An update on the cognitive impact of clinically-used hormone therapies in the female rat: models, mazes, and mechanisms.

In women, ovarian hormone loss associated with menopause has been related to cognitive decline. Hormone therapy (HT) may ameliorate some of these changes. Understanding the cognitive impact of female steroids, including estrogens, progestogens, and androgens, is key to discovering treatments that promote brain health in women. The preclinical literature has presented elegant and methodical experiments allowing a better understanding of parameters driving the cognitive consequences of ovarian hormone loss and HT. Animal models have been a valuable tool in this regard, and will be vital to future discoveries. Here, we provide an update on the literature evaluating the impact of female steroid hormones on cognition, and the putative mechanisms mediating these effects. We focus on preclinical work that was done with an eye toward clinical realities. Parameters that govern the cognitive efficacy of HT, from what we know thus far, include but are not limited to: type, dose, duration, and route of HT, age at HT initiation, timing of HT relative to ovarian hormone loss, memory type examined, menopause history, and hormone receptor status. Researchers have identified intricate relationships between some of these factors by studying their individual effects on cognition. As of late, there is increased focus on studying interactions between these variables as well as multiple hormone types when administered concomitantly. This is key to translating preclinical data to the clinic, wherein women typically have concurrent exposure to endogenous ovarian hormones as well as exogenous combination HTs, which include both estrogens and progestins. Gains in understanding the parameters of HT effects on cognition provide exciting novel avenues that can inform clinical treatments, eventually expanding the window of opportunity to optimally enhance cognition and brain health in aging women. This article is part of a Special Issue entitled Hormone Therapy.

Maternal and neonatal risk factors for mental retardation: defining the 'at-risk' child.

OBJECTIVE: To determine how mental retardation at age seven is related to certain maternal, perinatal, and neonatal characteristics. METHOD: A sample of 35,704 children followed from the prenatal period to age 7 years in the Collaborative Perinatal Project provided data on nine maternal and pregnancy characteristics and 12 neonatal factors. RESULTS: Low socioeconomic status of the family (SES) accounted for 44-50% of mental retardation and a low level of maternal education accounted for 20%. Other prenatal factors with significantly elevated relative risks, (P < 0.05) were maternal IQ score less than 70, weight gain in pregnancy less than 10 pounds and multiple birth. Maternal anemia in pregnancy accounted for 14% of mental retardation in blacks, and, urinary tract infections accounted for 6% of mental retardation in whites. Significant elevations in relative risk were found for major genetic and post-infection syndromes, CNS malformations, cerebral palsy, seizures, abnormal movements or tone, and low birth weight. Relative risk was also significantly increased with low 1 minute APGAR, primary apnea, and head circumference and length more than 2 SD below average but only in the low SES black subgroup. CONCLUSION: Early developmental events can be ranked on the basis of the strength of their association with mental retardation and such rankings can be used as a guide for defining risk status in early infancy.

Pediatric residency as preparation for primary care practice.

OBJECTIVES: To assess the effectiveness of pediatric residency training as preparation for primary care and make recommendations for improving residency training. METHOD: Two surveys were sent to graduate of the pediatric residency at the University of Colorado from 1984 to 1991. The first survey requested information about practice patterns and ratings of preparedness in 45 areas important for primary care. The second survey requested ratings of importance for increasing training time in 25 areas judged as inadequate in the first survey. RESULTS: Of 147 surveys mailed, 103 graduates responded and rated themselves as less than adequately trained in 25 of 45 areas selected for relevance to primary care. Graduates of the primary care track rated themselves as significantly better trained than graduates of nonprimary care tracks in 10 of 45 areas; nonprimary care graduates had higher ratings in 2 of 45 areas. The second survey (completed by 70 of the 103 initial responders) indicated that the top 5 areas needing increased time in residency training were, in descending order, orthopedics, developmental and behavioral problems, learning disability, attention-deficit hyperactivity disorder, and school difficulty. Graduates of the primary care track rated themselves as adequately trained in developmental and behavioral problems and attention-deficit hyperactivity disorder, but they and nonprimary care graduates felt inadequately prepared in the other 3 areas. CONCLUSION: Implications of these results change with different content areas, suggesting the need to improve training for all residents in some areas and extending to all residents some of the curriculum already implemented in the primary care track.

