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.

Neural responses to visual food cues: insights from functional magnetic resonance imaging.

The aim of this paper is to describe the patterns of functional magnetic resonance imaging activation produced by visual food stimuli in healthy participants, as well as in those with anorexia nervosa, bulimia nervosa, binge eating disorder and obesity. We conducted a systematic review of studies published in the last decade on normal and abnormal eating. This review suggested the existence of neural differences in response to the sight of food between healthy individuals, those with an eating disorder and obese subjects. Differences were identified in two brain circuits: (i) limbic and paralimbic areas associated with salience and reward processes and (ii) prefrontal areas supporting cognitive control processes.

Functional connectivity in obesity during reward processing.

Obesity is a health problem that has become a major focus of attention in recent years. There is growing evidence of an association between obesity and differences in reward processing. However, it is not known at present whether these differences are linked exclusively to food, or whether they can be detected in other rewarding stimuli. We compared responses to food, rewarding non-food and neutral pictures in 18 young adults with obesity and 19 normal-weight subjects using independent component analysis. Both groups modulated task-related activity in a plausible way. However, in response to both food and non-food rewarding stimuli, participants with obesity showed weaker connectivity in a network involving activation of frontal and occipital areas and deactivation of the posterior part of the default mode network. In addition, obesity was related with weaker activation of the default mode network and deactivation of frontal and occipital areas while viewing neutral stimuli. Together, our findings suggest that obesity is related to a different allocation of cognitive resources in a fronto-occipital network and in the default mode network.

[Long-term cognitive dysfunctions in preterm subjects with intraventricular haemorrhage]. / Disfunciones cognitivas a largo plazo en sujetos prematuros con hemorragia intraventricular.

INTRODUCTION: Intraventricular hemorrhage (IVH) in the neonatal period has been associated to developmental impairment or delay in preterm born children and adolescents. To our knowledge there is no study in literature which describes the effects of neonatal IVH in preterm subjects on different specific cognitive functions in adolescent samples. AIM. To explore general as well as specific cognitive performance in preterm adolescents with neonatal IVH, through a comprehensive neuropsychological assessment. SUBJECTS AND METHODS: Sixteen preterm born adolescents with IVH in the newborn period and thirty matched controls were recruited for neuropsychological testing. The intelligence quotient, learning, memory, visuospatial and visuoperceptive abilities, and frontal functions were evaluated. RESULTS: Significant differences were observed for full and performance intelligence quotient, as well as for several specific cognitive functions. After controlling for full intelligence quotient, and compared with preterm adolescents without IVH, differences remained significant for verbal learning and verbal memory. Subjects with IVH grades III-IV scored significantly lower than those with IVH grades I-II in verbal learning, everyday memory and visuoconstructive and visuospatial abilities. CONCLUSIONS: The present study suggests that long-term difficulties are evident for general cognitive performance as well as for specific cognitive abilities in preterm subjects with IVH in the newborn period. These data could explain the academic problems shown by these individuals and may suggest concrete intervention programs to minimize the effects of such deficits.

Disfunciones cognitivas a largo plazo en sujetos prematuros con hemorragia intraventricular / Long-term cognitive dysfunctions in preterm subjects with intraventricular haemorrhage

