Adverse Cognitive Outcomes Research Articles

Systematic review of child maltreatment screening tools used by different occupational groups: a study protocol

BackgroundChild maltreatment (CM) encompasses physical, emotional or sexual abuse, physical or emotional/psychological neglect or intimate partner (or domestic) violence and is associated with adverse cognitive, behavioural, physical and social outcomes...

Systematic review of variables that moderate and/or mediate the relationship between child maltreatment and adverse outcomes: a study protocol

IntroductionChild maltreatment (CM) is associated with adverse cognitive, behavioural, physical and social outcomes that often continue until adulthood. Systematic reviews on mediators and moderators of this relationship mostly investigate childhood...

Maternal fluoxetine impairs synaptic transmission and plasticity in the medial prefrontal cortex and alters the structure and function of dorsal raphe nucleus neurons in offspring mice

Selective serotonin (5-HT) reuptake inhibitors (SSRIs) are commonly prescribed to women during pregnancy and breastfeeding despite posing a risk of adverse cognitive outcomes and affective disorders for the child. The consequences of SSRI-induced excess of 5-HT during development for the brain neuromodulatory 5-HT system remain largely unexplored. In this study, an SSRI - fluoxetine (FLX) - was administered to C57BL/6 J mouse dams during pregnancy and lactation to assess its effects on the offspring. We found that maternal FLX decreased field potentials, impaired long-term potentiation, facilitated long-term depression and tended to increase the density of 5-HTergic fibers in the medial prefrontal cortex (mPFC) of female but not male adolescent offspring. These effects were accompanied by deteriorated performance in the temporal order memory task and reduced sucrose preference with no change in marble burying behavior in FLX-exposed female offspring. We also found that maternal FLX reduced the axodendritic tree complexity of 5-HT dorsal raphe nucleus (DRN) neurons in female but not male offspring, with no changes in the excitability of DRN neurons of either sex. While no effects of maternal FLX on inhibitory postsynaptic currents (sIPSCs) in DRN neurons were found, we observed a significant influence of FLX exposure on kinetics of spontaneous excitatory postsynaptic currents (sEPSCs) in DRN neurons. Finally, we report that no changes in field potentials and synaptic plasticity were evident in the mPFC of the offspring after maternal exposure during pregnancy and lactation to a new antidepressant, vortioxetine. These findings show that in contrast to the mPFC, long-term consequences of maternal FLX exposure on the structure and function of DRN 5-HT neurons are mild and suggest a sex-dependent, distinct sensitivity of cortical and brainstem neurons to FLX exposure in early life. Vortioxetine appears to exert fewer side effects with regards to the mPFC when compared with FLX.

Electroencephalographic Measures of Delirium in the Perioperative Setting: A Systematic Review.

Postoperative delirium (POD) is frequent in older adults and is associated with adverse cognitive and functional outcomes. In the last several decades, there has been an increased interest in exploring tools that easily allow the early recognition of patients at risk of developing POD. The electroencephalogram (EEG) is a widely available tool used to understand delirium pathophysiology, and its use in the perioperative setting has grown exponentially, particularly to predict and detect POD. We performed a systematic review to investigate the use of EEG in the pre-, intra-, and postoperative settings. We identified 371 studies, and 56 met the inclusion criteria. A range of techniques was used to obtain EEG data, from limited 1-4 channel setups to complex 256-channel systems. Power spectra were often measured preoperatively, yet the outcomes were inconsistent. During surgery, the emphasis was primarily on burst suppression (BS) metrics and power spectra, with a link between the frequency and timing of BS, and POD. The EEG patterns observed in POD aligned with those noted in delirium in different contexts, suggesting a reduction in EEG activity. Further research is required to investigate preoperative EEG indicators that may predict susceptibility to delirium.

Particulate Matter Exposure and Default Mode Network Equilibrium During Early Adolescence.

