Proxy-reported quality of life in adolescents and adults with dyskinetic cerebral palsy is associated with executive functions and cortical thickness.

PURPOSE: Quality of life (QOL) is a key outcome for people with cerebral palsy (CP), and executive functioning is an important predictor of QOL in other health-related conditions. Little is known about this association in CP or about its neural substrate. We aim to analyze the influence of executive functioning (including cognitive flexibility) as well as that of other psychological, motor, communication and socioeconomic variables on QOL and to identify neuroanatomical areas related to QOL in adolescents and adults with CP. METHODS: Fifty subjects diagnosed with dyskinetic CP (mean age 25.96 years) were recruited. Their caregivers completed the primary caregiver proxy report version of the CP QOL-Teen questionnaire. Motor status, communication, IQ, four executive function domains, anxiety/depression and socioeconomic status were evaluated. Correlations and multiple linear regression models were used to relate CP QOL domains and total score to these variables. Thirty-six participants underwent an MRI assessment. Correlations were examined between cortical thickness and CP QOL total score and between cortical thickness and variables that might predict the CP QOL total score. RESULTS: Executive functions predict scores in four domains of CP QOL (General well-being and participation, Communication and physical health, Family health and Feelings about functioning) in the regression model. Among the cognitive domains that comprise executive function, only cognitive flexibility measured in terms of performance on the Wisconsin card sorting test (WCST) predicts the CP QOL total score. Monthly income, fine motor functioning and communication ability predict scores on the domains Access to services and Family Health, Feelings about functioning and School well-being, respectively. The clusters resulting from the correlation between cortical thickness and both CP QOL total score and WCST performance overlapped in the posterior cingulate and precuneus cortices. CONCLUSIONS: Cognitive flexibility predicts proxy report CP QOL-Teen total score in dyskinetic CP. This relationship has its anatomical correlate in the posterior cingulate and precuneus cortices.

Seasonal differences in SO2 ground-level impacts from a power plant plume on complex terrain.

The objective of this study is to describe the seasonal differences in SO2 ground-level fumigations from a power plant situated on very complex terrain in the Iberian Peninsula within the Western Mediterranean Basin (WMB). The study area extends more than 80 km around the power plant on very complex semi-arid terrain. Considering different plume-rise schemes, by experimentation and modelling this study attempts to characterise the seasonal differences in both the plume footprint 80 km around the power plant and the turbulent regime (diurnal or nocturnal) driving the main contribution to the accumulated plume footprints at different distances from the power plant within a complex terrain region. Two markedly different SO2 ground-level distributions around the power plant are presented for the typical summer and winter dispersive scenarios in the area. Simulations show that the SO2 footprint of a plume being advected more than 450 m above ground level in complex terrain is highly dependent on the prevailing meteorological conditions and on the mesoscale perturbations of the synoptic flows within the lower layers of the troposphere. The results obtained show how on complex terrain, despite seasonal meteorological differences and under stable dispersive conditions, the simulated mechanical turbulence leeward of the mountain ranges reproduces highly concentrated SO2 fumigations on the ground more than 50 km away from the power plant. Besides, under summer convective activity, plume fumigations have been successfully simulated less than 15 km from the power plant. In conclusion, this study shows how measurements from air quality networks together with information obtained from atmospheric transport and diffusion models are able to characterise different transport scenarios. This is a clear advantage for the end-users and decision-makers who manage and optimise the regional air quality networks.

Raven's Coloured Progressive Matrices as a measure of cognitive functioning in Cerebral Palsy.

BACKGROUND: Cognitive dysfunction is frequent in Cerebral Palsy (CP). CP motor impairment and associated speech deficits often hinder cognitive assessment, with the result being that not all CP studies consider cognitive dysfunction. Raven's Coloured Progressive Matrices is a simple, rapid test which can be used in persons with severe motor impairment and speech limitations. We studied whether this test can offer a reliable measure of cognitive functioning in CP. METHOD: Visuoperceptual, language, memory and frontal lobe functions were evaluated in 30 participants with severe motor impaired CP and a variety of speech difficulties. The relationship between Raven's Coloured Progressive Matrices and a variety of tests was analysed. RESULTS: Raven's Coloured Progressive Matrices performance was associated with visuoperceptual, language, visual and verbal memory but not with frontal functions. Receptive vocabulary and visuospatial measures were the best predictors of Raven's Coloured Progressive Matrices raw scores. CONCLUSIONS: Raven's Coloured Progressive Matrices is a fast, easy-to-administer test able to obtain a measure related with linguistic, visuoperceptual, and memory cognitive functioning in persons with CP despite their motor and speech disorders.

Memory performance in a sample of very low birth weight adolescents.

Prematurely born participants with very low birth weight (VLBW) are at high risk of brain injury in the perinatal period and of later cognitive impairment. Studies of long-term memory sequelae in VLBW participants are scarce and focus on verbal and visual memory assessed by standard clinical memory tests. There is even less research into everyday memory, and the results obtained are contradictory. This study explores long-term memory deficits in VLBW adolescents using 2 standard clinical memory tests and 1 everyday memory test. Results show impairment only in everyday memory. These memory deficits are not specific; they are related to an impaired general cognitive performance. Unlike birth weight, gestational age is a good predictor of intelligence.

Differential cerebral and neuropsychological consequences in dizygotic twins with prenatal alcohol exposure.

AIM: To relate structural and functional findings in one adolescent dizygotic twin pair with prenatal alcohol exposure. METHOD: Neuropsychological and volumetric magnetic resonance studies were carried out on a 13-year-old preterm dizygotic twin pair with prenatal alcohol exposure. RESULTS: Neuropsychological and brain structural findings differed between the twins. The child with the more affected phenotype had large-scale cognitive deficits and presented significant atrophy in several brain structures. Both subjects had white matter volume reductions relative to the whole cerebral volume. CONCLUSION: The neuropsychological and neuroimaging data reflect long-term consequences of prenatal alcohol exposure.

Screening hospital admissions from the emergency department for occult carbon monoxide poisoning.

Because cases of unrecognized carbon monoxide (CO) poisoning have been described among patients admitted to the hospital with other diagnoses, screening hospital admissions with carboxyhemoglobin testing has the potential for preventing morbidity among patients as well as among their cohabitants. Carboxyhemoglobin levels were obtained on 753 patients admitted to the hospital from the emergency department over a 3-month period during the winter. Patients in whom CO poisoning was diagnosed in the emergency department prior to admission were excluded. The mean carboxyhemoglobin level was 2.52% +/- 1.85%; there was no significant difference in mean carboxyhemoglobin among patients with medical, surgical, neurological, and psychiatric admission diagnoses (F = 1.17; df = 3,746; P = .32). Two patients (0.3%; 95% confidence limits, 0.04% to 1.1%) from the entire admission cohort, and one of 20 patients (5%; 95% confidence limits, 0.3% to 26.9%) admitted with seizures, had carboxyhemoglobin levels greater than 10%. The carboxyhemoglobin levels of the two patients were only marginally elevated, with levels of 10.9% and 11.3%. The cost of the carboxyhemoglobin screening program was $2.26 per patient result, or approximately $2,100 over a 3-month winter heating season. A program for screening emergency department admissions with carboxyhemoglobin testing, although feasible in terms of cost, detected few cases of unrecognized CO poisoning.