Global Intelligence Quotient Research Articles

Association between prenatal glucocorticoid exposure and adolescent neurodevelopment: An observational follow-up study.

Prenatal exposure to supraphysiological glucocorticoid (GC) levels may lead to long-lasting developmental changes in numerous biological systems. Our prior study identified an association between prenatal GC prophylaxis and reduced cognitive performance, electrocortical changes, and altered autonomic nervous system (ANS) activity in children aged 8-9 years. This follow-up study aimed to examine whether these findings persisted into adolescence. Prospective observational follow-up study involving twenty-one 14- to 15-year-old adolescents born to mothers who received betamethasone for induction of fetal lung maturation in threatened preterm birth, but who were born with a normal weight appropriate for their gestational age (median 37+4 gestational weeks). Thirty-five children not exposed to betamethasone served as the reference group (median 37+6 gestational weeks). The primary endpoint was cognitive performance, measured by intelligence quotient (IQ). Key secondary endpoints included symptoms of attention-deficit/hyperactivity disorder (ADHD) and metabolic markers. Additionally, we determined electrocortical (electroencephalogram), hypothalamus-pituitary-adrenal axis (HPAA), and ANS activity in response to a standardized stress paradigm. No statistically significant group difference was observed in global IQ (adjusted mean: betamethasone 103.9 vs references 105.9, mean difference -2.0, 95% confidence interval [CI]: -7.12 to 3.12, p = 0.44). Similarly, ADHD symptoms, metabolic markers, the overall and stress-induced activity of the HPAA and the ANS did not differ significantly between groups. However, the betamethasone group exhibited reduced electrocortical activity in the frontal brain region (spectral edge frequency-adjusted means: 16.0 Hz vs 17.8 Hz, mean difference -1.83 Hz, 95% CI: -3.21 to -0.45, p = 0.01). In 14- to 15-year-old adolescents, prenatal GC exposure was not associated with differences in IQ scores or ANS activity compared to unexposed controls. However, decelerated electrocortical activity in the frontal region potentially reflects disturbances in the maturation of cortical and/or subcortical brain structures. The clinical significance of these changes remains unknown. Given the small sample size, selective participation/loss of follow-up and potential residual confounding, these findings should be interpreted cautiously. Further research is required to replicate these results in larger cohorts before drawing firm clinical conclusions.

Global health burden and cost of lead exposure in children and adults: a health impact and economic modelling analysis

Lead exposure is a worldwide health risk despite substantial declines in blood lead levels following the leaded gasoline phase-out. For the first time, to our knowledge, we aimed to estimate the global burden and cost of intelligence quotient (IQ) loss and cardiovascular disease mortality from lead exposure. In this modelling study, we used country blood lead level estimates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. We estimated IQ loss (presented as estimated loss in IQ points with 95% CIs) in the global population of children younger than 5 years using the blood lead level-IQ loss function from an international pooled analysis. We estimated the cost of IQ loss, which was calculated only for the proportion of children expected to enter the labour force, as the present value of loss in lifetime income from the IQ loss (presented as cost in US dollars and percentage of gross domestic product with a range). We estimated cardiovascular deaths (with 95% CIs) due to lead exposure among people aged 25 years or older using a health impact model that captures the effect of lead exposure on cardiovascular disease mortality that is mediated through mechanisms other than hypertension. Finally, we used values of statistical life to estimate the welfare cost of premature mortality (presented as cost in US dollars and percentage of GDP). All estimates were calculated by World Bank income classification and region (for low-income and middle-income countries [LMICs] only) for 2019. We estimated that children younger than 5 years lost 765 million (95% CI 443-1098) IQ points and that 5 545 000 (2 305 000-8 271 000) adults died from cardiovascular disease in 2019 due to lead exposure. 729 million of the IQ points lost (95·3% of the total global IQ loss) and 5 004 000 (90·2% of total) cardiovascular disease deaths due to lead exposure occurred in LMICs. IQ loss in LMICs was nearly 80% higher than a previous estimate. Cardiovascular disease deaths were six times higher than the GBD 2019 estimate. The global cost of lead exposure was US$6·0 trillion (range 2·6-9·0) in 2019, which was equivalent to 6·9% (3·1-10·4) of the global gross domestic product. 77% (range 70-78) of the cost was the welfare cost of cardiovascular disease mortality, and 23% (22-30) was the present value of future income losses from IQ loss. Our findings suggest that global lead exposure has health and economic costs at par with PM2·5 air pollution. However, much work remains to improve the quality of blood lead level measurement data, especially in LMICs. The Korea Green Growth Trust Fund and the World Bank's Pollution Management and Environmental Health Program.

