Executive functions and psychosocial impairment in children following arterial ischemic stroke

ABSTRACT

This study examined the executive function (EF) of children with a history of arterial ischemic stroke (AIS) and preserved intellectual abilities, with reference to age at stroke onset, lesion characteristics, language, and motor functioning. In addition, the associations between EF and emotional and behavioral functioning were investigated. A battery of standardized neuropsychological tests was administered to children with previous AIS aged 7–12 in order to assess EF, including inhibition, working memory, cognitive flexibility, and attention. Parents rated questionnaires regarding real-life emotional and behavioral functioning. Finally, clinical and neuroradiological data were also gathered. Thirty patients were enrolled. Eight children fall in the lower end of the normative range or below in more than half of the EF measures, with working memory, inhibition and cognitive flexibility equally impaired, and attention relatively better preserved. Larger lesion size and language deficits were significantly associated with higher EF impairment. Emotional and behavioral functioning was lower in children with weaker EF. Children with a history of AIS, even those with preserved intellectual functioning, have a high risk of showing poor EF, mostly regardless of clinical features or functional impairment. EF difficulties are in turn associated with emotional and behavioral problems. Therefore, a standardized evaluation of EF in this population is mandatory as part of the follow-up, in order to ensure an early intervention and prevent related difficulties.

KEYWORDS:

• Executive function
• pediatric arterial ischemic stroke
• perinatal stroke
• cognitive outcome
• arterial ischaemic stroke
• emotional functioning

Acknowledgement

We are grateful to the associations “Associazione per la Lotta all’Ictus Cerebrale (ALICe)” and “FightTheStroke” for their support to our study.

Authorship contribution statement

C. Rivella, A. Zanetti, P. Viterbori, M. Bertamino, P. Moretti: study concept and design; C. Rivella, A. Zanetti, S. Signa: acquisition of the data; C. Rivella, A. Zanetti, P. Viterbori: analysis and interpretation of data; C. Rivella, A. Zanetti, P. Viterbori, M. Bertamino, M. Severino, S. Signa: drafting the manuscript; C. Rivella, A. Zanetti, P. Viterbori, M. Bertamino, P. Moretti, L. Primavera, S. Signa, M. Severino: critical revision of the manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This study was supported by Compagnia di San Paolo [Grant ROL 20573] and the“Associazione per la Lotta all’Ictus Cerebrale” (ALICe Italia, PhD to SS). These sponsors had no involvement in any of the study steps: design, data collection, analysis, and interpretation, writing of the report and following submission.