Impaired Intellectual Functioning Research Articles

A case report of the neurocognitive and behavioral phenotype of mosaic trisomy 14

ABSTRACTMosaic trisomy 14 is associated with impaired intellectual functioning, although no study has examined the cognitive-behavioral profile associated with the syndrome. This study provides the first case description of the cognitive-behavioral phenotype associated with mosaic trisomy 14 by contrasting the performance an adolescent female (T14) with a group of females with Down syndrome (DS; n=9). T14 performed below age expectations on most direct assessments and demonstrated weaknesses relative to the DS group on aspects of language, adaptive functioning, and executive functioning. T14 also demonstrated strengths in delayed visual recall and social skills relative to the DS group.

Quality improvement in neurology: Epilepsy Quality Measurement Set 2017 update.

Epilepsy is a common condition in the United States. It is estimated that 1.2% of the population or 3.4 million people have epilepsy. This figure may be underestimated because of potential repercussions and stigma in disclosing epilepsy.1 Studies have shown that people with epilepsy are more likely to be unemployed or unable to work, have lower annual household incomes, be obese and physically inactive, and be less likely to marry.2,3 People with epilepsy can have poor overall health status, impaired intellectual and physical functioning, elevated risk of accidents and injuries, and negative side effects from antiseizure medications.2,3 It is estimated the annual direct medical cost of epilepsy in the United States is $9.6 billion; combined with indirect costs, the total rises to $15.5 billion yearly.2

PERAN ORANG TUA TERHADAP KETERAMPILAN MENYIKAT GIGI DAN MULUT PADA ANAK DISABILITAS INTELEKTUAL

Intellectual disability is a group of children with impaired intellectual function below an average of 70 or lower. This group experienced problems in terms of self-development skills such as tooth brushing. Tooth brushing is an activity the mechanical removal of from food scraps, germs and plaque. Growing and developing independence of children with intellectual disability was influenced by the role of parents. Parents who have a role as basic of children behavior was contributed to process child growth. This study aims to determine the relationship of parental role to the tooth brushing skill in intellectual disability children.This research method is analytic survey and used cross sectional design. Sampling technique using total sampling. The population in this research is intellectual disability children in SLB Pamardi Putra Banguntapan Bantul Yogyakarta as many as 30 people. The role of parent was measured using questionnaire and tooth brushing skills measured using check list (from Special Care Advocates in Dentistry (SAID) guidelines, 1995). Data analysis using Spearman correlation with significance level (0,05). The result of this research is p = 0.185 (> 0.05), it shows that there is no significant correlation between parent role to oral and brushing skills in intellectual disability children in SLB Pamardi Putra Banguntapan Yogyakarta.

Standardised Neuropsychological Assessment for the Selection of Patients Undergoing DBS for Parkinson's Disease.

DBS is an increasingly offered advanced treatment for Parkinson's disease (PD). Neuropsychological assessment is considered to be an important part of the screening for selection of candidates for this treatment. However, no standardised screening procedure currently exists. In this study, we examined the use of our standardised neuropsychological assessment for the evaluation of surgical candidates and to identify risk factors for subsequent decline in cognition and mood. A total of 40 patients were assessed before and after DBS. Evaluation of mood and case notes review was also undertaken. Before DBS, patients with PD demonstrated frequent impairments in intellectual functioning, memory, attention, and executive function, as well as high rates of mood disorder. Post-DBS, there was a general decline in verbal fluency only, and in one patient, we documented an immediate and irreversible global cognitive decline, which was associated with older age and more encompassing cognitive deficits at baseline. Case note review revealed that a high proportion of patients developed mood disorder, which was associated with higher levels of depression at baseline and greater reduction in levodopa medication. We conclude that our neuropsychological assessment is suitable for the screening of candidates and can identify baseline risk factors, which requires careful consideration before and after surgery.