Adolescent mothers and their children: changes in maternal characteristics and child developmental and behavioral outcome at school age.

This study examines stability and change in characteristics of adolescent mothers from their child's infancy to school age, describes cognitive and behavioral characteristics of their children at school age, and reports on the relationship between maternal characteristics and child behavior and development at school age. Cognitive status and childrearing attitudes were assessed in 43 adolescent mothers (mean age 16.3 years) when their children were infants (Time 1) and again when children were school age (Time 2). At school age, mothers also completed the Louisville Behavior Checklist, and children were administered the Slosson Intelligence Test and the Wide Range Achievement Test. Significant correlations were obtained between maternal measures at Time 1 and Time 2, and no significant differences were observed between mean scores at Time 1 and Time 2 on any measures. Children demonstrated average intelligence, but mean achievement was almost 1 SD below average. Significantly more children had high scores than expected on scales for hyperactivity and academic disability. Except for maternal vocabulary, maternal measures obtained at Time 1 were not directly related to children's IQ or behavior problems. Maternal vocabulary and authoritarian and hostile childrearing attitudes assessed at Time 1 contributed independently to prediction of achievement test scores in a positive direction. Mothers' vocabulary at Time 2 and high or increased hostile childrearing attitudes contributed positively to prediction of child IQ. Mothers who still had high scores in authoritarian childrearing attitudes or whose scores increased had children with lower IQs. Changes in attitudes or contemporary measures of attitudes were also related to behavior problems at school age.

PIP: This study examines the stability of childrearing attitudes of adolescent mothers during the period of their children's infancy to school age. The study provides a description of children's development and behavior at school age and assesses the relationship between maternal attitudes and cognitive intelligence and child development. The study population includes 41 adolescent mothers and their 42 first-born children who were recruited from clinics and nurseries at the University of Colorado Hospital. The follow-up group includes 43 participating and 26 nonparticipating families. Mothers were administered the Shipley Hartford Institute of Living Scale, the Parent Attitude Research Instrument, the Authoritarian Family Ideology Scale, and the Louisville Behavior Checklist. Children were administered the Slossom Intelligence Test and the Wide Range Achievement Test. Findings indicated that children aged 5-8 years had average intelligence but scored 1 standard deviation below the average. These scores were similar to scores among children of older low-income mothers. Maternal vocabulary, hostile childrearing attitudes, and controlling attitudes had significant first-order correlations with child outcome measures. Higher maternal vocabulary was associated with higher child intelligence. Predictors in the stepwise multiple regression included maternal vocabulary, authoritarian attitudes, hostile childrearing attitudes, and controlling attitudes. Higher authoritarian, controlling, and hostile attitudes in infancy predicted better achievement. At Time 2 (school age), the best maternal predictors of intelligence, but not achievement, were maternal vocabulary and education. Controlling attitudes or increases in controlling attitudes were now associated with antisocial behavior and inhibition. Children's achievement was associated with maternal characteristics at infancy only. The small sample size makes findings tentative.

Mastery motivation and temperament of 7-month-old infants.

PURPOSE: To examine relationships among infant mastery motivation, temperament, and cognition with the goal of highlighting infant behaviors to which nurses should be alert in the clinical environment to promote optimal infant development. SAMPLE: Subjects were 26 healthy, full-term infants, age 7 months, recruited from a well baby clinic. METHOD: A descriptive correlational design was used. Tools included the Bayley Scales of Infant Development, Fagan Test of Infant Intelligence, the Dimensions of Mastery Questionnaire, and the Revised Infant Temperament Questionnaire. RESULTS: Cognition was not related to either mastery motivation or temperament. Several relations between mastery motivation and temperament emerged. Infants with high mastery pleasure were rated as more cooperative and less difficult, and tended to be rated as more active and less irritable. Independent mastery, on the other hand, showed no correlation with temperament scores. Infants who were rated as high in persistence on the mastery motivation questionnaire were rated as more cooperative, more rhythmical, and less difficult on the temperament questionnaire, and they tended to be rated as more approachable and less irritable. Infants who were rated as high in competence tended to be rated as less difficult. CONCLUSIONS: While temperament and mastery motivation are related, information on mastery motivation provides additional information to the nurse that may be helpful both in planning interventions to promote infant development and in providing anticipatory guidance for parents.