Background: Air pollution exposure has been associated with adverse cognitive and mental health outcomes in children, adolescents, and adults, although youth may be particularly susceptible given ongoing brain development. However, the neurodevelopmental mechanisms underlying the associations among air pollution, cognition, and mental health remain unclear. We examined the impact of particulate matter (PM2.5) on resting-state functional connectivity (rsFC) of the default mode network (DMN) and three key attention networks: dorsal attention, ventral attention, and cingulo-opercular. Methods: Longitudinal changes in rsFC within/between networks were assessed from baseline (9-10 years) to the 2-year follow-up (11-12 years) in 10,072 youth (M ± SD = 9.93 + 0.63 years; 49% female) from the Adolescent Brain Cognitive Development (ABCD®) study. Annual ambient PM2.5 concentrations from the 2016 calendar year were estimated using hybrid ensemble spatiotemporal models. RsFC was estimated using functional neuroimaging. Linear mixed models were used to test associations between PM2.5 and change in rsFC over time while adjusting for relevant covariates (e.g., age, sex, race/ethnicity, parental education, and family income) and other air pollutants (O3, NO2). Results: A PM2.5 × time interaction was significant for within-network rsFC of the DMN such that higher PM2.5 concentrations were associated with a smaller increase in rsFC over time. Further, significant PM2.5 × time interactions were observed for between-network rsFC of the DMN and all three attention networks, with varied directionality. Conclusion: PM2.5 exposure was associated with alterations in the development and equilibrium of the DMN-a network implicated in self-referential processing-and anticorrelated attention networks, which may impact trajectories of cognitive and mental health symptoms across adolescence.

The Association of Cerebral Oxygen Desaturation with Postoperative Cognitive Dysfunction in Older Patients: A Review.

Postoperative cognitive dysfunction (POCD) is a neurological complication associated with surgery and anesthesia that is commonly observed in older patients, and it can significantly affect patient prognosis and survival. Therefore, predicting and preventing POCD is important. Regional cerebral oxygen saturation (rSO2) reflects cerebral perfusion and oxygenation, and decreased intraoperative cerebral oxygen saturation has been reported to increase the risk of POCD. In this review, we elucidated the important relationship between the decline in rSO2 and risk of POCD in older patients. We also emphasized the importance of monitoring rSO2 during surgery to predict and prevent adverse perioperative cognitive outcomes. The findings reveal that incorporating intraoperative rSO2 monitoring into clinical practice has potential benefits, such as protecting cognitive function, reducing perioperative adverse outcomes, and ultimately improving the overall quality of life of older adults.

The predictive value of MRI scores for neurodevelopmental outcome in infants with neonatal encephalopathy.

MRI scoring systems are utilized to quantify brain injury and predict outcome in infants with neonatal encephalopathy (NE). Our aim was to evaluate the predictive accuracy of total scores, white matter (WM) and grey matter (GM) subscores of Barkovich and Weeke scoring systems for neurodevelopmental outcome at 2 years of age in infants receiving therapeutic hypothermia for NE. Data of 162 infants were analyzed in this retrospective cohort study. DeLong tests were used to compare areas under the curve of corresponding items of the two scoring systems. LASSO logistic regression was carried out to evaluate the association between MRI scores and adverse composite (death or severe disabilities), motor and cognitive outcomes (Bayley developmental index <70). Weeke scores predicted each outcome measure with greater accuracy than the corresponding items of Barkovich system (DeLong tests p < 0.03). Total scores, GM and cerebellum involvement were associated with increased odds for adverse outcomes, in contrast to WM injury, after adjustment to 5' Apgar score, first postnatal lactate and aEEG normalization within 48 h. A more detailed scoring system had better predictive value for adverse outcome. GM injury graded on both scoring systems was an independent predictor of each outcome measure. A more detailed MRI scoring system had a better predictive value for motor, cognitive and composite outcomes. While hypoxic-ischemic brain injuries in the deep grey matter and cerebellum were predictive of adverse outcome, white matter injury including cortical involvement was not associated with any of the outcome measures at 2 years of age. Structured MRI evaluation based on validated scores may aid future clinical research, as well as inform parents and caregivers to optimize care beyond the neonatal period.