Introducción. La hemorragia intraventricular (HIV) se ha asociado a un déficit o retraso en el desarrollo cognitivo en niños y adolescentes con antecedentes de prematuridad. Sin embargo, no existe un estudio detallado sobre el rendimiento cognitivo específico de estos sujetos en la etapa adolescente. Objetivo. Explorar el rendimiento cognitivo general y específico de adolescentes que nacieron prematuros con HIV diagnosticada en el período neonatal, mediante una evaluación neuropsicológica exhaustiva que abarque diversos dominios cognitivos. Sujetos y métodos. Las funciones cognitivas de 16 sujetoscon antecedentes de prematuridad y HIV neonatal se compararon con las de 30 sujetos control. Se evaluó el cociente de inteligencia, el aprendizaje, la memoria, las habilidades visuoespaciales y visuoconstructivas, y las funciones frontales. Resultados. Se observaron diferencias significativas en el cociente de inteligencia total y manipulativo, así como en diversas variables cognitivas específicas. Tras controlar por el cociente de inteligencia total, y comparar con los prematuros sin HIV, se mantuvieron las diferencias en aprendizaje verbal y memoria verbal. Los sujetos con HIV grados III-IV rendían significativamentepeor en aprendizaje verbal, memoria de la vida cotidiana y habilidades visuoespaciales y visuoconstructivas respecto a los sujetos con HIV grados I-II. Conclusiones. Los adolescentes con antecedentes de prematuridad y HIV neonatal presentan disfunciones en el rendimiento cognitivo general, así como específico, que podrían explicar los problemas de rendimientoacadémico frecuentemente descritos en esta población

Introduction. Intraventricular hemorrhage (IVH) in the neonatal period has been associated to developmentalimpairment or delay in preterm born children and adolescents. To our knowledge there is no study in literature which describes the effects of neonatal IVH in preterm subjects on different specific cognitive functions in adolescent samples. Aim. To explore general as well as specific cognitive performance in preterm adolescents with neonatal IVH, through a comprehensive neuropsychological assessment. Subjects and methods. Sixteen preterm born adolescents with IVH in the newborn period and thirty matched controls were recruited for neuropsychological testing. The intelligence quotient, learning, memory, visuospatialand visuoperceptive abilities, and frontal functions were evaluated. Results. Significant differences were observed forfull and performance intelligence quotient, as well as for several specific cognitive functions. After controlling for full intelligence quotient, and compared with preterm adolescents without IVH, differences remained significant for verbal learning and verbal memory. Subjects with IVH grades III-IV scored significantly lower than those with IVH grades I-II inverbal learning, everyday memory and visuoconstructive and visuospatial abilities. Conclusions. The present study suggests that long-term difficulties are evident for general cognitive performance as well as for specific cognitive abilities in preterm subjects with IVH in the newborn period. These data could explain the academic problems shown by these individuals and may suggest concrete intervention programs to minimize the effects of such deficits

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.

[Long-term cognitive dysfunctions related to prematurity]. / Disfunciones cognitivas a largo plazo relacionadas con la prematuridad.

INTRODUCTION: Little is understood about the effects of prematurity on long-term cognitive functioning. No detailed studies have been carried out in a Spanish population to investigate the cognitive performance of adolescents who were born preterm. AIMS: To utilise the Wechsler intelligence scales to examine the performance of a broad sample of adolescents who were born preterm, to describe the clinical significance of this performance and to analyse the discriminatory powers of the different subtests. SUBJECTS AND METHODS: The intelligence quotients of 62 preterm subjects and 62 controls were evaluated by administering the full Wechsler intelligence scales. A number of specific neuropsychological functions were also assessed. RESULTS: Significant differences were observed in the overall, verbal and manipulative intelligence quotients, as well as in most of the subtests, although less than 30% of the preterm subjects displayed any alterations in their performance. The subtests that were most sensitive to the poor performance of the preterm subjects were vocabulary, coding and picture arrangement. The significant differences in learning, memory, cognitive flexibility and verbal fluency were not upheld on controlling for general cognitive performance. CONCLUSIONS: Adolescents with a history of prematurity as a group offer low performance on the Wechsler intelligence scale, although most of them achieve scores within the range of what can be considered to be normal. The different subtests that make up this scale do not exhibit the same degree of sensitivity when evaluating the possible difficulties preterm adolescents have in cognitive performance.