Cognitive Training for Visuospatial Processing in Children Aged 5½ to 6 Years Born Very Preterm With Working Memory Dysfunction

Compared with term-born peers, children born very preterm generally perform poorly in executive functions, particularly in working memory and inhibition. By taking advantage of neuroplasticity, computerized cognitive training of working memory in those children could improve visuospatial processing by boosting visual inhibition via working memory. To evaluate the long-term effect of cognitive working memory training on visuospatial processing in children aged 5½ to 6 years born very preterm who have working memory impairment. This multicenter (18 French university hospitals), open-label randomized clinical trial with 2 parallel groups (EPIREMED) was conducted from November 2016 to April 2018, with the last follow-up during August 2019. Eligible children from the EPIPAGE 2 cohort were aged 5½ to 6 years, were born between 24 and 34 weeks' gestation, and had a global intelligence quotient greater than 70 and a working memory index less than 85. Data were analyzed from February to December 2020. Children were randomized 1:1 to standard care management and a working memory cognitive training program (Cogmed software) for 8 weeks (25 sessions) (intervention) or to standard management (control). The primary outcome was the visuospatial index score from the Wechsler Preschool and Primary Scale of Intelligence, 4th Edition. Secondary outcomes were working memory, intellectual functioning, executive and attention processes, language skills, behavior, quality of life, and schooling. Neurobehavioral assessments were performed at inclusion and after finishing training at 6 months (intermeditate assessment; secondary outcomes) and at 16 months (final assessment; primary outcome). There were 169 children randomized, with a mean (SD) age of 5 years 11 months (2 months); 91 (54%) were female. Of the participants, 84 were in the intervention group (57 of whom [68%] completed at least 15 cognitive training sessions) and 85 were in the control group. The posttraining visuospatial index score was not different between groups at a mean (SD) of 3.0 (1.8) months (difference, -0.6 points; 95% CI, -4.7 to 3.5 points) or 12.9 (2.6) months (difference, 0.1 points; 95% CI, -5.4 to 5.1 points). The working memory index score in the intervention group significantly improved from baseline at the intermediate time point (difference, 4.7 points; 95% CI, 1.2-8.1 points), but this improvement was not maintained at the final assessment. This randomized clinical trial found no lasting effect of a cognitive training program on visuospatial processing in children aged 5½ to 6 years with working memory disorders who were born very preterm. The findings suggest that this training has limited long-term benefits for improving executive function. Transient benefits seemed to be associated with the developmental state of executive functions. ClinicalTrials.gov Identifier: NCT02757794.

Residential and school green and blue spaces and intelligence in children: The Generation XXI birth cohort

Green and blue spaces have numerous health benefits. It has been hypothesized that contact with these spaces can have an important role in cognitive development, because it provides children with unique stimuli that can help develop curiosity, creativity, awareness, and control. This study aimed to estimate the association between exposure to green and blue spaces and the various measures of intelligence quotient (IQ) among children from Porto Metropolitan Area (Portugal).This investigation used data from the Generation XXI birth cohort. Exposure was assessed by Geographic Information Systems using vegetation indexes and measures of accessibility to urban green spaces and blue spaces in the surroundings of the residence and school, measured at 0, 4, 7 and 10 years. The outcome was the verbal, performance, and global IQ, measured using the Wechsler Intelligence Scale for Children (WISC-III), administered at age 10. Associations were estimated using crude and adjusted multilevel models. The mediation role of air pollution and physical activity was quantified.This study included 3827 children. The adjusted models showed that having green spaces up to 800 m of the residence was positively associated with performance IQ (1.30 95%CI [0.26; 2.35]) and global IQ (1.27 [0.18; 2.36]). No clear associations were observed regarding accessibility to blue spaces. Physical activity appeared to have a minor mediation role.Children with urban green spaces around their residences had higher performance and global IQ. Local actors in the sectors of public health and urban planning should promote the creation of green spaces close to residential areas.

A randomized EPIREMED protocol study on the long-term visuo spatial effects of very preterm children with a working memory deficit

