Differences In Cognitive Outcomes Research Articles

Revisiting 'Effectiveness of problem-based learning curricula: theory, practice and paper darts'.

Revisiting 'Effectiveness of problem-based learning curricula: theory, practice and paper darts'.

Differences in Cognitive Outcomes After ECT Depending on BDNF and COMT Polymorphisms.

The study aimed to explore cognitive outcomes after electroconvulsive therapy (ECT) depending on which version of common single nucleotide polymorphisms the patient expressed for brain-derived neurotrophic factor (BDNF) and catechol-O-methyltransferase (COMT). A total of 87 patients from the clinical ECT service in Aberdeen, Scotland, were included in the study. Cognitive function testing (using Spatial Recognition Memory task from the Cambridge Neuropsychological Test Automated Battery and Mini-Mental State Examination) and mood ratings (Montgomery-Åsberg Depression Rating Scale) were performed before ECT, after 4 treatments, at the end of ECT and 1 and 3 months after the end of treatment. These scores were compared depending on BDNF and COMT variant at each time point using the Student t test and using a time series generalized least squares random effects model. No differences were found between the val and met versions of the BDNF or COMT polymorphism in either cognitive or mood outcomes at any time point during ECT treatment or up to 3 months of follow-up. This study did not detect significant differences in cognitive or mood outcomes between patients who have the val66val or met versions of the BDNF polymorphism. Our results suggest that these polymorphisms will not be helpful in clinical practice for predicting cognitive outcomes after ECT.

Tamoxifen versus aromatase inhibitors for the adjuvant treatment of breast cancer in older women: A feasibility study to examine differences in cognitive outcomes.

TPS626Background: Tamoxifen (TAM) and aromatase inhibitors (AIs) are the mainstay endocrine therapies (ETs) for the treatment of hormone-receptor-positive (HR+) breast cancer (BC). While these ETs dramatically improve BC outcomes by reducing estrogen activity, increased awareness of the neuroprotective effects of estrogen on cognition has led to concerns regarding potential adverse cognitive effects. Cognitive concerns are heightened by the fact BC is more common among older women, who are already at greater risk of cognitive impairment (CI). While the anti-estrogen properties of TAM and AIs are unique, their differential effect on cognition remains unknown. Our overarching objective is to compare the cognitive effects of TAM and AIs in older women; however, before undertaking the large multicenter study needed to meet this goal, we are conducting a feasibility study to i) establish metrics on participation, retention, and ET adherence, and ii) inform sample size calculation for the future multicenter stu...

A comparative study of postoperative cognitive dysfunction in elderly patients undergoing hip surgery after general anaesthesia and combined spinal and epidural anaesthesia

Background Post-operative cognitive dysfunction (POCD) is the subtle cerebral complication temporally seen following surgery. Objectives: To compare the influence of general anesthesia (GA) and of combined spinal-epidural anesthesia (CSEA) upon the early post-operative neurocognitive outcome in elderly (60-70 years) subjects undergoing hip surgery. To measure the impacts of preoperatively hospital stay on POCD. Methods: Total 60, patients were recruited in a prospective, randomized, parallel-group study. They were enrolled and randomized to receive either GA (N= 30) or CSEA (N = 30). All of them were evaluated on the Mini Mental State Examination (MMSE) for their cognitive function and Clock Drawing Test (CDT) for visuospatial function prior to the surgery. The operated patients were re-evaluated 3 days after the surgery on same scales. The data collected were analyzed to assess statistical significance. Results: We observed no statistically significant difference in cognitive and visuospatial function in both the group pre-operatively, which were comparable with respect to age, sex. We found significant cognitive impairment in patients exposed with GA postoperatively 23.33% whereas in CSEA only 6.66%. Visuospatial function was also significantly affected by GA (26.66%) in comparison to CSEA (13.33%). Duration of preoperative hospital stay didn’t affect the neurocongitive functions postoperatively. Conclusions: We observed a positive difference in cognitive outcome with CSEA as compared to GA. Certain aspects of the cognition were affected to a greater extent like visuospatial functioning with exposure to GA undergoing hip surgery. Keywords: Postoperative Cognitive Dysfunction, Cognitive Impairment, Visuospatial Function, Mini Mental State Examination, Clock Drawing Test

Long-Term Cognitive and Behavioral Outcomes following Resolution of Sleep Disordered Breathing in Preschool Children.

