Blood Pressure, body mass index and neurocognitive outcomes: How vascular risk factors may influence neurocognitive function in children
BY: Stephanie Dephoure
Supervisor: Dr. Nomazulu Dlamini
This past summer, I had the amazing opportunity to participate in the Institute of Medical Science’s Summer Undergraduate Research Program under the supervision of Dr. Nomazulu Dlamini and the Children’s Stroke Program at SickKids Hospital. My project investigated the effects of vascular risk factors (body mass index [BMI] and blood pressure [BP]) on various neurocognitive outcomes in children with cerebral arteriopathies.
Cerebral arteriopathies present in various subtypes, such as Moyamoya disease, arterial dissection and vasculitis. These conditions impact the normal functioning or structure of cerebral arteries, placing these individuals at an increased risk for complications such as cognitive impairment or stroke1. Focal cerebral arteriopathies are the most important predictor of recurrence of stroke and are responsible for 35% of arterial ischemic stroke cases in the pediatric population2. Despite the increased risk for developing stroke, many children with arteriopathies may face challenges relating to their neurocognitive function, even in the absence of stroke.
While a number of previous studies involving children without arteriopathies have documented a correlation between increased BMI and BP and impaired neurocognitive functioning3,4,5,6 ,this had yet to be investigated in children with cerebral arteriopathies. Investigation of relationships like this one is important because it may reveal important factors that augment the poor outcomes of the disease and can negatively affect the quality of life of children and their families. Identifying these factors and the relationships surrounding them may allow healthcare providers, educators and parents to address the needs of the child more effectively. Thus, they can support optimal brain and cognitive development during impressionable childhood years.
Through analyzing neuropsychological and cardiovascular data from a retrospective set of patients, we were able to determine that factors like BMI and hypertensive BP may contribute to poor neuropsychological outcomes in this population. Particularly, aspects of cognitive function such as impaired working memory, communication abilities and perceptual reasoning correlated with increased BMI while difficulties in visual perception and self-care correlated significantly with elevated BP. The ability to adapt to changing conditions correlated with both BMI and BP.
Aside from the scientific knowledge I gained through working on this project with the team, I learned a lot about the scientific process and clinical research. While it is idealistic for research to be a linear, efficient and quick process, I learned that this is often not the case. Various set-backs such as patient recruitment, missing data and re-evaluation of certain aspects of a project can cause the project timeline to be readjusted constantly. Despite these challenges, I learned that it is important to keep the impact of the work in mind – research has a vital role in improving our healthcare system as well as the individual lives of patients and their families. Thus, while the process can seem complex at times, it is rewarding to know that one day a project I worked on may have a real impact on the lives of people, making any obstacles worth it.
- Beslow L, Jordan L. Pediatric stroke: the importance of cerebral arteriopathy and vascular malformations. Child’s Nervous System [Internet]. 2010;26(10):1263-1273. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3061823/
- Steinlin M, Bigi S, Stojanovski B, Gajera J, Regényi M, El-Koussy M et al. Focal Cerebral Arteriopathy. Stroke [Internet]. 2017;48(9):2375-2382. Available from: https://www.ahajournals.org/doi/10.1161/STROKEAHA.117.016818
- Lande M, Batisky D, Kupferman J, Samuels J, Hooper S, Falkner B et al. Neurocognitive Function in Children with Primary Hypertension after Initiation of Antihypertensive Therapy. The Journal of Pediatrics [Internet]. 2018;195:85-94.e1.
- Davis C, Cooper S. Fitness, fatness, cognition, behavior, and academic achievement among overweight children: Do cross-sectional associations correspond to exercise trial outcomes?. Preventive Medicine. 2011;52:S65-S69.
- Azurmendi A, Braza F, Sorozabal A, García A, Braza P, Carreras M et al. Cognitive abilities, androgen levels, and body mass index in 5-year-old children. Hormones and Behavior. 2005;48(2):187-195
- Staiano A, Abraham A, Calvert S. Competitive versus cooperative exergame play for African American adolescents’ executive function skills: Short-term effects in a long-term training intervention. Developmental Psychology. 2012;48(2):337-342.