Health Conditions in Adults With Cerebral Palsy: The Association With CP Subtype and Severity of Impairments.

Kate Himmelmann,Ulrica Jonsson,Meta N Eek,Katharina Stibrant Sunnerhagen

doi:10.3389/fneur.2021.732939

Abstract

Aim: To determine the prevalence of common health conditions in adults with cerebral palsy (CP) and to identify associations with the CP subtype or the severity of impairments.Methods: A population-based, cross-sectional study of 153 adults with CP born from 1959 to 1978 (87 males, 66 females; median age 48 years 3 months, range 37–58 years; 41% with unilateral spastic, 36% bilateral spastic, 19% dyskinetic, and 4% with ataxic CP). Data was gathered through interviews, physical assessments, and medical record reviews.Results: The most common health conditions in adults with CP were pain 65%, upper gastrointestinal disorders 33%, dysphagia 29%, epilepsy 29%, and depression 27%. Cerebral palsy subtype was significantly associated with the presence of pain (p = 0.029), gastrointestinal (p < 0.001), and respiratory disorders (p = 0.006). A more severe physical impairment was associated with a higher prevalence of gastrointestinal disorders (p < 0.001), respiratory disorders (p < 0.001), and pressure ulcers (p < 0.001). Intellectual disability was associated with a higher prevalence of gastrointestinal disorders (p < 0.001), pneumonia (p = 0.001) epilepsy (p = 0.001), and pressure ulcers (p < 0.001), but with a lower prevalence of pain (p < 0.004) and hypertension (p = 0.043).Conclusion: The prevalence of several common health conditions is related to the CP subtype and severity of impairments, indicating that CP plays a role in the development of these health conditions. Follow-up of adults with CP needs to include not only impairments, but general health as well. Increased attention directed toward signs of gastrointestinal and respiratory disorders in individuals with either dyskinetic CP, gross motor function classification system (GMFCS) levels IV–V, or intellectual disability, is recommended.

Highlights

Adults with cerebral palsy (CP) have a higher prevalence of many different health conditions, compared to the general population [1,2,3,4]
Several reports have shown that adults with CP have a higher prevalence of cardiovascular and respiratory disease, including health conditions such as heart failure, ischemic heart disease, stroke, hypertension, obesity, diabetes, and asthma, and an increased prevalence of mental health disorders such as depression and anxiety compared to the general population [1,2,3,4,5]
Pain was significantly associated with CP subtype, and was less often reported from participants with a more impaired communication or with intellectual disability (Table 2)

Summary

Introduction

Adults with cerebral palsy (CP) have a higher prevalence of many different health conditions, compared to the general population [1,2,3,4] Musculoskeletal problems such as musculoskeletal pain, contractures, and scoliosis have long been recognized as complications of CP, but recent studies have broadened the focus to include medical and mental health. CP is a condition with marked variations in symptoms and severity between individuals, ranging from independent to totally dependent in all daily activities. These individual variations are often described using classification systems such as the gross motor function classification system (GMFCS) [6] and the communication function classification system (CFCS) [7]. Intellectual disability is diagnosed based on standardized intelligence testing and evaluation of adaptive skills [9]

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