Disfunciones cognitivas a largo plazo relacionadas con la prematuridad / Long-term cognitive dysfunctions related to prematurity

Introducción. Los efectos de la prematuridad sobre el funcionamiento cognitivo a largo plazo son poco conocidos. En población española no existe un estudio detallado del rendimiento cognitivo de los adolescentes nacidos prematuros. Objetivo. Explorar el rendimiento en las escalas de inteligencia de Wechsler en una amplia muestra de adolescentes con antecedentes de prematuridad, describir la significación clínica de este rendimiento y analizar la capacidad discriminativa de los distintos subtests. Pacientes y métodos. Se evaluó el coeficiente de inteligencia de 62 sujetos pretérmino y 62 controles a través de la administración completa de las escalas de inteligencia Wechsler. Además, se evaluaron diversas funciones neuropsicológicas específicas. Resultados. Se observaron diferencias significativas en los cocientes de inteligencia total, verbal y manipulativo, así como en la mayoría de subtests, aunque menos del 30% de los sujetos prematuros presentaron un rendimiento alterado. Los subtests más sensibles al bajo rendimiento de los prematuros fueron: vocabulario, claves e historietas. Las diferencias significativas en aprendizaje, memoria, flexibilidad cognitiva y fluidez verbal, no se mantuvieron al controlar por el rendimiento cognitivo general. Conclusiones. Los adolescentes con antecedentes de prematuridad como grupo presentan un bajo rendimiento en la escala de inteligencia de Wechsler, aunque la mayoría de ellos obtienen puntuaciones dentro del intervalo de la normalidad. Los distintos subtests que componen esta escala no presentan el mismo grado de sensibilidad al evaluar las posibles dificultades de rendimiento cognitivo de los adolescentes pretérmino

Introduction. Little is understood about the effects of prematurity on long-term cognitive functioning. No detailed studies have been carried out in a Spanish population to investigate the cognitive performance of adolescents who were born preterm. Aims. To utilise the Wechsler intelligence scales to examine the performance of a broad sample of adolescents who were born preterm, to describe the clinical significance of this performance and to analyse the discriminatory powers of the different subtests. Subjects and methods. The intelligence quotients of 62 preterm subjects and 62 controls were evaluated by administering the full Wechsler intelligence scales. A number of specific neuropsychological functions were also assessed. Results. Significant differences were observed in the overall, verbal and manipulative intelligence quotients, as well as in most of the subtests, although less than 30% of the preterm subjects displayed any alterations in their performance. The subtests that were most sensitive to the poor performance of the preterm subjects were vocabulary, coding and picture arrangement. The significant differences in learning, memory, cognitive flexibility and verbal fluency were not upheld on controlling for general cognitive performance. Conclusions. Adolescents with a history of prematurity as a group offer low performance on the Wechsler intelligence scale, although most of them achieve scores within the range of what can be considered to be normal. The different subtests that make up this scale do not exhibit the same degree of sensitivity when evaluating the possible difficulties preterm adolescents have in cognitive performance

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.

Abnormal orbitofrontal development due to prematurity.

OBJECTIVE: To investigate the effects of prematurity on sulcal formation. METHODS: We evaluated the depth and volume of the primary olfactory sulcus (developed at 16 weeks' gestation) and the secondary orbital sulci (which start to develop at 28 weeks' gestation) in a sample of 22 adolescents with history of very-preterm birth (VPTB). We compared this preterm sample with a sample of subjects born at term and matched by age, gender, and sociocultural status. The Anatomist/BrainVISA 3.0.1 package was used to identify and quantify the sulci. In addition, voxel-based morphometry (VBM) was used to analyze possible reductions of gray and white matter in the orbitofrontal area. RESULTS: Compared with controls, we found a significant reduction in the secondary sulci depth but not in the primary sulcus in the VPTB. VBM analysis showed reduced gray-matter volume in VPTB in the orbital region. CONCLUSIONS: Premature birth affects cerebral gyrification, and this impairment is not reversible during childhood. Identification of the specific factors involved in abnormal brain maturation may lead to effective interventions.

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.

[A neuropsychological study of triplets with a history of prematurity]. / Estudio neuropsicologico de trillizas con antecedentes de prematuridad.