Cognitive and language outcomes for pediatric hearing loss with otologic surgery

ObjectivesTo test the hypothesis that surgical otologic intervention for any type of pediatric hearing loss decreases the odds for incident adverse cognitive and linguistic developmental outcomes. Study designRetrospective cohort database study. MethodsElectronic medical record data from the TriNetX Research Network were queried for children with congenital, sensorineural, conductive, and mixed hearing loss (HL) between ages 0 and 5 years. Patients were further stratified by presence (HL + surgery) or absence (HL-surgery) of surgical intervention at any point following diagnosis, including cochlear implantation, tympanoplasty with or without mastoidectomy, and tympanostomy. Primary outcomes were defined as odds for new adverse cognitive or linguistic outcomes at any point given HL treatment status [odds ratio with 95% confidence interval, (OR; 95%CI, p-value)]. Cohorts were balanced using propensity-score matching (PSM) based on US census-defined demographics and clinically relevant congenital conditions. ResultsOf 457,636 total patients included in the study, 118,576 underwent surgery (HL + surgery cohort) and 339,060 did not (HL-surgery). In matched cohorts, surgical otologic intervention significantly decreased the odds of developing cognitive disorders including scholastic, motor, psychological developmental disorders, and pervasive developmental delays (p < 0.01). ConclusionsSurgical interventions for treatment of pediatric HL including cochlear implantation, tympanoplasty with or without mastoidectomy, and tympanostomy should be considered as they may prevent delays in development.

In Utero Exposure to Alcohol and Tobacco and Electroencephalogram Power During Childhood

Prenatal alcohol exposure (PAE) and prenatal tobacco exposure (PTE) are risk factors associated with adverse neurobehavioral and cognitive outcomes. To quantify long-term associations of PAE and PTE with brain activity in early and middle childhood via electroencephalography (EEG). This cohort study included participants enrolled in the Safe Passage Study (August 2007 to January 2015), from which a subset of 649 participants were followed up in the Environmental Influences on Child Health Outcomes Program. From September 2018 through November 2022, EEG recordings were obtained at ages 4, 5, 7, 9, or 11 years. Data were analyzed from November 2022 to November 2023. Maternal self-reported consumptions of alcohol and tobacco during pregnancy were captured at the recruitment interview and at up to 3 visits during pregnancy (20-24, 28-32, and ≥34 weeks' gestation). Classifications of PAE (continuous drinking, quit-early drinking, and nondrinking) and PTE (continuous smoking, quit-early smoking, and nonsmoking) were previously obtained. EEG band powers (theta, alpha, beta, gamma) were extracted from the EEG recordings. Linear regression models were used to estimate the associations of PAE and PTE with EEG estimates. The final sample included 649 participants (333 [51.3%] female) aged 4, 5, 7, 9, or 11 years. Children whose mothers were in the quit-early drinking cluster had increased alpha power (0.116 [95% CI, 0.023 to 0.209] μV2; P = .02) compared with individuals without PAE. The magnitude of this increase was approximately double for children exposed to continuous drinking (0.211 [95% CI, 0.005 to 0.417] μV2; P = .04). Children whose mothers were in the continuous smoking cluster had decreased beta power (-0.031 [95% CI, -0.059 to -0.003] μV2; P = .03) and gamma power (-0.020 [95% CI, -0.039 to -0.000] μV2; P = .04) compared with the nonsmoking cluster. In exploratory sex-stratified models, male participants in the quit-early PAE cluster had greater EEG power in the alpha band (0.159 [95% CI, 0.003 to 0.315] μV2; P = .04) compared with those with no PAE, and the difference was approximately double for male participants with continuous PAE (0.354 [95% CI, 0.041 to 0.667] μV2; P = .03). Male participants in the continuous PTE cluster had decreased beta (-0.048 [95% CI, -0.090 to - 0.007] μV2; P = .02) and gamma (-0.032 [95% CI, -0.061 - 0.002] μV2; P = .04) power compared with those with no PTE. These findings suggest that even low levels of PAE and PTE were associated with long-term alterations of brain activity.

A maternal low-protein diet results in sex-specific differences in synaptophysin expression and milk fatty acid profiles in neonatal rats.