Maternal characteristics of adolescent mothers and older mothers of infants.

Cognitive status and childrearing attitudes of adolescent mothers were compared with those of older women from the same socioeconomic status when their children were infants. The 106 adolescent mothers were significantly lower than the 47 older women on measures of cognitive status but significantly higher in authoritarian attitudes.

The relationship between social support and stress in adolescent mothers.

This study addressed the questions of whether younger and older adolescent mothers differ in type and amount of stress and social support and whether social support can reduce stress in this population. Research achieves were examined to identify mothers 18 years old and younger who attended a special well-baby clinic during a 1-year period when the Barth questionnaire, a measure of perceived stress, was being collected. There were 62 who had completed at least two or more questionnaires that included a measure of attitude toward the pregnancy, attitudes toward childrearing, attitudes toward the infant, and assessment of social support completed in early infancy. Of these, 47 also completed the Barth questionnaire and 48 had a measure of life event stress in the first year. Compared with senior (age 17 and 18) adolescent mothers, junior mothers (younger than age 17) had significantly more negative attitudes toward the pregnancy (p < .007), less current perceived stress after the baby was born (p < .02), and more social support (p < .002). Path analysis indicated that those who were more anxious during pregnancy got more support even after partialing out the effects of maternal age; but after birth, social support was associated with less stress. Hostile childrearing attitudes contributed to increased stress with a pattern suggesting that those with more hostile attitudes engaged in behavior that contributed directly to making their lives more stressful as well as less effective in obtaining the support they needed.

Evaluation of developmental/behavioral training in primary care.

Primary care and regular track residents in one pediatric program were compared with respect to knowledge, perceived level of competence, and attitudes relative to developmental and behavioral pediatrics from beginning to end of the residency. Measures of knowledge and self-perception of competence showed a common pattern characterized by (1) no differences between primary care and regular track residents on entry into the program, (2) significant progress in both groups over the period of the residency, (3) significantly greater progress by primary care residents. Ratings regarding relevance of developmental and behavioral issues for pediatric practice showed that ratings of relevance were significantly higher at the beginning of the residency among primary care residents and remained higher throughout.

Growth parameters and attention to faces at 4 to 6 months of age.

Duration of attention to faces and response decrement were studied in 57 full-term infants between 15.1 and 28.5 weeks of age during a health maintenance clinic visit. Six measures of growth, obtained from the medical record, included weight, length, and head circumference at birth, and weight, length, and head circumference at the time of the clinic visit. Correlation analysis revealed that longer average initial fixation time was associated with male sex, shorter birth length, and larger ponderal index. Multiple regression analysis indicated that together these three variables accounted for 17% of the variance in average initial fixation time (p less than 0.05). Length at the time of the health maintenance visit and male sex also were associated with longer average initial fixation time and, together, accounted for 13% of the variance (p less than 0.05). Response decrement was larger in children with larger head circumference at birth, in girls, and in infants with a larger ponderal index at birth. Together, these three variables accounted for 27% of the variance (p less than 0.001). Results suggest that more efficient processing of visual information may be related to neurophysiological maturity at term, and raises the possibility that neurophysiological maturity may account for a substantial portion of the correlation between attention behavior and later intelligence.

Neonatal hyperviscosity association with lower achievement and IQ scores at school age.