BackgroundVery preterm children generally perform poorly in executive functions and particularly in working memory. Adaptive training tasks encouraging these children to work continuously on their personal working memory capacity can be very useful. Above all in preschool-age children, several cognitive training programs focused on improving working memory capacity. Cogmed is a computerized visuospatial cognitive training program that improves working memory in children and adolescents with attention-deficit/hyperactivity disorder. The main objective is to assess the long-term effects (18 months) of cognitive training (Cogmed) on visuospatial processing in preschool-age very preterm children with working memory impairment.MethodsThe EPIREMED study is a prospective, randomized, controlled, multicentric trial nested in a population based epidemiological survey. An intervention group (Cogmed cognitive training) and a control group (standard care management) will compare children aged 5½ to 6 years, born between 24- and 34-weeks’ gestational age, with a global intelligence quotient > 70 and a working memory index < 85. The study will include 166 children from national study EPIPAGE-2 (Epidemiological Study on Small Gestational Ages). The intervention consists of 25 sessions administered over a 5- to 8-week period. The primary endpoint will be the visuospatial processing, assessed by the score of the visuospatial index: score of the WPPSI-IV (Wechsler Preschool and Primary Scale of Intelligence). The secondary endpoints will allow to assess the executive functions, language and abilities, infant behavior, quality of life assessment, school performance and parental anxiety.DiscussionThis project’s primary goal is to demonstrate the necessity of early visuospatial memory assessment within the vulnerable population of very preterm children, and to prove the feasibility and efficacy of computerized cognitive training using online software programs. A better global neuropsychological development improvement (visuospatial processing and other far transfer) can be expected with an improvement in learning and decreased behavioral problems. In the long term, these improvements might also reduce those global costs linked to the consequences of extreme prematurity.Trial registrationNCT02757794 (registered on 2nd May 2016 at ClinicalTrial.gov).

Baseline neuropsychological characteristics in patients with epilepsy with left temporal lobe encephaloceles compared with left mesial temporal sclerosis

BackgroundTemporal lobe encephaloceles (TE) are increasingly recognized as a cause of drug-resistant temporal lobe epilepsy. Improved recognition of these lesions offers an opportunity to treat them with a limited resection sparing the hippocampus. However, as they can be difficult to identify on imaging, additional clues pointing to the diagnosis can be helpful. We sought to understand the baseline cognitive/neuropsychological profile in patients with left temporal lobe epilepsy caused by encephaloceles compared with that caused by mesial temporal sclerosis (MTS), a common entity in the differential diagnosis. MethodsNeuropsychological testing, including language (semantic and phonemic fluency and naming), verbal memory, intelligence quotient (IQ), and executive function measures were compared across two groups (five patients with left TE and five age- and gender-matched patients with left MTS). Other clinical variables related to cognition, including patient age, electroencephalographic characteristics, epilepsy duration, and factors related to antiseizure medication dosing, were also compared between groups. ResultsMore patients with left MTS had atypical language lateralization (3/5 with right-sided language in the group with MTS compared with 0/5 in the group with TE). Patients with MTS had significantly worse scores on the Verbal Comprehension Index (VCI) subscore of the Wechsler Adult Intelligence Scale (WAIS; p = 0.026). General IQ was also worse in patients with MTS (p = 0.028). There was a trend towards worse executive function in patients with MTS as measured on Trails B (p = 0.096). Other measures related to language and verbal memory did not differ significantly between the groups nor did other relevant clinical variables, except epilepsy duration, which was significantly longer in patients with MTS (p = 0.0001). ConclusionsThis pilot study demonstrates few significant differences between the groups with left MTS and TE surveyed. A higher rate of atypical language lateralization was noted in patients with left MTS. The higher baseline global IQ and VCI scores in patients with left TE compared with patients with MTS may be attributable to longer duration of epilepsy in patients with left MTS. Future work with a larger sample size will focus on establishing a unique neuropsychological profile related to epilepsy due to TE.