This study aimed to determine the long term effects of resolution of SDB in preschool children, either following treatment or spontaneous recovery, on cognition and behavior. Children diagnosed with SDB at 3-5y (N = 35) and non-snoring controls (N = 25), underwent repeat polysomnography (PSG) and cognitive and behavioral assessment 3 years following a baseline study. At follow-up, children with SDB were grouped into Resolved and Unresolved. Resolution was defined as: obstructive apnea hypopnea index (OAHI) ≤1 event/h; no snoring detected on PSG; and no parental report of habitual snoring. 57% (20/35) of children with SDB received treatment, with SDB resolving in 60% (12/20). 43% (15/35) were untreated, of whom 40% (6/15) had spontaneous resolution of SDB. Cognitive reduced between baseline and follow-up, however this was not related to persistent disease, with no difference in cognitive outcomes between Resolved, Unresolved or Control groups. Behavioral functioning remained significantly worse in children originally diagnosed with SDB compared to control children, regardless of resolution. Change in OAHI did not predict cognitive or behavioral outcomes, however a reduction in nocturnal arousals, irrespective of full resolution, was associated with improvement in attention and aggressive behavior. These results suggest that resolution of SDB in preschool children has little effect on cognitive or behavioral outcomes over the long term. The association between sleep fragmentation and behavior appears independent of SDB, however may be moderated by concomitant SDB. This challenges the assumption that treatment of SDB will ameliorate associated cognitive and behavioural deficits and supports the possibility of a SDB phenotype.

T-Tau is Associated with Objective Memory Decline Over Two Years in Persons Seeking Help for Subjective Cognitive Decline: A Report from the Gothenburg-Oslo MCI Study.

There is a need to find very early markers for pre-clinical Alzheimer's disease as interventions early in the disease process are thought to be most effective. The present study aimed to address the potential relation between cerebrospinal fluid (CSF) biomarkers and reduced cognitive function in a relatively young cohort of memory clinic patients with subjective cognitive decline. 122 patients (mean age 63 years) with subjective cognitive decline were recruited from two university memory clinics and followed for two years. The main finding was that the subgroup with objective memory decline during the study period had significantly higher T-tau at baseline than the group with improved memory. Baseline CSF variables showed a trend toward more pathological values in the patients with memory decline compared to those who improved or remained stable. The baseline memory score of those who declined was significantly better than the baseline score of those who improved over two years. The general trend for the whole group was improved memory and executive test scores. There were no differences in cognitive scores based on CSF quartiles at baseline, nor were there differences in cognitive outcome for patients with early amnestic mild cognitive impairment versus average cognitive function at baseline. The main finding that T-tau rather than amyloid-β was associated with memory decline do not support the prevailing opinion about the chain of events assumed to take place in Alzheimer's disease. In addition, memory decline was not associated with poor baseline memory score. Thus, a memory cut-off indicating low baseline memory would not would have identified the declining group.

Epigenetic contributions to cognitive aging: disentangling mindspan and lifespan.

Epigenetic modifications of chromatin structure provide a mechanistic interface for gene–environment interactions that impact the individualization of health trajectories across the lifespan. A growing body of research indicates that dysfunctional epigenetic regulation contributes to poor cognitive outcomes among aged populations. Here we review neuroepigenetic research as it relates to cognitive aging, focusing specifically on memory function mediated by the hippocampal system. Recent work that differentiates epigenetic contributions to chronological aging from influences on mindspan, or the preservation of normal cognitive abilities across the lifespan, is also highlighted. Together, current evidence indicates that while age-related memory impairment is associated with dysfunction in the coordinated regulation of chromatin modification, animal models that show individual differences in cognitive outcome underscore the enormous mechanistic complexity that surrounds epigenetic dynamics in the aged hippocampus.