Long-Term Neurological Deficits in Child Survivors of Plasmodium falciparum Cerebral Malaria in Sub-Saharan Africa

Cerebral malaria, characterized by multiple seizures, coma, and other neurological abnormalities, is a particularly devastating complication of Plasmodium falciparum malaria. Children in sub-Saharan Africa comprise the most susceptible group to cerebral malaria worldwide, with more than 575,000 cases each year. Long-term neurological deficits—including motor impairments, language regression, cognitive deficits, behavioural abnormalities, and epilepsy—occur in approximately 25% of child survivors of cerebral malaria, which is now recognized as the leading cause of childhood neurodisability in sub-Saharan Africa. These neurological sequelae generate a significant economic and social burden as child survivors’ impaired intellectual function impacts their prospects for education and future employment. While current understanding of risk factors, disease mechanisms, and treatments for these neurological deficits is lacking, recent studies have shown great promise in revolutionizing the way that cerebral malaria is diagnosed and treated. It is speculated that during an acute attack of cerebral malaria, an inflammatory response to malarial antigens in neural blood vessels triggers a cascade of events that ultimately results in cerebral tissue damage and hemorrhaging into the brain, causing long-term brain damage. Potential risk factors for neurological deficits include the duration of coma, the occurrence of multiple seizures, and high fever. Malaria retinopathy and angiopoietin are being investigated as potential biomarkers to improve the definitive diagnosis of cerebral malaria. New drug therapies to prevent long-term neurological deficits after cerebral malaria include erythropoietin and statins, and cognitive rehabilitation and speech therapy have been shown to be successful in rehabilitating survivors.

Intellectual Functioning in Offspring of Parents with Bipolar Disorder: A Review of the Literature.

Impaired intellectual functioning is an important risk factor for the emergence of severe mental illness. Unlike many other forms of mental disorder however, the association between bipolar disorder and intellectual deficits is unclear. In this narrative review, we examine the current evidence on intellectual functioning in children and adolescents at risk for developing bipolar disorder. The results are based on 18 independent, peer-reviewed publications from 1980 to 2017 that met criteria for this study. The findings yielded no consistent evidence of lower or higher intellectual quotient (IQ) in offspring of parents diagnosed with bipolar disorder. Some tentative evidence was found for lower performance IQ in offspring of bipolar parents as compared to controls. It is recommended that future research examine variability in intellectual functioning and potential moderators. These findings demonstrate the need to examine how intellectual functioning unfolds across development given the potential role of IQ as a marker of vulnerability or resilience in youth at high risk for affective disorders.

Taylor-type focal cortical dysplasia: is the epilepsy always resistant to medical treatment?

Patients with Taylor-type focal cortical dysplasia (TTFCD) generally present with medically intractable epilepsy and impaired neurological and/or intellectual functioning. Surgery usually proves to be the only treatment approach leading to control of seizures. We describe a 17-year-old girl with TTFCD who exhibited a very long period of seizure remission. Combined clinical and neuroimaging findings were compatible with a diagnosis of a balloon cell-subtype TTFCD. As for the clinical course, partial motor seizures began at one year of age and ceased at five: our patient has had no seizure recurrence over a 12-year-follow-up. Moreover, throughout the 15-year follow-up, neurological examinations and cognitive abilities always remained within normal limits. Neuropsychological assessment clearly showed no impairments in executive functions: planning abilities, working memory, attention and impulse control, or constructive aspects of motor coordination. The predominant deficits pertained to verbal abilities in the context of borderline intellectual performances. To our knowledge, this case report documents the longest duration of seizure remission in a patient with TTFCD, thus emphasizing the possible benign course of such dysplastic lesions which usually have a poor prognosis, leading to early surgical treatment.

Classification Accuracy of Sequentially Administered WAIS-IV Short Forms

A Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV) short form (SF) may be effective for ruling out subnormal intelligence. To create a useful SF, subtest administration should follow the order prescribed in the manual and, depending upon individual performance, be terminated after completion of 2, 3, 4, or 5 subtests. One hundred and twenty-two patients completed the WAIS-IV. In two analyses, Full-Scale IQs (FSIQs) ≤69 and ≤79 were classified as impairment. Classification accuracy statistics indicated that all SFs using both cutoff scores exceeded the base rate (i.e., 14% and 34%) of subnormal intelligence, with hit rates ranging from 84% to 95%. The FSIQ cutoff of ≤69 had poor sensitivity for detecting impaired intellectual functioning with the 2-, 3-, 4-, and 5-subtest SFs; specificity, positive predictive value (PPV), and negative predictive value (NPV) were excellent for each SF. With the FSIQ cutoff of ≤79, sensitivity was strong to excellent for the 3-, 4-, and 5-subtest SFs as were specificity, PPV, and NPV.