T138. ADOLESCENT ONSET OF PSYCHOSIS IMPACTS SEGREGATION OF CORTICO-SUBCORTICAL NETWORKS DURING DEVELOPMENT

BackgroundFunctional connectivity (FC) during the resting-state is reduced in schizophrenia, especially within the Default Mode Network (DMN) (Dong 2018), and between the hippocampus, striatum and ventral tegmental area (VTA), which together conform a Midbrain Network (Gangadin 2019). Cross-sectional studies in adult samples have reported altered FC between dopamine synthesizing centers in midbrain and cortical areas in schizophrenia (Martino 2018). Conceptualizing schizophrenia as a neurodevelopmental disorder, we hypothesize that these changes may take place in early ages, prior to the clinical onset of psychosis. Therefore, we aim to examine FC of the DMN and Midbrain networks longitudinally in adolescents at increased risk of developing psychosis compared with youth with early onset psychosis and healthy volunteers (HV).MethodsThis longitudinal case-control study encompassed adolescents (12.6–18.9 years old) with psychosis risk syndrome (PRS; n=47), first episode of psychosis (FEP; n=59), and age and sex-matched HV (n=34). Fourteen out of the 30 PRS with follow-up assessment developed psychosis (t-PRS). Resting-state fMRI data was available for 88 subjects at baseline and follow-up [no significant differences in relation to drop-outs]: 10 t-PRS re-scanned at 3–12 months (at transition), and 14 PRS who did not transited (nt-PRS), 35 FEP; and 29 HV re-scanned at 10–36 month follow-up. After exclusion due to poor acquisition or excess movement, the final sample encompassed: 27 FEP, 9 t-PRS, 12 nt-PRS and 28 HV. Individual time series were extracted from Regions of Interest (ROI): for the DMN, the medial Prefrontal Cortex (mPFC), precuneus (PC), and bilateral temporo-parietal junction (Schilbach 2016); and for the Midbrain Network, the associative and limbic striatum, VTA and subiculum (Gangadin 2019). The orthogonal parameters of movement, white matter and cerebrospinal fluid (and their derivatives) and head motion scrubbing regressors were regressed out before performing the correlations. Multivariate mixed-effect models were estimated, including group (4), time and group by time interaction as fixed effects; and time and individual variability as random effects.ResultsThere were no significant differences within-network FC. There was a significant group by time interaction in FC between the two networks (p = .02), driven by VTA-PC (pFDR = .02) and VTA-mPFC (pFDR = .04). Post-hoc analyses showed a significant reduction in FC in nt-PRS over time (psFDR ≤ .03), with FEP and t-PRS showing an opposite pattern (psFDR ≤ .01) in both networks. There was a trend-level reduction in FC over time in HV (ps ≤ .09), which showed significant differences relative to FEP (ps ≤ .04) in the VTA-PC and VTA-mPFC, and with t-PRS in the VTA-PC (p = .02). There was no significant difference between HV and nt-PRS. Cumulative dose of antipsychotics was negatively correlated with FC between mPFC-VTA in FEP at follow-up (r = -.41; p = .04); yet group by time effects survived when used as covariable. Sex, socio-economic status or global intelligence quotient did not exert significant effects.DiscussionOur findings suggest that the onset of psychosis during adolescence impacts on the age-normative reduction of FC between the DMN and Midbrain networks, characteristic of the network segregation which takes place during typical brain functional development (Satterthwaite 2013). Antipsychotic medication on cortico-subcortical FC appear to have a reversing effect on these findings, although longitudinal group differences in network connectivity persist despite controlling for this effect. Our data sheds light on the changes in the organization of brain function taking place in the early stages of psychosis, coinciding with a key developmental period.

Do infants of breast-feeding mothers benefit from additional long-chain PUFA from fish oil? A 6-year follow-up.

Fish-oil supplements are marketed as enhancing intelligence and cognitive performance. However, empirical data concerning the utility of these products in healthy term infants are mixed, particularly with respect to lasting effects into childhood. We evaluated whether fish-oil supplementation during infancy leads to better neurocognitive/behavioural development at 6 years. We conducted a double-blind randomised controlled trial of supplementation with n-3 long-chain PUFA in 420 healthy term infants. Infants received either fish oil (containing at least 250 mg DHA and at least 60 mg EPA) or placebo (olive oil) daily from birth to 6 months of age. Neurodevelopmental follow-up was conducted at a mean age of 6 years (sd 7 months), whereby 335 children were assessed for language, executive functioning, global intelligence quotient and behaviour. No significant differences were observed between the groups for the main neurocognitive outcomes. However in parent-report questionnaire, fish-oil supplementation was associated with negative externalising (P = 0·035, d = 0·24) and oppositional/defiant behaviour (P = 0·006, d = 0·31), particularly in boys (P = 0·01, d = 0·45; P = 0·004, d = 0·40). Our results provide evidence that fish-oil supplementation to predominantly breast-fed infants confers no significant cognitive or behavioural benefit to children at 6 years.

Gene polymorphisms of cognitive function in patients with bipolar disorder: A systematic review and meta-analysis

Objectives: Evidence showed that the etiology of cognitive impairment in bipolar disorder (BD) is related to genetic susceptibility. But results from many studies evaluating the association between candidate genes and cognitive function in BD are inconsistent. To define the effect of risk target single-nucleotide polymorphisms (SNPs) on the association of cognition in BD, we did a systematic review and meta-analysis to study the risk genetic variants. Methods: A search for literature was conducted through online databases updated as of October 2018. Recruited studies were compared for cognitive difference in BD patients with certain gene polymorphisms. Results: Meta-analyses were conducted, for two SNPs of target genes including brain-derived neurotrophic factor (rs6265) and calcium channel, voltage-dependent, L type, alpha 1C subunit (rs1006737), in the recruited seven studies. Quantitative analysis showed no significance in the association between the polymorphisms of rs6265 or rs1006737 with global intelligence quotient or rs6265 with Wisconsin Card Sorting test in BD. Conclusion: Our results implied that the cognitive impairment in patients with BD might not be explained by a SNP in current evidence. We suggest that further studies with larger sample size and deeper phenotype are needed to elucidate the relevance of gene variant model contributed to the susceptibility of cognitive dysfunction in patients with BD.

Assessment of School-Aged Children of Mothers With Idiopathic Generalized Epilepsy.