The developmental origins of health and disease hypothesis have highlighted the link between early life environment and long-term health outcomes in offspring. For example, maternal protein restriction during pregnancy and lactation can result in adverse metabolic and cognitive outcomes in offspring postnatal. Hence, in the present study, we assess whether an isocaloric low-protein diet (ILPD) affects the fatty acid profile in breast milk, the hippocampal synaptophysin (Syn) ratio, and the oxidative stress markers in the neonatal stage of male and female offspring. The aim of this work was to assess the effect of an ILPD on the fatty acid profile in breast milk, quantified the hippocampal synaptophysin (Syn) ratio and oxidative stress markers in neonatal stage of male and female offspring. Female Wistar rats were fed with either a control diet or an ILPD during gestation to day 10 of lactation. Oxidative stress markers were assessed in serum and liver. All quantifications were done at postnatal day 10. The results showed: ILPD led to decreases of 38.5% and 17.4% in breast milk volume and polyunsaturated fatty acids content. Significant decreases of hippocampal Syn ratio in male offspring (decreases of 98% in hippocampal CA1 pyramidal and CA1 oriens, 83%, stratum pyramidal in CA3, 80%, stratum lucidum in CA3, and 81% stratum oriens in CA3). Male offspring showed an increase in pro-oxidant status in serum and liver. Thus, the data suggest that male offspring are more vulnerable than females to an ILPD during gestation and lactation.

Electrophysiological recording in deep brain stimulation: Current status

Deep brain stimulation (DBS) is a surgical treatment critical for alleviating symptoms of Parkinson's disease (PD), especially when medication fails to manage motor dysfunctions effectively. The accuracy of electrode placement in the subthalamic nucleus (STN) is critical for the procedure's success. The long-standing debate between electrophysiological recording (MER) and imaging-based targeting remains at the forefront of neurosurgical discussions. MER has traditionally been used to enhance the precision of DBS targeting, indicated by changes in local field potentials (LFPs), which correlate with Parkinsonian motor symptoms such as rigidity, bradykinesia, and tremor. However, the necessity of MER has been questioned due to advances in imaging techniques and the potential risks associated with the practice, including hemorrhage and cognitive decline post-surgery. A critical appraisal of the literature reveals mixed opinions, with recent meta-analyses showing no significant increase in hemorrhage risks with MER but demonstrating a modest increase in adverse cognitive outcomes using multiple electrodes. Despite improved imaging modalities enabling more accurate radiological targeting, MER remains a favored technique among surgeons for its direct feedback on electrode placement. Additionally, the aspect of conducting surgery under awake conditions versus general anesthesia is reviewed, considering the anxiety and discomfort associated with awake surgery against the limitations of performing electrophysiological recordings under general anesthesia. The current consensus underscores the importance of accurate electrode placement, achievable through a combination of MER, test stimulation, and intraoperative imaging, while also acknowledging the growing confidence in image-guided procedures performed under general anesthesia. This review highlights the need for individualized approaches considering patient-specific risks and the evolving landscape of DBS surgery.

Individualized Coordination and Empowerment for Care Partners of Persons with Dementia (ICECaP): Study rationale and protocol

The majority of care for >10 million older adults with dementia (PWD) in the United States depends on at least on 11 million unpaid care partners (CPs). CPs are at greater risk of adverse physical, psychological, and cognitive health outcomes relative to non-caregiving peers. The goal of this paper is to establish the rationale, design, and protocol for a pilot randomized control trial to test the efficacy of the CP-focused intervention, ICECaP: Individualized Coordination and Empowerment for Care Partners of Persons with Dementia. ICECaP involves the assignment of a trained dementia care coordinator to a CP. The care coordinator maintains at least monthly contact with the CP with hybrid delivery (in-person, phone, e-mail, and video calls) and provides individualized support with care coordination for the CP navigating the PWD's care in a complex healthcare system, as well as supportive counseling, psychoeducation, and skills training for the CP. This trial will compare outcomes from baseline to 12-months among CPs who receive ICECaP versus routine care (controls). Outcomes include CP depression, burden, anxiety, and quality of life; CPs' reactions to the behavioral symptoms of dementia; and use of support services for the PWD. This trial will also assess mechanisms of intervention efficacy including changes in CP dementia knowledge, caregiving preparedness, self-efficacy, and optimism. Publication of this intervention protocol will benefit other dementia care teams seeking to support CPs and PWDs.