Working memory training and poetry-based stimulation programs: are there differences in cognitive outcome in healthy older adults?

Neuropsychological interventions have been mainly applied with clinical populations, in spite of the need of preventing negative changes across life span. Among the few studies of cognitive stimulation in elderly, surprisingly there is no enough research comparing direct and indirect active stimulation programs. This study aims to verify wheter there are differences between two cognitive interventions approaches in older adults: a structured Working Memory (WM) Training Program versus a Poetry-based Stimulation Program. Fourteen older adults were randomly assigned to participate into one of the two intervention groups. The assessed neurocognitive components were attention, episodic and working memory, communicative and executive functions. WM Training activities were based on Baddeley's model; Poetry-based Stimulation Program was composed by general language activities. Data were analyzed with one-way ANCOVA with Delta scores and pre and post-training tests raw scores. WM group improved performance on WM, inhibition, and cognitive flexibility measures, while Poetry group improved on verbal fluency and narrative discourse tasks. Both approaches presented benefits; however WM Training improved its target function with transfer effects to executive functions, being useful for future studies with a variety of dementias. Poetry-based Stimulation also improved complex linguistic abilities. Both approaches may be helpful as strategies to prevent dysfunctional aging changes.

Sex differences in behavioral outcome following neonatal hypoxia ischemia: Insights from a clinical meta-analysis and a rodent model of induced hypoxic ischemic brain injury

Hypoxia ischemia (HI; reduced oxygen and/or blood flow to the brain) is one of the most common injuries among preterm infants and term infants with birth complications. Both populations show cognitive/behavioral deficits, including impairments in sensory, learning/memory, and attention domains. Clinical data suggests a sex difference in HI outcomes, with males exhibiting more severe cognitive/behavioral deficits relative to matched females. Our laboratory has also reported more severe behavioral deficits among male rats with induced HI relative to females with comparable injury (Hill et al., 2011a,b). The current study initially examined published clinical studies from the past 20years where long-term IQ outcome scores for matched groups of male and female premature infants were reported separately (IQ being the most common outcome measure). A meta-analysis revealed a female “advantage,” as indicated by significantly better scores on performance and full scale IQ (but not verbal IQ) for premature females. We then utilized a rodent model of neonatal HI injury to assess sham and postnatal day 7 (P7) HI male and female rats on a battery of behavioral tasks. Results showed expected deficits in HI male rats, but also showed task-dependent sex differences, with HI males having significantly larger deficits than HI females on some tasks but equivalent deficits on other tasks. In contrast to behavioral results, post mortem neuropathology associated with HI was comparable across sex. These findings suggest: 1) neonatal female “protection” in some behavioral domains, as indexed by superior outcome following early injury relative to males; and 2) female protection may entail sex-specific plasticity or compensation, rather than a reduction in gross neuropathology. Further exploration of the mechanisms underlying this sex effect could aid in neuroprotection efforts for at-risk neonates in general, and males in particular. Moreover, our current report of comparable anatomical damage coupled with differences in cognitive outcomes (by sex) provides a framework for future studies to examine neural mechanisms underlying sex differences in cognition and behavior in general.

HIV-associated neurocognitive disorders: Antiretroviral regimen, central nervous system penetration effectiveness, and cognitive outcomes

The human immunodeficiency virus (HIV) can give rise to a spectrum of neuropsychological impairments known collectively as HIV-associated neurocognitive disorders (HAND). Although antiretroviral therapy (ART) has reduced the incidence of HIV dementia, the prevalence of milder forms of HAND has increased. It has been postulated that incomplete central nervous system (CNS) viral suppression or potential drug toxicity, both of which could be related to the CNS penetration effectiveness (CPE) of ART regimens, may contribute to this phenomenon. This study compared cognitive outcomes in clade C-infected HIV patients in South Africa treated for 1 year with ART regimens with differing CPE scores. We assessed 111 HIV-positive patients with varying levels of cognitive function at baseline (pre-ART) and then a year later. A neuropsychological battery was administered at both visits to derive global deficit scores. ART regimen data were collected at the follow-up visit. Some participants remained ART-naïve during this period, thus providing a non-treatment control group. Significantly more ART recipients maintained or improved cognitive function compared with patients not on ART (p=0.017). There was no significant difference in cognitive outcomes between higher and lower CPE regimen groups (p=0.473). ART preserves or improves cognition in HIV-infected patients after 1 year, irrespective of the regimen's CPE. South Africa's current low CPE-scored first-line regimen performed as well as higher CPE-scored regimens. These findings are reassuring for South Africa, but larger, longer-term studies would be more definitive.