The aim is to examine the cognitive domains, behavioral domains, and electroencephalogram (EEG) findings in children of mothers with idiopathic generalized epilepsy who had been exposed to antiepileptic drugs (AEDs) in utero. Forty school-aged children born to 23 mothers with idiopathic generalized epilepsy were compared with 40 healthy children born to 34 healthy mothers. Stanford-Binet Intelligence Scale was applied to all children to assess their cognitive functions. Child Behavior Checklist was used to assess their behavioral characteristics. EEG was done for the epileptic mothers and their children. Children exposed to AEDs showed significantly lower scores in the verbal reasoning, visual reasoning, and global intelligence quotient (IQ). There was a significantly positive correlation between children's global IQ and maternal global IQ. Multiple regression analysis showed that in utero exposure to valproate and maternal IQ were the most independent factors affecting children's IQ. EEG findings of participating children were normal. Exposure to valproic acid during fetal life and maternal IQ represent confounding factors affecting the IQ of children with in utero exposure to AEDs.

Abstract 4910: Neurocognitive effects of central nervous system directed chemotherapy in Non Hodgkin Lymphoma diseased children

Abstract Background and Purpose. Because the blood-brain barrier serves as a pharmacological barrier, malignant cells can remain in the central nervous system (CNS) despite systemic chemotherapy. Consequently, CNS-directed treatment is an essential part of therapy for Non-Hodgkin lymphoma (NHL). We aimed in this analysis to determine the neurocognitive effects of CNS-directed chemotherapy in children with NHL. Methods. In a cross-sectional study 20 NHL diseased children and 10 healthy controls were tested for neurocognitive functions. The selection criteria were: 3 years or more after the end of NHL chemotherapy only regimen, no anaemia, no CNS or systemic diseases. Both patients and healthy controls were examined for global intelligence quotient (IQ), verbal IQ, performance IQ, attention measures, auditory tests, long and short memory, math skills and academic achievement. Results. No decline in global IQ in NHL children compared to healthy controls but there was a significant decline of attention, verbal comprehension and performance IQ. Among 20 NHL diseased children 18 had poor recent and immediate memories while remote memory was normal in 16 children. Young age at diagnosis and treatment intensity were the commonest risk factors. Conclusion. In absence of cranial irradiation, childhood survivors of NHL experience long-term neurocognitive deficits after chemotherapy treatment. Global IQ is not a sufficiently sensitive measure to detect specific CNS deficits in NHL diseased children. The deficits are mainly present in basic neurophysiologic processes of attention and executive functioning. Note: This abstract was not presented at the meeting. Citation Format: Abeer Abd Elmoneim, Ahlam Eladawy, Mona Abu Elkasem, Soumaya Hadhood. Neurocognitive effects of central nervous system directed chemotherapy in Non Hodgkin Lymphoma diseased children [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 4910.

Physicians' Understanding of Nutritional Factors Determining Brain Development and Cognition in the Middle East and Africa.

PurposeProper nutrition is essential for brain development during infancy, contributing to the continued development of cognitive, motor, and socio-emotional skills throughout life. Considering the insufficient published data in the Middle East and North Africa, experts drafted a questionnaire to assess the opinions and knowledge of physicians on the impact of nutrition on brain development and cognition in early life.MethodsThe questionnaire consisted of two parts: The first focused on the responders' demographic and professional characteristics and the second questioned the role of nutrition in brain development and cognition. Descriptive statistics were used to summarize respondents' characteristics and their responses to questions.ResultsA total of 1,500 questionnaires were distributed; 994 physicians responded. The majority of the surveyed physicians (64.4%) felt that nutrition impacts brain development in early childhood (0–4 years), with almost 90% of physicians agreeing/strongly agreeing that preventing iron, zinc, and iodine deficiency would improve global intelligence quotient. The majority of physicians (83%) agreed that head circumference was the most important measure of brain development. The majority of physicians (68.9%) responded that the period from the last trimester until 18 months postdelivery was crucial for brain growth and neurodevelopment, with 76.8% believing that infants breast-fed by vegan mothers have an increased risk of impaired brain development.ConclusionThe results of this study show that practicing physicians significantly agree that nutrition plays an important role in brain and cognitive development and function in early childhood, particularly during the last trimester until 18 months postdelivery.