A Scientific Research Review on the Pattern of Psychopathological Comorbidity in Persons with Intellectual Disabilities

Intellectual disability is an alternate term which is currently preferred for the disability historically known as mental retardation. Intellectual disability also called intellectual developmental disorder is a neuro-developmental disorder that typically occurs before the age of 18 years. It is characterized by impaired intellectual and adaptive functioning which is defined by an IQ score below 70 as well as a delay in general daily living skills. According to AAID (2010) intellectual disability is a disability characterized by significant limitations in intellectual functioning which includes reasoning, learning and problem solving, and adaptive behavior which covers a range of everyday social and practical skills. The prevalence rate of intellectual disability based on overall general population is approximately 1% and prevalence rates vary by age. Prevalence for severe intellectual disability is approximately 6 per 1000. According to National Sample Survey Organization (NSSO) under the department of Statistics Government of India the current prevalence rate of intellectual disability is about 20 (3%) per 1000 from general population. Intellectual disability is a complex type of disability; however the problem is compounded significantly when complicated by emotional and behavior problems. Psychopathology is not only the most common complication associated with intellectual but it also carries the most critical consequences. Persons with intellectual disability do experience with full spectrum of psychiatric disorders like psychosis, depression, anxiety, epilepsy, schizophrenia etc. Persons with intellectual disability seem to be more vulnerable to emotional disorders, behavioral disorders and psychopathology as compared to general population. The present study has been undertaken with a view to understand the pattern of psychopathology present in persons with intellectual disability. An attempt was made to study the diagnostic issues, socio-demographic and clinical variables associated with psychopathology of persons with intellectual disability through a research review.

C-29 * Intellectual Ability and Functional Outcome in Bipolar Disorder and Schizophrenia

Objective: Deficits in intellectual ability and functional outcome are consistently found in schizophrenia (SZ). Recently, there has been a growing interest in the role of psychotic symptoms in bipolar disorder (BP) as markers for impairment typically associated with SZ. This study examined intellectual ability and functional outcome in BP with psychotic features (BP+), BP without psychotic features (BP-), SZ, and normal controls (NC). Method: Individuals (71 SZ, 60 BP + , 68 BP-, 51 NC) were assessed using the UCSD Performance Based Skills Assessment (UPSA), which assesses everyday functioning in five domains (comprehension, finance, transportation, and household skills). Additionally, subtests from the Wechsler Adult Intelligence Scale-III were used to estimate IQ. Results: Results indicated that the SZ group performed worse on all domains of the UPSA and had a lower estimated IQ compared to the BP + , BP-, and NC groups (p < .05). Only performance on the transportation scale of the UPSA differentiated BP + , BP- and NC groups, with the BP+ group performing significantly lower (p < .05). Estimated IQ did not differ between the BP + , BP-, and NC groups and was correlated with all UPSA domains. Conclusion(s): Consistent with previous findings, results indicate impaired intellectual functioning and deficits across functional domains in SZ. This study extends findings to BP, indicating that the transportation scale of the UPSA may be sensitive to psychotic symptoms. Given that intellectual abilities did not differ between BP+ and BP-, further research should investigate cognitive processes underlying this impairment as a potential therapeutic target relevant for improving everyday functioning in the disorder.