A left cerebellar pathway mediates language in prematurely-born young adults

Preterm (PT) subjects are at risk for developmental delay, and task-based studies suggest that developmental disorders may be due to alterations in neural connectivity. Since emerging data imply the importance of right cerebellar function for language acquisition in typical development, we hypothesized that PT subjects would have alternate areas of cerebellar connectivity, and that these areas would be responsible for differences in cognitive outcomes between PT subjects and term controls at age 20 years. Nineteen PT and 19 term control young adults were prospectively studied using resting-state functional MRI (fMRI) to create voxel-based contrast maps reflecting the functional connectivity of each tissue element in the grey matter through analysis of the intrinsic connectivity contrast degree (ICC-d). Left cerebellar ICC-d differences between subjects identified a region of interest that was used for subsequent seed-based connectivity analyses. Subjects underwent standardized language testing, and correlations with cognitive outcomes were assessed. There were no differences in gender, hand preference, maternal education, age at study, or Peabody Picture Vocabulary Test (PPVT) scores. Functional connectivity (FcMRI) demonstrated increased tissue connectivity in the biventer, simple and quadrangular lobules of the L cerebellum (p<0.05) in PTs compared to term controls; seed-based analyses from these regions demonstrated alterations in connectivity from L cerebellum to both R and L inferior frontal gyri (IFG) in PTs compared to term controls. For PTs but not term controls, there were significant positive correlations between these connections and PPVT scores (R IFG: r=0.555, p=0.01; L IFG: r=0.454, p=0.05), as well as Verbal Comprehension Index (VCI) scores (R IFG: r=0.472, p=0.04). These data suggest the presence of a left cerebellar language circuit in PT subjects at young adulthood. These findings may represent either a delay in maturation or the engagement of alternative neural pathways for language in the developing PT brain.

The Development of Young Children of Immigrants in Australia, Canada, the United Kingdom, and the United States

In spite of important differences in some of the resources immigrant parents have to invest in their children, and in immigrant selection rules and settlement policies, there are significant similarities in the relative positions of 4- and 5-year-old children of immigrants in Australia, Canada, the United Kingdom, and the United States. Children of immigrants underperform their counterparts with native-born parents in vocabulary tests, particularly if a language other than the official language is spoken at home, but are not generally disadvantaged in nonverbal cognitive domains, nor are there notable behavioral differences. These findings suggest that the cross-country differences in cognitive outcomes during the teen years documented in the existing literature are much less evident during the early years.

