Quality of life and psychological impact in adult patients with hemorrhagic moyamoya disease who received no surgical revascularization

Objectives: Surgical treatment for adult hemorrhagic moyamoya disease (MMD) remains controversial. A large proportion of Chinese adult patients with hemorrhagic MMD still choose conservative treatment. In this study, we investigated to assess psychological function and quality of life (QoL) in adult patients with hemorrhagic MMD who received no surgical revascularization.

Methods: 26 adult patients with hemorrhagic MMD who presented with only intraventricular hemorrhage (IVH), 20 patients with spontaneous IVH whose DSA results were negative and 30 healthy controls were identified and matched for age, gender, living area, etc. Psychological function and QoL were evaluated by Short Form-36 (SF-36), Symptom Check List 90 (SCL-90), Self-rating Depression Scale (SDS), Self-rating Anxiety Scale (SAS) and daily life questionnaire respectively one year after the initial stroke. Multiple logistic regression model was built up to screen out the independent risk factors related to depression and reduced QoL.

Results: Heavier social and mental burden was observed in adult patients with hemorrhagic MMD compared with the patients with spontaneous IVH. The QoL of cases was particularly reduced in the psychological domains. 19 (73%) cases developed depression, indicating the probable higher incidence of psychological disorder in Asian patients. Multiple logistic regression analysis suggested the independent risks of reduced QoL and depression involved in personality types and education background.

Conclusions: Our data revealed that poor education background or introverted personality type may be attributed to the development of depression in Chinese adult hemorrhagic MMD patients who received no surgical revascularization associated with QoL impairment. The treatment decisions for these patients should consider the possible improvement of QoL.