Treating Individuals With Intellectual Disabilities and Challenging Behaviors With Adapted Dialectical Behavior Therapy

Approximately one third of adults with intellectual and developmental disabilities have emotion dysregulation and challenging behaviors (CBs). Although research has not yet confirmed that existing treatments adequately reduce CBs in this population, dialectical behavior therapy (DBT) holds promise, as it has been shown to effectively reduce CBs in other emotionally dysregulated populations. This longitudinal single-group pilot study examined whether individuals with impaired intellectual functioning would show reductions in CBs while receiving standard DBT individual therapy used in conjunction with the Skills System (DBT-SS), a DBT emotion regulation skills curriculum adapted for individuals with cognitive impairment. Forty adults with developmental disabilities (most of whom also had intellectual disabilities) and CBs, including histories of aggression, self-injury, sexual offending, or other CBs, participated in this study. Changes in their behaviors were monitored over 4 years while in DBT-SS. Large reductions in CBs were observed during the 4 years. These findings suggest that modified DBT holds promise for effectively treating individuals with intellectual and developmental disabilities.

Intellectual functioning and multi-dimensional attentional processes in long-term survivors of a central nervous system related pediatric malignancy

AimsCentral nervous system (CNS) malignancies and/or their treatment in pediatric cancer survivors are known to be associated with deficits in neuropsychological functions. We report findings from a nation-wide study of childhood cancer survivors to investigate intelligence and attention/concentration from a multi-dimensional perspective in a diverse sample from this population. Main methodsFour hundred forty-four pediatric cancer survivors between 6 and 17years of age, who had suffered CNS involvement associated with their malignancy, were evaluated. All patients completed a measure of general intelligence. Attention was measured by a continuous performance test (CPT) and by parental report using a standardized psychological inventory. Key findingsSocial economic status (SES) was a significant predictor of intellectual functioning and scores on independent measures of attention. After controlling for SES, cranial radiation therapy (CRT) was strongly predictive of impairments in intellectual functioning. Patients who had completed a transplant procedure did not have significant impairments in intellectual functioning when compared to other participants. CPT performance was most clearly influenced by a younger age at diagnosis and the presence of a supratentorial brain tumor. Reaction time was lower in patients who had received CRT. Gender did not correlate with CPT performance, but caregiver reports of deficits in attentional functioning were more prevalent in girls compared to boys. SignificanceThese findings are important given the large, representative sample and multi-dimensional assessment of attentional functioning. The presence of a very strong SES effect on all dependent variables must be addressed in studies of this nature.

Postictal psychosis in temporal lobe epilepsy: a case–control study

To investigate the prevalence of postictal psychosis (PP) in patients with temporal lobe epilepsy (TLE) and to estimate the predictive value of various variables for the development of PP. By retrospectively reviewing the charts of all patients evaluated with video-electroencephalogram (EEG)-monitoring at our unit between January 1995 and February 2012, we identified 684 patients with TLE, of which 48 patients had a history of PP. Patients with TLE and PP were compared with 200 controls (patients with TLE without a psychotic history) on demographic, clinical, EEG and magnetic resonance imaging (MRI) variables. The prevalence of PP in our TLE sample was 7.0%. Aggressive behaviour during PP was present in 22.9% of the sample. Univariate analysis revealed that PP was significantly associated with early age at epilepsy onset (P = 0.007), longer duration of epilepsy (P = 0.002), presence of ictal fear (P = 0.005), impaired intellectual function (P = 0.045), and bilateral ictal and interictal epileptiform activity (both P < 0.0001). Using logistic regression analysis, ictal fear [odds ratio (OR) 2.88; P = 0.015] and bilateral interictal EEG activity (OR 6.40; P < 0.0001) were predictive of PP development. No association of PP with MRI pathology or epilepsy-relevant aetiological factors was found. PP is a frequent and potentially dangerous complication within the course of TLE. Bilateral or widespread functional central nervous system disturbances rather than distinct structural brain alterations or certain predisposing aetiologies of epilepsy appear to be a risk factor for the development of PP. Ictal fear may be a predictive clinical variable of PP in TLE.