Intellectual outcome after a cortical lesion with versus without epilepsy: A life span neurodevelopmental view

In patients with cortical lesions, the structure of intelligence has never been studied as a function of age at lesion onset and presence vs absence of lesional epilepsy over the life span. MethodTwo thousand one hundred eighty-six cases were assembled bearing unilateral cortical lesions occurring at all ages (1301 with seizures) with postlesion verbal intelligence quotient (IQ) (VIQ) and performance IQ (PIQ). ResultsGlobal IQ significantly and constantly decreased as a function of age at lesion onset in the cases without epilepsy, and increased in the cases with epilepsy. Beyond the lesion onset age of 12 years, VIQ was significantly higher than PIQ in the cases without epilepsy, and lower in the cases with epilepsy. The VIQ/PIQ × lesion-side interaction indicative of hemispheric specialization increased significantly linearly with age at lesion onset in the patients without epilepsy but ceased to progress at the lesion-onset age of 30 years and beyond in the cases with epilepsy. ConclusionPostlesion global IQ, the difference between VIQ and PIQ, and the laterality index all vary significantly as a function of age at lesion onset. In addition, these changes over the life span are all quite different between cases with and without epilepsy.

Inteligencia emocional y bullying en escolares de primaria

Diferentes estudios señalan claras diferencias en los perfiles de inteligencia emocional asociados a los roles de víctima o agresor en el fenómeno del bullying (Casas, Ortega, Del Rey,2015). Estos estudios se centran habitualmente en población adolescente, pero existen menos estudios que analicen este fenómeno en menores de 11 años. El Estudio Cisneros (Piñuel, 2006) refleja que los índices de acoso escolar en primaria superan a los de secundaria, por esto consideramos necesario el análisis de las características emocionales de los menores de 11 años implicados en el bullying. El objetivo de este trabajo es analizar el perfil emocional de escolares de entre 8 y 11 años implicados en el bullying. Para ello se entrevistaron 291 niños de entre 8 y 11 años en los que se evaluaron las variables, Inteligencia emocional rasgo con el Inventario de Inteligencia Emocional BarOn ICE: NA (Bar-On, 2004), y Rol asociado al fenómeno de bullying con el Test Bull-S (Cerezo, 2002).Los resultados confirma que la prevalencia de bullying en esta edad es alta (18% agresores y 12% víctimas) siendo los chicos los que en la mayor parte de las ocasiones asumen el papel de agresor (90%) y víctima (67%).Tras realizar un ANOVA de un factor se confirmó con un índice de significación &lt;0,05 que losniños agresores puntuaban más bajo en el cociente de Inteligencia Emocional Global así como en las dimensiones Habilidades Interpersonales y Manejo del Estrés. A su vez las victimas presentaron puntuaciones inferiores en dichas dimensiones en comparación con los observadores pero más elevadas que las de los agresores.Podemos concluir que el papel de la Inteligencia Emocional en los niños de primaria implicados en el fenómeno de bullying es un aspecto a tener en cuenta, a la hora de diseñar estrategias de prevención.

N–3 Fatty Acid Supplementation in Mothers, Preterm Infants, and Term Infants and Childhood Psychomotor and Visual Development: A Systematic Review and Meta-Analysis

Epidemiologic studies link maternal seafood and n-3 (ω-3) polyunsaturated fatty acid (PUFA) consumption with improved childhood cognitive development; trials show mixed results. We investigated effects of n-3 PUFA supplementation on child cognitive and visual outcomes. We systematically reviewed and meta-analyzed randomized controlled trials of n-3 PUFA supplementation in mothers or infants (age≤2 y) and evaluated standardized measures of cognitive or visual development up to age 18 y. Of 6286 abstracts and 669 full-text articles, 38 trials with 53 intervention arms were included. Data were extracted independently in duplicate. Findings were pooled using random-effects meta-analysis across supplementation periods (maternal, preterm, term infant); we also explored subgroup analyses stratified by supplementation period. Heterogeneity was explored using I2, stratified analysis, and meta-regression. Cognitive development was assessed by Bayley Scales of Infant Development mental and psychomotor developmental indexes (MDI, PDI) and intelligence quotient (IQ); visual acuity was assessed by electrophysiological or behavioral measures. The 38 trials (mothers: n=13; preterm infants: n=7; term infants: n=18) included 5541 participants. When we explored effects during different periods of supplementation, n-3 PUFA supplementation improved MDI in preterm infants (3.33; 95% CI: 0.72, 5.93), without statistically significant effects on PDI or IQ in different intervention period subgroups. Visual acuity [measured as the logarithm of the minimum angle of resolution (logMAR)] was improved by supplementation in preterm (-0.08 logMAR; 95% CI: -0.14, -0.01 logMAR) and term infants (-0.08 logMAR; 95% CI: -0.11, -0.05 logMAR), with a nonsignificant trend for maternal supplementation (-0.02 logMAR; 95% CI: -0.04, 0.00 logMAR). In main analyses pooling all supplementation periods, compared with placebo, n-3 PUFA supplementation improved MDI (n=21 trials; 0.91; 95% CI: 0.005, 1.81; P=0.049), PDI (n=21 trials; 1.06 higher index; 95% CI: 0.10, 2.03; P=0.031), and visual acuity (n=24; -0.063 logMAR; 95% CI: -0.084, -0.041 logMAR; P<0.001) but not IQ (n=7; 0.20; 95% CI: -1.56, 1.96, P=0.83), although few studies assessed this endpoint. Potential publication bias was identified for MDI (Eggers P=0.005), but not other endpoints. Significant differences in findings were not identified by world region, race, maternal education, age at outcome assessment, supplementation duration, DHA or EPA dose, DHA:AA ratio, or study quality score (P-interaction>0.05 each). n-3 PUFA supplementation improves childhood psychomotor and visual development, without significant effects on global IQ later in childhood, although the latter conclusion is based on fewer studies.

