Neurocognitive effects of Moyamoya disease and concomitant epilepsy

•Results of neurocognitive evaluation in Moyamoya disease revealed a prominent executive burden.•This dysexecutive pattern likely accounts for demonstrated difficulties with verbal memory.•This case links a vascular dysexecutive pattern to verbal and visual memory in Moyamoya.•The patient's seizures may contribute to his otherwise higher than expected affective symptoms. Moyamoya disease (MMD) is a rare degenerative cerebrovascular disorder that leads to recurrent strokes and cerebral hypoperfusion. Seizures are not uncommon in MMD especially following surgical treatment for the disease. Cognitive changes that are largely executive in nature have been documented following MMD and surgical treatment, although research is limited in adults. The present case report details the comprehensive neurocognitive evaluation of a patient with MMD and concomitant epilepsy. Neurocognitive findings revealed a prominent dysexecutive pattern and atypically poor performance in areas such as visual and verbal memory. The patient reported significant affective symptoms and functional decline. This case offers insight into unique neurocognitive results that may present in adult MMD cases and underscores the importance of interpreting results in the context of neurological comorbidities in this rare disease.