PSYCHOSOCIAL PHENOTYPES OF OLDER ADULTS WITH PAIN AND THEIR ASSOCIATED CLINICAL OUTCOMES

Abstract Older adults experience higher rates of pain than any other age group, with a domino effect on quality of life and well-being. Existing literature reveals associations between pain and adverse psychosocial, physical, and cognitive outcomes, with psychosocial variables linking all other aspects of well-being in older adults. Therefore, a comprehensive understanding of the associations of psychosocial variables with clinical outcomes in older adults with pain is needed. Grounded in the Biopsychosocial Model of Chronic Pain for Older Adults, we analyzed cross-sectional 2021 data from the nationally representative survey conducted by the National Health and Aging Trends Study. We performed latent class analysis to identify psychosocial clusters (including anxiety, depression, affect, self-realization, resilience, and social participation) of older adults with pain and then used multiple regression analyses to compare pain characteristics, physical health, and cognition among different clusters. We identified four clusters: “Intermediate Psychosocial Phenotype,” “Favorable Psychosocial Phenotype,” “Adverse Psychosocial Phenotype,” and “Compensated Psychosocial Adversity.” Clusters with more psychosocial adversity had worse pain, physical, and cognitive outcomes while controlling for race/ethnicity, gender, and age. Increased self-realization and resilience were seen in clusters with better clinical outcomes. Our findings provide important information for precision pain management interventions for older adults based on their psychosocial phenotypes. Further research should analyze longitudinal trajectories of psychosocial phenotypes as older adults’ pain experience progresses. Clinically, pain treatment decisions should include a comprehensive evaluation of psychosocial factors, with associated health policy initiatives aimed at assessing differences in care utilization and cost among older adults based on phenotype.

The MEDITAGING study: protocol of a two-armed randomized controlled study to compare the effects of the mindfulness-based stress reduction program against a health promotion program in older migrants in Luxembourg

BackgroundMigration is a phenomenon worldwide, with older migrants, particularly those with fewer socioeconomic resources, having an increased risk of developing adverse cognitive and health outcomes and social isolation. Therefore, it is of utmost importance to validate interventions that promote healthy aging in this population. Previous studies have shown a positive impact of mindfulness based-stress reduction (MBSR) on outcomes such as cognition and sleep. However, only a few studies verified its potential in older adults, especially with vulnerable populations such as migrants. This article presents the protocol of the MEDITAGING study, which is the first to investigate the MBSR effects in migrants aged ≥55 in comparison to a health promotion program.MethodsMEDITAGING is a two-arm randomized, double-blinded, controlled study, which will include older Portuguese-speaking migrants (n = 90). Participants are randomized to the MBSR or a health promotion program. Both interventions are conducted in groups over a total of 8 weeks, incorporating weekly meetings, an additional 4-hour class, and extra at-home tasks. The health promotion program has the same structure as the MBSR but comprises different activities related to dementia prevention, healthy habits, cognitive stimulation, sleeping, nutrition, watercolor painting, and physical activity. The assessment of executive functioning, physiological stress measures, self-reported questionnaires, and qualitative interviews are conducted at baseline, after 8 weeks (post-intervention), and at a follow-up session (from one to 3 months thereafter). Analyzes will be conducted using a modified intention-to-treat approach (all participants with at least 3 days of participation in the group-sessions and one post-intervention observation).DiscussionThis study will test effects of a mindfulness-based intervention against an active control condition in older adult migrants, which few studies have addressed.Trial registrationClinicalTrials.gov NCT05615337 (date of registration: 27 September 2022; date of record verification: 14 November 2022).

Multiple Chronic Conditions and Midlife Cognitive Function in Black and White Adults: The Bogalusa Heart Study

