Attention and executive functioning profiles in children following perinatal arterial ischemic stroke

Danielle D. Bosenbark

doi:10.17918/etd-6614

Background: Despite its recognition as the most frequent form of stroke in children and being a major source of long-standing neurological sequelae, there is a dearth of research concerning the psychosocial and neuropsychological profile of perinatal arterial ischemic stroke (PAIS). Prior research has documented a high incidence of Attention Deficit Hyperactivity Disorder (ADHD)-a disorder characterized by prominent impairments in attention and executive functioning skills-among children with a history of PAIS, yet there are no prior studies comprehensively investigating this profile in these children. Moreover, medical and neurophysiological factors may contribute to outcomes in these domains are largely understudied in this population. A elevated understanding of the attention and executive functioning profile in PAIS will not only better inform clinicians of the cognitive outcomes, but may also lead to better interventions to address-or strategies for management of-the subsequent sequelae of PAIS. Objectives: The present study sought to: 1) investigate and describe the profile of attention and executive functioning in children following perinatal stroke; and 2) examine the influence of clinical and demographic factors on attention and executive functioning outcomes in children following perinatal stroke. Participants: Forty-one children aged 3-15 diagnosed with perinatal arterial ischemic stroke, recruited from the Children's Hospital of Philadelphia (CHOP) in Philadelphia, Pennsylvania. Patients were identified through the CHOP Pediatric Stroke Program's ambulatory patient care clinic and IRB-approved Stroke Registry. Method: Children underwent a single-session neuropsychological assessment focusing on attention and executive functioning domains at CHOP. Additionally, parents/legal guardians completed questionnaires regarding real-world functioning of attention and executive functioning during the visit as well, providing a functional measure of these domains. Demographic (age, sex, race, and family socioeconomic) and medical variables (lesion size, lesion location, presence of epilepsy) were collected for each participant. Results: Although intellectual performance was in the lower normative range (mean = 94.38; SD = 15.90), it was significantly lower than FSIQ in the normative sample. Additionally, measures of attention, verbal fluency, inhibitory control, flexibility/shifting, planning/organizing, and processing speed were significantly lower in children with PAIS than in the normative sample (all p<0.001); working memory was not significantly different. The presence of comorbid epilepsy, larger stroke volume, and older age at time of testing significantly influenced performance on several attention and executive functioning measures, whereas sex, stroke location (anatomical), and stroke laterality did not. Conclusions: Overall, children with PAIS evidenced significant attention and executive functioning impairment in comparison to typically developing peers in the normative population. Children with comorbid epilepsy, larger stroke volume, and/or older age were at increased risk for deficits in these cognitive domains.

Attention and executive functioning profiles in children following perinatal arterial ischemic stroke

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Attention and executive functioning profiles in children following perinatal arterial ischemic stroke

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