Reducing GABAAα5 Receptor-Mediated Inhibition Rescues Functional and Neuromorphological Deficits in a Mouse Model of Down Syndrome

Down syndrome (DS) is associated with neurological complications, including cognitive deficits that lead to impairment in intellectual functioning. Increased GABA-mediated inhibition has been proposed as a mechanism underlying deficient cognition in the Ts65Dn (TS) mouse model of DS. We show that chronic treatment of these mice with RO4938581 (3-bromo-10-(difluoromethyl)-9H-benzo[f]imidazo[1,5-a][1,2,4]triazolo[1,5-d][1,4]diazepine), a selective GABA(A) α5 negative allosteric modulator (NAM), rescued their deficits in spatial learning and memory, hippocampal synaptic plasticity, and adult neurogenesis. We also show that RO4938581 normalized the high density of GABAergic synapse markers in the molecular layer of the hippocampus of TS mice. In addition, RO4938581 treatment suppressed the hyperactivity observed in TS mice without inducing anxiety or altering their motor abilities. These data demonstrate that reducing GABAergic inhibition with RO4938581 can reverse functional and neuromorphological deficits of TS mice by facilitating brain plasticity and support the potential therapeutic use of selective GABA(A) α5 NAMs to treat cognitive dysfunction in DS.

Neurocognitive consequences of a paediatric brain tumour and its treatment: a meta‐analysis

This meta-analysis provides a systematic review of studies into intellectual and attentional functioning of paediatric brain tumour survivors (PBTS) as assessed by two widely used measures: the Wechsler Intelligence Scale for Children (3rd edition; WISC-III) and the Conners' Continuous Performance Test (CPT). Studies were located that reported on performance of PBTS (age range 6-16y). Meta-analytic effect sizes were calculated for Full-scale IQ, Performance IQ, and Verbal IQ as measured by the WISC-III, and mean hit reaction time, errors of omission, and errors of commission as measured by the CPT. Exploratory analyses investigated the possible impacts of treatment mode, tumour location, age at diagnosis, and time since diagnosis on intelligence. Twenty-nine studies were included: 22 reported on the WISC-III in 710 PBTS and seven on CPT results in 372 PBTS. PBTS performed below average (p(s) <0.001) on Full-scale IQ (Cohen's d=-0.79), Performance IQ (d=-0.90), and Verbal IQ (d=-0.54). PBTS committed more errors of omission than the norm (d=0.82, p<0.001); no differences were found for mean hit reaction time and errors of commission. Cranial radiotherapy, chemotherapy, and longer time since diagnosis were associated with lower WISC-III scores (p(s) <0.05). PBTS have seriously impaired intellectual functioning and attentiveness. Being treated with cranial radiotherapy and/or chemotherapy as well as longer time since diagnosis leads to worse intellectual functioning.

767 Late Effects in Survivors of Infant Leukemia in Single Center

BackgroundAcute lymphoblastic leukemia (ALL) is the most common childhood malignancy, accounting for 30%of all cancers occurring in childhood .long term sequel of treatment are now being reported. Children who survive...