AbstractBackgroundIn late‐life, multiple chronic conditions (MCCs) has been associated with cognitive decline and Alzheimer’s Disease and related dementias. However, this relationship has not been investigated in a middle‐aged population, a time when MCCs first begin to develop, or in rural and low socioeconomic settings, where individuals are at a higher risk of MCCs. We examined the relationship between MCCs and midlife cognitive function among Black and White men and women from a rural, community‐based cohort in Bogalusa, Louisiana.MethodsThis cross‐sectional study includes 1,223 Black (33%) and White (67%) individuals (mean age 48.10 ± 5.26; 59% female) from the Bogalusa Heart Study with a complete neuropsychological (NP) assessment, and no history of stroke. Six chronic conditions were selected from the CMS (Centers for Medicare &amp; Medicaid Services) Data Warehouse, and defined using self‐reported data, medication use, and physiological/laboratory measures (Table 1). MCCs was defined as the coexistence of ≥2 conditions. NP performance was measured by global cognitive z‐scores (GCS) and by domain specific z‐scores for attention and processing, episodic memory, and executive function. All z‐scores were standardized for age, sex, and race. Regression models assessed the association between MCCs and cognitive outcomes, adjusting for alcohol consumption, smoking status, and education.ResultsA total of 66% participants had MCCs; 44.4% (n = 543) had 2 CCs, 17.8% (n = 218) had 3 CCs, and 3.8% (n = 46) had 4+ CCs. Compared to no chronic conditions, having 2,3, and ≥4 CCs was significantly associated with poorer executive function z‐scores after adjusting for covariates (all p’s &lt; 0.05). Having three MCCs had the worst impact on executive function z‐scores (‐0.88(.20), p &lt;0.001) (Table 2). The most prevalent conditions in this group were hypertension, dyslipidemia, and diabetes which co‐occurred in 87.7% (n = 165) of participants with three CCs.ConclusionThis study suggests that the presence of MCCs is associated with lower executive function performance as early as midlife. Hypertension and dyslipidemia commonly occur together and are particularly prevalent in midlife. These findings highlight the importance of addressing chronic conditions earlier in life, a less studied and critical time window for potential prevention of adverse cognitive outcomes in late life.

Abstract 14028: Stroke Location, White Matter Disconnections, and Neurodevelopmental Outcomes in Infants With Congenital Heart Disease

Objectives: Infants with congenital heart disease (CHD) are at risk for stroke, although associations with neurodevelopmental outcomes have varied. In adults with stroke, location and altered structural connectivity (disconnections) have been linked to neurologic symptoms. We assessed whether stroke (1) location and (2) white matter disconnections are related to neurodevelopment in infants with CHD. Methods: Infants underwent pre- and post-operative brain MRI in prospective studies at 3 centres (UBC, UCSF, SickKids) and completed 18-month neurodevelopmental assessments using Bayley Scales with separate motor and cognitive composites. Adverse outcomes were defined as composite score &lt;85. Strokes were manually segmented. Voxel-wise lesion symptoms maps (VLSM) were used to assess relationships between lesion location and neurodevelopment. Disconnectomes were generated using stroke segmentations as seeds for tractography and diffusion MRI from healthy controls. Voxel-wise disconnectome-symptoms maps (VDSM) of associations between structural disconnections and neurodevelopment were developed. Results: 50 infants with strokes had neurodevelopmental outcomes data. Most strokes were small (&lt;1/3 of arterial territory; n= 33) and in the left MCA territory (Fig 1A). However, strokes in the right basal ganglia and adjacent central white matter were most strongly associated with adverse motor and cognitive outcomes (Fig 1B). White matter disconnections extended beyond areas of injury (Fig 1C); these were extensive even in small strokes. Disconnections of tracts passing through the right basal ganglia were most strongly associated with adverse motor and cognitive outcomes (Fig 1D). Conclusions: Strokes involving the basal ganglia, particularly in the right hemisphere, were associated with worse motor and cognitive outcomes in infants with CHD. These data draw increasing attention to the right hemisphere in early-life stroke and neurodevelopment.

Intra-uterine exposure to lower maternal haemoglobin concentration is associated with impaired cognitive function in stunted adolescents: results from a 17-year longitudinal cohort study in Indonesia

The long-term impact of maternal anaemia on cognitive performance remains unknown. Indonesian longitudinal cohort data of 363 paired pregnant mothers and their 10–14-year-old offspring were used to investigate the association between maternal haemoglobin (Hb) concentration and their offspring’s cognitive function (assessed by Raven’s Progressive Matrices test) during adolescence. The weighted anaemia prevalence was 49.3% in pregnant mothers and 22.2% in adolescents. Adolescents who were stunted, anaemic, or living in a rural area had significantly lower cognitive scores than their counterparts. Maternal Hb was not associated with adolescent cognitive function (β: 0.14; 95%CI: −0.052–0.340). However, the effect of maternal Hb concentration on offspring’s cognitive function was modified by stunting status (β, stunted: 0.44; 95%CI: 0.05–0.82; non-stunted: 0.01; 95%CI: −0.02–0.24). This study shows adverse cognitive outcomes at adolescent age are likely multi-causal and can be partially explained by intra-uterine exposure to low maternal Hb concentrations.