Enteral iron supplementation in preterm and low birth weight infants

Preterm infants are at risk of exhausting their body iron stores much earlier than healthy term newborns. It is widespread practice to give enteral iron supplementation to preterm and low birth weight infants to prevent iron deficiency anaemia. However, it is unclear whether supplementing preterm and low birth weight infants with iron improves growth and neurodevelopment. It is suspected that excess exogenous iron can contribute to oxidative injury in preterm babies, causing or exacerbating conditions such as necrotising enterocolitis and retinopathy of prematurity. Additionally, the optimal dose and timing of commencement and cessation of iron supplementation are uncertain. To evaluate the effect of prophylactic enteral iron supplementation on growth and neurodevelopmental outcomes in preterm and low birth weight infants. The secondary objectives were to determine whether iron supplementation results in improved haematological parameters and prevents other causes of morbidity and mortality. We used the standard search strategy of the Cochrane Neonatal Review Group. We searched Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 8), MEDLINE (1951 to August 2011), CINAHL (1982 to August 2011) and conference proceedings and previous reviews. Randomised controlled trials (RCTs) and quasi-randomised trials that compared enteral iron supplementation with no iron supplementation, or different regimens of enteral iron supplementation in preterm or low birth weight infants or both. We extracted data using the standard methods of the Cochrane Neonatal Review Group. Both review authors separately evaluated trial quality and data extraction. We synthesised data using risk ratios (RRs), risk differences (RDs) and weighted mean differences (WMDs). Where data about the methodology and results or both were lacking, we made an attempt to contact the study authors for further information. We included twenty-six studies (2726 infants) in the analysis. The heterogeneity of participants, methods and results precluded an extensive quantitative synthesis. Of the 21 studies comparing iron supplementation with controls, none evaluated neurodevelopmental status as an outcome. Of thirteen studies reporting at least one growth parameter as an outcome, only one study of poor quality found a significant benefit of iron supplementation. Regarding haematological outcomes, no benefit for iron supplementation was demonstrated within the first 8.5 weeks of postnatal life (16 trials), except by two poor quality studies. After this age, most studies reported a higher mean haemoglobin in iron-supplemented infants. We were only able to include a limited number of studies in a quantitative meta-analysis, which suggested the haemoglobin concentration in iron-supplemented infants was higher by about 6 g/L at six to nine months. One study comparing high dose and low dose iron supplementation monitored neurodevelopmental outcome for one year, without finding any significant difference between the groups. One study comparing early versus late commencement of iron supplementation found no difference in cognitive outcome, but an increased rate of abnormal neurological examination in the late iron group at five years of age. The studies comparing high and low doses of iron indicated that there was no discernible haematological benefit in exceeding 'standard' doses of iron (i.e. 2 mg/kg/day to 3 mg/kg/day). The available data suggest that infants who receive iron supplementation have a slightly higher haemoglobin level, improved iron stores and a lower risk of developing iron deficiency anaemia when compared with those who are unsupplemented. However, it is unclear whether iron supplementation in preterm and low birth weight infants has long term benefits in terms of neurodevelopmental outcome and growth. The optimum timing and duration of iron supplementation remains unclear.

Early Surgical Therapy for Drug-Resistant Temporal Lobe Epilepsy

Despite reported success, surgery for pharmacoresistant seizures is often seen as a last resort. Patients are typically referred for surgery after 20 years of seizures, often too late to avoid significant disability and premature death. We sought to determine whether surgery soon after failure of 2 antiepileptic drug (AED) trials is superior to continued medical management in controlling seizures and improving quality of life (QOL). The Early Randomized Surgical Epilepsy Trial (ERSET) is a multicenter, controlled, parallel-group clinical trial performed at 16 US epilepsy surgery centers. The 38 participants (18 men and 20 women; aged ≥12 years) had mesial temporal lobe epilepsy (MTLE) and disabling seizues for no more than 2 consecutive years following adequate trials of 2 brand-name AEDs. Eligibility for anteromesial temporal resection (AMTR) was based on a standardized presurgical evaluation protocol. Participants were randomized to continued AED treatment or AMTR 2003-2007, and observed for 2 years. Planned enrollment was 200, but the trial was halted prematurely due to slow accrual. Receipt of continued AED treatment (n = 23) or a standardized AMTR plus AED treatment (n = 15). In the medical group, 7 participants underwent AMTR prior to the end of follow-up and 1 participant in the surgical group never received surgery. The primary outcome variable was freedom from disabling seizures during year 2 of follow-up. Secondary outcome variables were health-related QOL (measured primarily by the 2-year change in the Quality of Life in Epilepsy 89 [QOLIE-89] overall T-score), cognitive function, and social adaptation. Zero of 23 participants in the medical group and 11 of 15 in the surgical group were seizure free during year 2 of follow-up (odds ratio = ∞; 95% CI, 11.8 to ∞; P < .001). In an intention-to-treat analysis, the mean improvement in QOLIE-89 overall T-score was higher in the surgical group than in the medical group but this difference was not statistically significant (12.6 vs 4.0 points; treatment effect = 8.5; 95% CI, -1.0 to 18.1; P = .08). When data obtained after surgery from participants in the medical group were excluded, the effect of surgery on QOL was significant (12.8 vs 2.8 points; treatment effect = 9.9; 95% CI, 2.2 to 17.7; P = .01). Memory decline (assessed using the Rey Auditory Verbal Learning Test) occurred in 4 participants (36%) after surgery, consistent with rates seen in the literature; but the sample was too small to permit definitive conclusions about treatment group differences in cognitive outcomes. Adverse events included a transient neurologic deficit attributed to a magnetic resonance imaging-identified postoperative stroke in a participant who had surgery and 3 cases of status epilepticus in the medical group. Among patients with newly intractable disabling MTLE, resective surgery plus AED treatment resulted in a lower probability of seizures during year 2 of follow-up than continued AED treatment alone. Given the premature termination of the trial, the results should be interpreted with appropriate caution. clinicaltrials.gov Identifier: NCT00040326.