Efficacy of Stereotactic Conformal Radiotherapy vs Conventional Radiotherapy on Benign and Low-Grade Brain Tumors

ImportanceEvidence for application of stereotactic and other conformal radiotherapy techniques in treating brain tumors is largely based on data derived from dosimetric, retrospective, or small prospective studies. Therefore, we conducted a randomized clinical trial of stereotactic conformal radiotherapy (SCRT) compared with conventional radiotherapy (ConvRT) evaluating clinically meaningful end points.ObjectiveTo compare neurocognitive and endocrine functional outcomes and survival at 5 years in young patients with residual and/or progressive benign or low-grade brain tumors treated with SCRT and ConvRT techniques.Design, Setting, and ParticipantsThis phase 3 randomized clinical trial enrolled 200 young patients (ages 3-25 years) with residual or progressive benign or low-grade brain tumors at a single center between April 2001 to March 2012. Patients were randomly allocated (1:1) to either SCRT (n = 104) or ConvRT (n = 96) arms.InterventionsPatients were randomly assigned to either high-precision SCRT or ConvRT to a dose of 54 Gy in 30 fractions over 6 weeks.Main Outcomes and MeasuresDetailed neuropsychological and neuroendocrine assessments were performed at preradiotherapy baseline, at 6 months, and annually thereafter until 5 years on longitudinal follow-up. Change in these functional parameters was compared between the 2 arms as the primary end point and overall survival (OS) as the secondary end point.ResultsIn total, 200 young patients (median [interquartile range] age, 13 [9-17] years; 133 males and 67 females) were enrolled. Mean full-scale or global intelligence quotient (IQ) and performance IQ scores over a period of 5 years were significantly superior in patients treated with SCRT compared with those treated with ConvRT (difference in slope = 1.48; P = .04 vs difference in slope = 1.64; P = .046, respectively). Cumulative incidence of developing new neuroendocrine dysfunction at 5 years was significantly lower in patients treated with SCRT compared with ConvRT (31% vs 51%; P = .01) while developing a new neuroendocrine axis dysfunction in patients with preexisting dysfunction in at least 1 axis at baseline was also significantly lower in the SCRT arm compared with the ConvRT arm (29% vs 52%; P = .02). Five-year OS in SCRT and ConvRT arms was 86% and 91%, respectively (P = .54).Conclusions and RelevanceIn young patients with residual and/or progressive benign or low-grade brain tumors requiring radiotherapy for long-term tumor control, SCRT compared with ConvRT achieves superior neurocognitive and neuroendocrine functional outcomes over 5 years without compromising survival.Trial Registrationclinicaltrials.gov Identifier: NCT00517959

Air Pollution and Neuropsychological Development: A Review of the Latest Evidence

For the last decade, literature on the detrimental impacts of air pollution on brain, cognition and behavior has exponentially increased. Our aim is to review the latest epidemiologic literature on the association between outdoor air pollution and neuropsychological developmental in children. Two independent researchers searched for published studies between January 1, 2012 and June 12, 2015 in MEDLINE, Web of Science, and Science direct using defined keywords on outdoor air pollution and neuropsychological development. Selection of articles was based on study eligibility criteria. We encountered sufficient evidence of detrimental effects of pre- or postnatal exposure to polycyclic aromatic hydrocarbons on global intelligence quotient. The evidence was also sufficient for the association between pre- or postnatal exposure to fine particulate matter (PM2.5) and autism spectrum disorder, and limited evidence was encountered between nitrogen oxides and autism spectrum disorder. For other exposure-outcome associations reviewed, the evidence was inadequate or insufficient. Although evidence is not yet conclusive and further research is needed, the latest epidemiological studies support the hypothesis that pre- or postnatal exposure to ambient pollution, particularly polycyclic aromatic hydrocarbons, PM2.5, and nitrogen oxides has a negative impact on the neuropsychological development of children. The public health impact of air pollutants cannot be ignored and the precautionary principle should be applied to protect children.

Early kidney transplantation improves neurocognitive outcome in patients with severe congenital chronic kidney disease.

