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PEDIATRICS Vol. 112 No. 2 August 2003, pp. 324-331

Transcranial Doppler Ultrasonography and Neurocognitive Functioning in Children With Sickle Cell Disease

Mary C. Kral, PhD*, Ronald T. Brown, PhD*,{ddagger}, Paul J. Nietert, PhD§, Miguel R. Abboud, MD*, Sherron M. Jackson, MD* and George W. Hynd, EdD||

* Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
{ddagger} College of Health Professions, Medical University of South Carolina, Charleston, South Carolina
§ Center for Health Care Research, Medical University of South Carolina, Charleston, South Carolina
|| Office of Research and External Affairs, University of Georgia, Athens, Georgia

Objective. We examined the relationship between cerebral blood flow velocity, measured by transcranial Doppler (TCD) ultrasonography, and neurocognitive functioning.

Methods. Participants were 60 children who had sickle cell disease (HbSS) and had no documented history of stroke. Children were classified according to Stroke Prevention Trial in Sickle Cell Anemia criteria (normal, conditional, and abnormal), and their performance was compared on measures of intellectual abilities, academic achievement, sustained attention/concentration, executive function, and parent and teacher ratings of executive function.

Results. Children with abnormal TCD values performed more poorly than children with conditional TCD values on measures of verbal intelligence and executive function. Children with conditional TCD values performed more poorly than children with normal TCD values on measures of sustained attention/concentration and executive function. TCD values also were a significant predictor of auditory working memory in exploratory analyses.

Conclusions. Our findings support the hypothesis that neurocognitive functions subserved by the frontal systems (eg, sustained attention/concentration and executive function) seem to be the most useful indices of progressive cerebrovasculopathy in children with HbSS disease.

Key Words: transcranial Doppler ultrasonography • sickle cell anemia • neurocognitive functioning • pediatric

Abbreviations: SCD, sickle cell disease • CVA, cerebrovascular accident • MRI, magnetic resonance imaging • CNS, central nervous system • TCD, transcranial Doppler • STOP, Stroke Prevention Trial in Sickle Cell Anemia • Vmean, mean velocity • WASI, Wechsler Abbreviated Scale of Intelligence • VIQ, verbal IQ • BRIEF, Behavior Rating Inventory of Executive Function • MANCOVA, multivariate analyses of covariance • ANCOVA, analyses of covariance • SD, standard deviation

Received for publication Jul 8, 2002; Accepted Dec 5, 2002.




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