (P = .008), and sleep apnea (P = .021). Baseline performances in visual perception and construction (z = -1.11, P = .001) and visuospatial memory (z = -0.93, P = .002) were below average. Pre-post comparisons showed that CM-I patients had stable cognitive and psychological functioning after surgery, without significant changes from preoperative levels. CONCLUSION CM-I patients had below average performance in visuospatial and visuoconstructional abilities preoperatively. Prospective longitudinal data following surgery demonstrated improved neurologic status without any decline in cognition or psychological functioning. Routine pre- and postoperative formal neuropsychological assessment in CM-I patients help quantify cognitive and behavioral changes associated with surgical decompression.
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Affiliation(s)
- Scott C Seaman
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa, USA
| | - Carolina Deifelt Streese
- Department of Neurology, University of Iowa Hospitals and Clinics, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa, USA
| | - Kenneth Manzel
- Department of Neurology, University of Iowa Hospitals and Clinics, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa, USA
| | - Janina Kamm
- Department of Clinical Psychology, The Chicago School of Professional Psychology, Chicago, Illinois, USA
| | - Arnold H Menezes
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa, USA
| | - Daniel Tranel
- Department of Neurology, University of Iowa Hospitals and Clinics, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa, USA.,Iowa Neuroscience Institute, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.,Department of Psychological and Brain Sciences, University of Iowa College of Liberal Arts and Sciences, Iowa City, Iowa, USA
| | - Brian J Dlouhy
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa, USA.,Pappajohn Biomedical Institute, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.,Iowa Neuroscience Institute, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
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Houston JR, Hughes ML, Bennett IJ, Allen PA, Rogers JM, Lien MC, Stoltz H, Sakaie K, Loth F, Maleki J, Vorster SJ, Luciano MG. Evidence of Neural Microstructure Abnormalities in Type I Chiari Malformation: Associations Among Fiber Tract Integrity, Pain, and Cognitive Dysfunction. PAIN MEDICINE 2021; 21:2323-2335. [PMID: 32388548 DOI: 10.1093/pm/pnaa094] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Previous case-control investigations of type I Chiari malformation (CMI) have reported cognitive deficits and microstructural white matter abnormalities, as measured by diffusion tensor imaging (DTI). CMI is also typically associated with pain, including occipital headache, but the relationship between pain symptoms and microstructure is not known. METHODS Eighteen CMI patients and 18 adult age- and education-matched control participants underwent DTI, were tested using digit symbol coding and digit span tasks, and completed a self-report measure of chronic pain. Tissue microstructure indices were used to examine microstructural abnormalities in CMI as compared with healthy controls. Group differences in DTI parameters were then reassessed after controlling for self-reported pain. Finally, DTI parameters were correlated with performance on the digit symbol coding and digit span tasks within each group. RESULTS CMI patients exhibited greater fractional anisotropy (FA), lower radial diffusivity, and lower mean diffusivity in multiple brain regions compared with controls in diffuse white matter regions. Group differences no longer existed after controlling for self-reported pain. A significant correlation between FA and the Repeatable Battery for the Assessment of Neuropsychological Status coding performance was observed for controls but not for the CMI group. CONCLUSIONS Diffuse microstructural abnormalities appear to be a feature of CMI, manifesting predominantly as greater FA and less diffusivity on DTI sequences. These white matter changes are associated with the subjective pain experience of CMI patients and may reflect reactivity to neuroinflammatory responses. However, this hypothesis will require further deliberate testing in future studies.
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Affiliation(s)
- James R Houston
- Department of Psychology, Middle Tennessee State University, Murfreesboro, Tennessee
| | | | - Ilana J Bennett
- Department of Psychology, University of California, Riverside, California, USA
| | - Philip A Allen
- Department of Psychology, University of Akron, Akron, Ohio
| | - Jeffrey M Rogers
- Faculty of Health Sciences, University of Sydney, Sydney, Australia
| | - Mei-Ching Lien
- School of Psychological Science, Oregon State University, Corvallis, Oregon
| | - Haylie Stoltz
- Department of Psychology, Middle Tennessee State University, Murfreesboro, Tennessee
| | - Ken Sakaie
- Department of Diagnostic Radiology, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Francis Loth
- Department of Mechanical Engineering, University of Akron, Akron, Ohio
| | - Jahangir Maleki
- Center for Neuro-Restoration, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Sarel J Vorster
- Department of Neurological Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Mark G Luciano
- Department of Neurosurgery, Johns Hopkins Medical Center, Baltimore, Maryland, USA
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Bolognese PA, Brodbelt A, Bloom AB, Kula RW. Chiari I Malformation: Opinions on Diagnostic Trends and Controversies from a Panel of 63 International Experts. World Neurosurg 2019; 130:e9-e16. [PMID: 31121369 DOI: 10.1016/j.wneu.2019.05.098] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 05/10/2019] [Accepted: 05/11/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Chiari I malformation (CMI) and the topics concerning it have been the subject of numerous discussions and polarizing controversies over the course of the last 20 years. METHODS The opinions of 63 recognized international CMI experts from 4 continents, with a collective surgical experience of >15,000 CMI cases, were gathered through a detailed questionnaire. RESULTS Three facts emerged from the analysis of the results: 1) Most of the replies showed a high level of consensus on most CMI-related topics. 2) Several topics, which had been considered controversial as recently as 10 years ago, are now more widely accepted. 3) The so-called 5-mm rule was rejected by 88.5% of the CMI experts who responded to the questionnaire. CONCLUSIONS Sixty three recognized international CMI experts from 4 continents, with a collective surgical experience of >15,000 CMI cases were polled about a number of CMI topics. The results showed a high level of consensus, as well as a paradigm shift.
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Affiliation(s)
| | - Andrew Brodbelt
- The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | | | - Roger W Kula
- Chiari Neurosurgical Center, Lake Success, New York, USA
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