Relationship Between Kawasaki Disease Heterogeneity and Cognitive Development of Patients, Caregiver Stress

01B580AM – Kawasaki disease on the wrist and hand of a 6-year-old girl.
Study researchers sought to assess the link between Kawasaki disease and patient cognitive profiles or caregiver parenting stress.

Higher education levels of caregivers of children with Kawasaki disease (KD) are associated with lower levels of parenting stress, but most caregivers of children with KD who develop coronary artery lesions (CALs) still report increased stress compared with the general population, according to study findings published in BMJ Open. Additionally, neither intravenous immunoglobulin (IVIG) treatment nor CAL was linked to cognitive profiles of patients with KD.

This case-control study included 176 children with KD (mean age, 5.5 years) and 85 healthy participants (mean age, 6.4 years). To assess cognitive impairment, the study investigators administered the Mullen Scales of Early Learning to patients younger than 4 years old, and the Wechsler Intelligence Scale to those between 4 and 7 years old. Those who were older than 7 years old were given the Wechsler Intelligence Scale for Children-Fourth Edition.

Caregivers also completed the Parenting Stress Index (PSI)-Short Form to assess parenting function and stress associated with KD management.

Caregivers of children with KD who developed CAL had significantly greater levels of parenting stress compared with caregivers of children without CAL (P =.019). In addition, caregivers with a master’s degree or above education level had significantly less parenting stress than those with only a bachelor’s degree (P =.01) or lower (P =.021).

No differences were found between the patients and healthy controls regarding any developmental index, cognitive function, or parenting stress. There was also no association between IVIG administration or CAL and the cognitive score of patients with KD.

Limitations of the study included the small sample size as well as the case-control design, which limited the ability of the study researchers to draw causal relationships.

Likewise, while the multisystemic vasculitis and potential blood perfusion in the brain in patients with KD may increase levels of stress among parents caring for them, the study did not provide definitive conclusions on how best to manage this stress or whether this stress impacted patient outcomes.

Considering “caregivers of patients with KD who had CAL may feel stress about unpredictable sequela caused by CAL,” the investigators of this study suggested that caregivers of children with KD “may require support or help to fulfil their parenting roles.”


Wang LJ, Tsai ZY, Chang LS, Kuo HC. Cognitive development of children with Kawasaki disease and the parenting stress of their caregivers in Taiwan: a case-control study. BMJ Open. 2021;11(6):e042996. doi:10.1136/bmjopen-2020-042996