Maternal Stress: The First 14 Months Postpartum

SYNOPSIS Objective. Maternal stress is a psychological response to the demands of motherhood. A high level of maternal stress is a risk factor for maternal mental health problems, including depression and anxiety, as well as adverse infant socioemotional and cognitive outcomes. Yet, levels of maternal stress (i.e., levels of stress related to parenting) among low-risk samples are rarely studied longitudinally, particularly in the first year after birth. Design. We measured maternal stress in an ethnically diverse sample of low-risk, healthy U.S. mothers of healthy infants (N = 143) living in South Florida across six time points between 2 weeks and 14 months postpartum using the Parenting Stress Index-Short Form, capturing stress related to the mother, mother-infant interactions, and the infant. Results. Maternal distress increased as infants aged for mothers with more than one child, but not for first-time mothers whose distress levels remained low and stable across this period. Stress related to mother-infant dysfunctional interactions lessened over the first 8 months. Mothers’ stress about their infants’ difficulties decreased from 2 weeks to 6 months, and subsequently increased from 6 to 14 months. Conclusions. Our findings suggest that maternal stress is dynamic across the first year after birth. The current study adds to our understanding of typical developmental patterns in early motherhood and identifies potential domains and time points as targets for future interventions.

Untreated Early Childhood Caries and Possible Links with Brain Development

Untreated early childhood caries (ECC) is a global public health concern. In the short term, untreated ECC can lead to pain, infection, and disrupted sleep, among other issues. In the long term, it is associated with poor oral health in later life, increased risk of caries in permanent teeth, and adverse effects on physical and psychological development. There may be a link between untreated ECC and adverse cognitive and neurodevelopmental outcomes in young children, although the exact pathways are not fully understood. One possible pathway is through the relationship between mastication and brain stimulation. Impaired masticatory function due to ECC can affect the hippocampus, a key region responsible for memory and learning. Furthermore, untreated ECC can cause chronic inflammation, leading to the release of pro-inflammatory cytokines that may damage the brain. Sleep disturbances resulting from ECC-related pain and discomfort can also impact brain development and cognitive functioning. Additionally, frequent use of antibiotics and analgesics to address ECC-related infections can disrupt the gut microbiome, potentially affecting the brain through the gut–brain axis. Untreated ECC can cause nutritional deficiencies and elevated nutritional risk, and can further hinder brain development. Addressing ECC comprehensively with early childhood health initiatives can help mitigate potential long-term consequences and promote optimal brain development in young children.

Physical and brain frailty in ischaemic stroke or TIA: Shared occurrence and outcomes. A cohort study.

There is increasing interest in the concept of frailty in stroke, including both physical frailty and imaging-evidence of brain frailty. We aimed to establish the prevalence of brain frailty in stroke survivors as well as the concurrent and predictive validity of various frailty measures against long-term cognitive outcomes. We included consecutively admitted stroke or transient ischaemic attack (TIA) survivors from participating stroke centres. Baseline CT scans were used to generate an overall brain frailty score for each participant. We measured frailty via the Rockwood frailty index, and a Fried frailty screening tool. Presence of major or minor neurocognitive disorder at 18-months following stroke or TIA was established via a multicomponent assessment. Prevalence of brain frailty was established based upon observed percentages within groups defined by frailty status (robust, pre-frail, frail). We assessed the concurrent validity of brain frailty and frailty scales via Spearman's rank correlation. We conducted multivariable logistic regression analyses, controlling for age, sex, baseline education and stroke severity, to evaluate association between each frailty measure and 18-month cognitive impairment. Three-hundred-forty-one stroke survivors participated. Three-quarters of people who were frail had moderate-severe brain frailty and prevalence increased according to frailty status. Brain frailty was weakly correlated with Rockwood frailty (Rho: 0.336; p < 0.001) and with Fried frailty (Rho: 0.230; p < 0.001). Brain frailty (OR: 1.64, 95% CI = 1.17-2.32), Rockwood frailty (OR: 1.05, 95% CI = 1.02-1.08) and Fried frailty (OR: 1.93, 95% CI = 1.39-2.67) were each independently associated with cognitive impairment at 18 months following stroke. There appears to be value in the assessment of both physical and brain frailty in patients with ischaemic stroke and TIA. Both are associated with adverse cognitive outcomes and physical frailty remains important when assessing cognitive outcomes.