Issues related to increased systemic perfusion pressure during cardiopulmonary bypass and its safety

We read with great interest the article by Siepe et al. [1] ‘Increased systemic perfusion pressure during cardiopulmonary bypass (CPB) is associated with less early postoperative cognitive dysfunction and delirium’ along with the conference discussion with Dr Pepper. This prospective, randomized, single-center trial sought to find differences in cognitive outcome after elective or urgent coronary artery bypass grafting (CABG) surgery based on the different systemic perfusion pressures during CPB. On surprisingly low number of patients authors were able to prove statistically significant difference with regard to occurrence of postoperative delirium and concluded that elevated perfusion pressure is not associated with increased morbidity and mortality. We have a few remarks regarding the study and the interpretation of the results.

Pierre Robin Sequenz: Pränatale Diagnostik und interdisziplinäre Therapie

Pierre Robin Sequence (PRS) is characterised by mandibular micrognathia and/or retrognathia, glossoptosis and upper airway obstruction (UAO). In severe cases, UAO and cyanosis occur immediately after birth and endoscopic intubation may become necessary. Therefore, prenatal diagnosis with referral to a specialized department is important. A non-invasive interdisciplinary treatment protocol is presented. The postnatal adjustment of the preepiglottic baton plate (PEBP) as early as possible is essential in this concept. In a randomised cross-over trial with 11 patients with isolated PRS, the PEBP was found to reduce the apnoea index significantly and to be superior to a conventional palatal plate. An uncontrolled longitudinal study indicated that the UAO had normalised 3 months after discharge; all infants showed adequate weight gain with bottle feeding. In a comparative study with 34 healthy children and 34 children with isolated PRS, no significant differences in cognitive outcome was found. Interdisciplinary co-operation between prenatal care, neonatology and orthodontics is a pre-requisite for optimal postnatal therapy. Complications of UAO can be avoided by early and adequate treatment, resulting in good results for feeding, speech and facial profile. Invasive surgical treatment options like tongue-lip-adhesion, mandibular extension or distraction should be obsolete.

Cognitive Function After Intrauterine Growth Restriction and Very Preterm Birth

To evaluate the effects of intrauterine growth restriction (IUGR) with absent or reversed end-diastolic blood flow in the umbilical artery and very preterm birth on cognitive outcome at 5 to 8 years of age. We studied 34 children with IUGR born at a median of 26.9 gestational weeks (GWs) (range: 24-29 GWs) (PT-IUGR), 34 matched preterm appropriate-for-gestational age (PT-AGA) children, and 34 term AGA children (T-AGA) by using the Wechsler Preschool and Primary Scale of Intelligence, Wechsler Intelligence Scale for Children, Strengths and Difficulties Questionnaire, and Brown's attention-deficit disorder (ADD) scales. The PT-IUGR group had mean (SD) scores on the verbal IQ (VIQ) and full-scale IQ (FSIQ) of 83.8 (17.3) and 78.9 (16.6), respectively, compared with the PT-AGA group, which had scores of 96.0 (14.5) and 90.1 (14.2) (P = .003 and P < .007), and the T-AGA group, which had scores of 101.3 (12) and 102.9 (13.2) (P < .001 and P < 001), respectively. The VIQ difference remained significant after adjustment for parental level of education, gestational age at birth, and neonatal morbidity. Performance IQ (PIQ) did not differ between the PT-IUGR and PT-AGA groups; their mean PIQs were lower than that of the T-AGA group (P < .001). Boys in the PT-IUGR group scored lower than girls in VIQ and FSIQ (P = .005 and .007, respectively). Behavior and ADD scores did not differ between the preterm groups. Children born very preterm after IUGR have an increased risk for cognitive impairment at early school age compared with children delivered very preterm for other reasons. Differences in cognitive outcome were restricted to boys who may have been especially vulnerable to the influence of IUGR and very preterm birth.