INTRODUCTION AND AIMS: Prematurity has often been associated with a general intellectual deficit and with different structural brain disorders which can be revealed by volumetric measurements performed by magnetic resonance imaging (MRI). In turn, perinatal asphyxia, even when it is not accompanied by neurological disorders, is related to a deficit in specific neuropsychological functions. CASE REPORT: This study describes the case of three 13 year old female triplets, with a history of extreme prematurity and perinatal asphyxia, the long term effects of which are evaluated in terms of cognitive performance. We studied their performance in the neuropsychological functions of intelligence, memory, and visual perceptual, visual constructive, visual spatial and frontal functions. In two of the subjects, structural MRI and volumetric analysis of the hippocampuses were performed. In all the subjects, intelligence was found to be above average, the most notable result being the superior score in case 1. Verbal learning and the long term retention of verbal material were altered in case 3, where there was also a smaller hippocampal volume. CONCLUSIONS: In the context of a multiple birth, we have seen that extreme prematurity, accompanied by non severe perinatal asphyxia without hypoxic ischemic encephalopathy, can exert very diverse effects on neurocognitive development. It can be normal, and even superior, or show a deficit in some skill. In our case, the functions that were most liable to suffer these antecedents are long term memory and verbal learning. This disorder is accompanied by bilateral involvement of the hippocampus, which can be observed using MRI.

Estudio neuropsicológico de trillizas con antecedentes de prematuridad / A neuropsychological study of triplets with a history of prematurity

Introducción y objetivos. La prematuridad se ha asociado frecuentemente a un déficit intelectivo general y a distintas alteraciones cerebrales estructurales evidenciables por volumetría mediante resonancia magnética (RM). A su vez, la asfixia perinatal, aun cuando no se acompaña de alteraciones neurológicas, está relacionada con déficit en funciones neuropsicológicas específicas. Casos clínicos. El presente trabajo describe tres hermanas gemelas, de 13 años de edad, con antecedentes de prematuridad extrema y asfixia perinatal, cuyos efectos sobre el rendimiento cognitivo a largo plazo se evalúan. Estudiamos el rendimiento en las funciones neuropsicológicas de inteligencia, memoria, funciones visuoperceptivas, visuoconstructivas y visuoespaciales y frontales. En dos de los casos se realizó una RM estructural y un análisis volumétrico de los hipocampos. En los tres casos, la inteligencia estaba por encima de la media; destaca la puntuación `superior' en el caso 1. Aparece alterado el aprendizaje verbal y la retención a largo plazo de material verbal en el caso 3, el cual muestra, además, una reducción del volumen hipocampal. Conclusiones. En el contexto de un embarazo múltiple, hemos observado que la extrema prematuridad, acompañada de asfixia perinatal no grave, sin encefalopatía hipoxicoisquémica, puede tener unos efectos muy diversos sobre el desarrollo neurocognitivo. Éste puede ser normal, e incluso superior, o mostrar un déficit en alguna habilidad. En nuestro caso, las funciones más susceptibles a estos antecedentes son la memoria a largo plazo y el aprendizaje verbales. Esta afectación se acompaña de una alteración bilateral del hipocampo, que se puede observar a través de la RM (AU)

Introduction and aims. Prematurity has often been associated with a general intellectual deficit and with different structural brain disorders which can be revealed by volumetric measurements performed by magnetic resonance imaging (MRI). In turn, perinatal asphyxia, even when it is not accompanied by neurological disorders, is related to a deficit in specific neuropsychological functions. Case report. This study describes the case of three 13-year-old female triplets, with a history of extreme prematurity and perinatal asphyxia, the long-term effects of which are evaluated in terms of cognitive performance. We studied their performance in the neuropsychological functions of intelligence, memory, and visual-perceptual, visual-constructive, visual-spatial and frontal functions. In two of the subjects, structural MRI and volumetric analysis of the hippocampuses were performed. In all the subjects, intelligence was found to be above average, the most notable result being the ‘superior’ score in case 1. Verbal learning and the long-term retention of verbal material were altered in case 3, where there was also a smaller hippocampal volume. Conclusions. In the context of a multiple birth, we have seen that extreme prematurity, accompanied by nonsevere perinatal asphyxia without hypoxic-ischemic encephalopathy, can exert very diverse effects on neurocognitive development. It can be normal, and even superior, or show a deficit in some skill. In our case, the functions that were most liable to suffer these antecedents are long-term memory and verbal learning. This disorder is accompanied by bilateral involvement of the hippocampus, which can be observed using MRI (AU)