Renal replacement therapy has become available for the majority of patients suffering from severe congenital chronic kidney disease (CKD). Data on the long-term neurocognitive outcome and the impact of early kidney transplantation (KTx) in this setting is unclear. Neurocognitive outcomes in 15 patients (11 male) with isolated congenital CKD (stage 3-5) requiring KTx at a mean age of 2.8±1.3 were assessed at a mean age of 8.3±1.4years. Patients underwent neurological examination and testing for neuromotor and neurocognitive function using three independent tests. Pre-emptive KTx was performed in six patients, and nine patients were dialyzed prior to KTx for a mean period of 11.1±8.6months. Neuromotor function was abnormal in 8/15 patients. HAWIK-III showed a global intelligence quotient (IQ) of 93.5±11.4 (P=0.05) due to a significantly reduced performance IQ of 89.1±11.3 (P<0.01). In three patients, the global IQ was clinically significantly reduced by >1 SD to <85. In patients with neuromotor dysfunction, performance IQ was lower than in patients with normal neuromotor function (83.8±10.2 vs. 96.2±9.0, P=0.04). Time on dialysis was inversely correlated to verbal IQ (r=0.78, P=0.02). Pre-emptive KTx and duration of dialysis treatment <3months was associated with superior neurocognitive outcome. Early (pre-emptive) KTx results in superior long-term neurocognitive outcome in children with severe congenital CKD.

The Efficacy of Cognitive Stimulation on Depression and Cognition in Elderly Patients with Cognitive Impairment: A Retrospective Cohort Study

Cognitive decline due to neurodegenerative diseases is a prevalent worldwide problem. Both pharmacological and non-pharmacological treatments to improve, delay or stop disease progression are of vital importance. Cognitive stimulation is frequently used in clinical practice; however, there are few studies that demonstrate its efficacy. Aim: To evaluate the efficacy of cognitive stimulation in patients with mild cognitive impairment (CDR = 0.5) and dementia (CDR = 1). Methods: A retrospective cohort study was performed. Patients with cognitive impairment receiving weekly cognitive stimulation (16 or 24 sessions) were evaluated with a complete neuropsychological battery before and after the stimulation program. Each stimulation session was carried out by a trained neuropsychologist. Results: Forty two patients receiving cognitive stimulation were evaluated over a period of 12.53 months (SD 5.5). Patients were grouped as 11 amnesic mild cognitive impairment (aMCI), 23 multi domain mild cognitive impairment (mMCI) and 8 Mild Alzheimer's Dementia (CDR 1). None of the groups improved their cognitive functions after the cognitive stimulation program. MCI group was also divided according to their global intelligence quotient (IQ) into two groups: low (IQ &lt; 98.5) and high (IQ &gt; 98.5). Each group was compared before and after the stimulation program and no significant difference was found (<em>p</em> ≥ 0.05). Moreover, MCI group was also analyzed according to the duration of the stimulation program: less than 9, between 9 and 13 and more than 13 months. Different duration groups were compared before and after the cognitive stimulation program and no significant differences were found. Depression, anxiety and subjective memory symptoms were also analysed and neither improvement nor worsening could be demonstrated. Conclusions: Patients remained stable, both in cognitive and behavioural domains, for more than 18 months. However, no significant cognitive or behavioural improvement can be reported in these patients after the stimulation program (duration time: 12.53 months SD 5.5).

Neurological involvement in children with E. coli O104:H4-induced hemolytic uremic syndrome

The aim of this study was to analyze the neurological involvement and outcome in pediatric patients with hemolytic uremic syndrome (HUS) during the 2011 epidemic caused by Escherichia coli O104:H4. Clinical data and data from magnetic resonance imaging (MRI) scans and electroencephalography (EEG) during the acute phase of the disease and during follow-up at 3 and 6 months were analyzed in 50 patients. Twenty-five of these patients underwent neuropsychological testing (WISC IV) during follow-up. Neurological involvement (stupor or coma, seizures, visual disturbances, paresis, myocloni) was initially observed in 14/50 (28%) patients. One patient died. EEG abnormalities were more frequent in patients with neurological involvement than in those without (12/14 vs. 13/25, respectively). Cranial MRI scans were analyzed in nine patients with neurological involvement, of whom five showed abnormal findings. At the 3- and 6-month follow-ups, EEG abnormalities were found in 14/40 (35%) and 7/36 (19%) patients, respectively, whereas 28/42 (67%) and 17/39 (44%) patients, respectively, complained about on-going reduced performance. Neuropsychological testing showed a slightly lower global intelligence quotient in patients with neurological involvement versus those without (113.4 ± 2.8 vs. 119.4 ± 1.8, respectively). Neurological involvement was frequent in our cohort. Accordingly, the incidence of pathological EEG findings was high, even in patients without clinical signs of neurological involvement. Nevertheless, major neurological sequelae were rare, and neuropsychological outcome was favorable after 6 months.