A longitudinal study was conducted to determine whether the early neurologic and motor impairment observed in children with neonatal polycythemia and hyperviscosity persisted into school age. Forty-nine children who had neonatal polycythemia and hyperviscosity were evaluated at a mean age of 7 years. Of these, 21 (group 1) received a partial plasma exchange transfusion, whereas 28 (group 2) received symptomatic care. Forty control children (group 3) with a normal neonatal hematocrit were also evaluated. Testing consisted of a battery of measures to evaluate IQ, achievement, neuromotor function, and gross and fine motor skills. Maternal education and IQ were also assessed to avoid potential confounding by differences in the home environment. The neonatal course of the children with polycythemia and hyperviscosity was characterized by an increased number of problems, including hypoglycemia and cyanosis. At 7 years of age, the 49 children who had hyperviscosity (groups 1 and 2) had significantly lower "spelling" and arithmetic achievement test results and gross motor skill scores. Scores for reading, visual motor integration, and neurologic signs did not differ significantly from group 3. Maternal IQ scores were similar for both groups. Left-hand preference was seen in 14% of group 1 and 2 children and 7% of group 3 children (not significant). The scores for IQ, achievement, neuromotor function, and visual motor integration were compared for the hyperviscosity group (groups 1 and 2) and the control group (group 3) by multivariate analysis of variance with sex and hyperviscous group as independent variables and maternal education and maternal IQ as covariates (P = .040).(ABSTRACT TRUNCATED AT 250 WORDS)

Fathers of infants born to adolescent mothers. A study of paternal characteristics.

Fifty-one males and 192 female subjects participated in an investigation of the characteristics of fathers of infants born to mothers aged younger than 18 years. Fathers were categorized by age: younger than 20 years v older than 20 years. Another group of older fathers paired with older women (greater than or equal to 20 years) was included for comparison. The older fathers paired with adolescent mothers were more similar to adolescent fathers than to older men paired with older women. The major differences between the adolescent partners and older partners of adolescent mothers occurred in the perception of marital conflict and ego development. The adolescent couple and the older man paired with an older woman perceived more marital conflict than did the older father and adolescent mother. Adolescent mothers paired with an older man also perceived less marital conflict than adolescent women whose partners were adolescents.

Infants of adolescent mothers. Maternal characteristics and developmental status at 1 year of age.

The Bayley Scales of Infant Development were administered at 1 year of age to 54 healthy infants of adolescent mothers. Information was obtained regarding maternal cognitive and emotional maturity, child-rearing attitudes, attitudes toward the infant, and psychosocial status at one year. The average Bayley Mental Scale score was 113, and the average Bayley Motor Scale score was 105. There was a negative correlation between the Bayley Mental Scale score and maternal age and education. Bayley Motor Scale scores were predictable from a combination of maternal authoritarian attitudes, abuse potential, and infant's birth weight. Although high authoritarian attitudes in mothers have been associated with poor cognitive development at later ages, they may represent an important strength in adolescent mothers during the first year.

Predictive value of early testing of auditory localization for language development.

This pilot study attempted to determine whether atypical localization to voice during the first year of life could be predictive of later delayed language development. 22 children who had been tested at six to nine months of age and found to have normal hearing were retrospectively divided into "atypical' and 'normal' groups. They were then evaluated for language development at four years of age. The atypical group had significantly lower scores on two of the four measures of language competence, but the results must be interpreted with caution because of the small number of children in the study.

Preschool developmental testing in prediction of school problems. Studies of 55 children in Denver.

Sixty-five children from lower income families, first evaluated with the Denver Developmental Screening Test (DDST) and the Stanford-Binet Intelligence Scale at age 4 to 6 years, were followed up 3 years later to determine how well preschool test results could predict later school problems. Eighty-eight per cent of children with Abnormal DDSTs, 66% of children with Questionable DDSTs, and 32% of children with Normal DDSTs showed later school problems. Combining DDST and IQ results did not change the total number of children who would be misclassified, but the type of misclassification changed. When developmental screening is used to identify children at risk for developing school problems, children with Questionable findings should be referred for further evaluation along with those with Abnormal findings since a high percentage of Questionables develop school problems despite adequate intelligence.