[Evaluation of diffuse cerebral atrophy in patients with a history of traumatic brain injury and its relation to cognitive deterioration]. / Evaluación de la atrofia cerebral difusa en pacientes con antecedentes de traumatismo craneoencefálico y su relación con el deterioro cognitivo.

INTRODUCTION: Diffuse damage secondary to traumatic brain injury (TBI) can be studied through volumetric analysis of several structures that are sensible to this kind of injury, such as corpus callosum, ventricular system, hippocampus, basal ganglia and the volume of cerebrospinal fluid spaces. OBJECTIVE: Our aim is to describe how closed head injury (CHI) occurred in early years produce diffuse damage, and how this damage affects general cognitive functioning at long term. PATIENTS AND METHODS: Initially the group of subjects was composed of 27 head injured children and adolescents following paediatric moderate to severe TBI. From this initial group we selected 15 patients without focal lesion, or in case of having suffered focal lesion, this was smaller than 2,600 mm3. These subjects were assessed by means of volumetric analysis of cerebrospinal fluid spaces, corpus callosum, hippocampus and caudate nucleus, comparing the results with a matched control group. We calculated the degree of general cognitive ability of these subjects through tests of intellectual, memory, frontal lobe and motor speed functioning. RESULTS: This study demonstrates that early CHI produce a volume decrease in all measured structures. Corpus callosum atrophy is the factor that better explains general cognitive impairment. CONCLUSIONS: Diffuse damage secondary to moderate to severe peadiatric TBI has long term effects on several cerebral structures and on cognitive performance. Corpus callosum atrophy is the best predictor for general cognitive impairment, compared with other affected structures.

Evaluación de la atrofia cerebral difusa en pacientes con antecedentes de traumatismo craneoencefálico y su relación con el deterioro cognitivo / Evaluationo of diffuse cerebral atrophy in patients with a history of traumatic brain injury and its relation to cognitive deterioration

Introducción. El daño cerebral difuso (DCD) secundario al traumatismo craneoencefálico (TCE) puede estudiarse a través de la evaluación volumétrica de diversas estructuras, entre las cuales destacan el cuerpo calloso, el hipocampo y los ganglios basales. Asimismo, el volumen de líquido cefalorraquídeo es también una buena medida de pérdida de masa encefálica. Objetivo. Evaluar el DCD producido por un TCE cerrado infantil y observar los efectos que éste tiene a largo plazo sobre el rendimiento cognitivo general. Pacientes y métodos. Se partió inicialmente de una muestra de 27 pacientes con TCE cerrado infantil, moderado o grave, de la cual se seleccionaron 15 sujetos, por carecer de lesiones focales, o en su caso, que éstas fueran inferiores a 2.600 mm3. En los 15 sujetos estudiados se realizó un análisis volumétrico del líquido cefalorraquídeo, del cuerpo calloso, del hipocampo y del núcleo caudado y se comparó con un grupo control. Además, se evaluó su deterioro cognitivo general mediante test de inteligencia, de memoria, y de la evaluación de las funciones frontales y motoras. Resultados. Los resultados mostraron que los pacientes con antecedentes de traumatismo presentaban atrofia en todas las estructuras medidas y que la atrofia del cuerpo calloso fue la variable que mejor explicaba el deterioro cognitivo general. Conclusiones. El daño difuso causado por TCE moderado-grave en la infancia persiste a largo plazo y comporta déficit cognitivos; la atrofia del cuerpo calloso es la que mejor predice el deterioro cognitivo general de los afectados, con relación a otras estructuras indicadoras de DCD (AU)