The Influence of Education and Home Environment on the Cognitive Outcomes of Preschool Children in Germany

Educational inequality is a well-established topic among the scientific community in Western countries. Major individual differences emerge well before children arrive at school. Therefore the following analysis deals with the explanation of early differences in cognitive outcomes. However, there is not much research done in Germany. The main question is if the strong effect of the educational background and the home environment on their outcomes and on the improvement exists as well. To test this, data of the project “Preschool Education and Educational Careers among Migrant Children” was used. The results of structural equation models confirm that the home environment and the education of the parents are important for children's outcomes at the age of 3 to 4. In addition both factors also play a major role for the explanation of the improvement of the cognitive abilities. The results show that in Germany the home environment and parental education are important predictors of cognitive abilities. As a main result the study shows that it is very important to control for earlier abilities of the children and to encourage low educated parents to be active with their children, since in that way they can compensate for their lower educational background.

Cognitive development in Dravet syndrome: A retrospective, multicenter study of 26 patients

To clarify the role of epilepsy and genetic background in determining the cognitive outcome of patients with Dravet syndrome. In this retrospective study, we reviewed the clinical history and cognitive development of 26 patients who had been followed with standardized evaluations since seizure onset. The cognitive outcome was quantified as differential general quotient (dGQ) between ages 12 and 60 months. Statistical analysis correlated the dGQ with genotype and epilepsy course. Epilepsy started at the mean age of 5.6 months. All patients experienced prolonged convulsive seizures, whereas absences and myoclonus were reported in 17. Cognitive outcome was poor in almost all patients; the mean dGQ was 33 points, varying from 6-77 points. The analysis of individual cognitive profiles identified seven patients in whom the dGQ was <20 points; the main clinical characteristic in this subset of patients was lack of early absences and myoclonus. The statistical analysis of the whole series failed to reveal significant differences in cognitive outcome with regard to the presence of SCN1A mutations and their type. In particular, mutation-carrier patients with the best cognitive outcome harbored either missense or truncating mutations. Dravet syndrome encompasses different epileptic and cognitive phenotypes that probably result from both genetic and epigenetic factors. In this series, early appearance of myoclonus and absences was associated with the worst cognitive outcome.

Inequality During the Early Years: Child Outcomes and Readiness to Learn in Australia, Canada, United Kingdom, and United States

This study of the emergence of inequality during the early years is based upon a comparative analysis of children at the age of about five years in Australia, Canada, the United Kingdom and the United States. We study a series of child outcomes related to readiness to learn, focusing on vocabulary development and externalizing behavior. Our major findings are three in number. First, significant inequalities in child capacities emerge even in these early years in all four countries but the disparities are notably greater in the United States and the United Kingdom than in Australia, and particularly in Canada. Second, large differences in cognitive outcomes exist in all countries between children from disadvantaged backgrounds and the mainstream and these are of similar magnitudes across countries. Differences across countries in the overall disparity between cognitive outcomes of the least and most advantaged, therefore, largely reflect variation in the degree to which children at the top of the SES distribution out-perform those in the middle. Third, disparities in social and behavioral development are markedly smaller than in cognitive outcomes and differ from cognitive outcomes in their association with SES across countries. While the smallest SES gaps are found in Australia and Canada for both types of outcome, differences in cognitive outcomes are greatest in the US, while differences in behavioral outcomes are greatest in the UK.