Abstract 2373: Childhood Stroke Impairs Functional Behavior

BACKGROUND: Stroke can affect children with long-term impairment of intellectual ability and increased risk of attention deficits and psychiatric disorders. Although limited studies in the literature suggest that stroke can chronically impair functional behavior and social adaptation, these functional outcomes have received little attention. We performed a pilot case-control study to examine the hypothesis that pediatric stroke impairs adaptive behavior, and we addressed the secondary hypotheses that stroke volume and location predict impaired functional behavior. METHODS: Children ages 6-15 years who had neonatal or childhood onset arterial ischemic stroke were identified by chart review at the Nationwide Children’s (Columbus, OH, USA) and Royal Children’s Hospital (Melbourne, Australia). Subjects were included if they could complete the test battery. Age- and gender-matched children who had asthma were selected as controls. Stroke cases were assessed with the Pediatric Stroke Outcome Measure and had an MRI brain scan after the acute phase of stroke. Cases and controls underwent functional assessments at least one year after the incident stroke. The battery of tests and ratings included the Wechsler Abbreviated Scales of Intelligence, WISC-IV Processing Speed Index, Child Behavior Checklist, Adaptive Behavior Assessment System, and Child &amp; Adolescent Scale of Participation. Infarct volumes were measured by manual segmentation. RESULTS: The sample included 10 children with perinatal stroke, 26 with acquired childhood stroke, and 15 controls. Median age at assessment was 8.7 yrs (IQR 6.9-11.9) and median time after presentation was 5.1 yrs (IQR 2.8-7.4). The median PSOM for stroke cases was 1 (range 0-8.0) and for controls was 0 (range 0-1). Stroke was significantly associated with lower levels of multiple daily living skills (p range 0.001-0.025), functional academics (p=0.048), and self-care (p=0.020), as well as a trend toward impaired school participation (p=0.064), but was not associated with impaired intellectual functioning or behavioral adjustment. Larger Infarcts showed a trend association with higher PSOM total scores (p=0.091). Infarcts that involved both cortex and subcortical parenchyma were associated with poorer daily living skills (p range 0.005-0.052) and a trend toward impaired home community participation (p=0.079). Age of stroke onset was not associated with impairments. Conclusions: Stroke causes deficits that may not be appreciated by standard IQ screening or report of overt behavior disorders. These deficits can affect daily living skills and result in impaired adaptive behavior. Strokes involving both cortex and subcortex, as a proxy for more extensive strokes, may be particularly associated with impaired adaptive behavior. These results are “best case” estimates because our study excluded mentally retarded or grossly impaired children.

When to use DoLS? A further complication

Shah & Heginbotham[1][1] describe a number of issues relating to the Deprivation of Liberty Safeguards (DoLS) of the Mental Capacity Act. A recent court case[2][2] appears to complicate matters further. The defendant was a 55-year-old lady with ‘a significant impairment in intellectual functioning

The jumping to conclusions bias in delusions: Specificity and changeability.

There are indications that a jumping to conclusions bias (JTC) plays a role in the formation and maintenance of delusions and should be targeted in therapy. However, it is unclear whether (a) JTC is uniquely associated with delusions or simply an epiphenomenon of schizophrenia or impaired intellectual functioning and (b) it can be changed by varying task demands, motivational factors, or feedback. Seventy-one patients with schizophrenia spectrum disorders and either acute or remitted delusions and 68 healthy controls were included. Patients were assessed with self- and observer-rated symptom measures. All participants were assessed for intellectual ability and performed the classic beads task with a ratio of 80:20. They were then presented with task variations that involved increasing the difficulty of the ratio to 60:40, introducing a rule for which correct decisions were rewarded by monetary gains and false decisions led to financial losses, and providing feedback on the accuracy of the previous decisions. Participants with current delusional symptoms took fewer draws to decision (DTD) than did those in remission and healthy controls. DTD were associated with observer-rated delusions, but controlling for negative symptoms or intelligence rendered this association insignificant. DTD increased after the difficulty of the task increased and after feedback. The study demonstrated that JTC is linked to delusions but that this association is not unique. Patients with delusions are principally able to adapt their decisions to altered conditions but still decide relatively quickly even when decisions have negative consequences. These difficulties might stem in part from impaired intellectual functioning.

Eyelid fluttering, typical EEG pattern, and impaired intellectual function: A homogeneous epileptic condition among the patients presenting with eyelid myoclonia

This retrospective study aims to review the electroclinical features of patients presenting with eyelid myoclonia (EM) with and without absences. The Italian chapter of the International League Against Epilepsy (ILAE) has been conducting an electroclinical study of patients with EM. Among these, we searched for and selected the patients presenting with both impairment of intellectual functions and a peculiar ictal electroencephalography (EEG) pattern, that is, a discharge of fast generalized polyspikes/polyspikes and waves. We found 18 patients matching this electroclinical picture. All the patients were photosensitive. All of them had associated generalized, mostly nocturnal, tonic-clonic seizures. During the evolution, 13 patients presented episodes of EM status. Despite adequate antiepileptic treatment, the patients remained drug resistant for many years or throughout the evolution. The degree of impairment of intellectual functions varied from borderline level to moderate mental retardation. The patients we described herein can be considered a homogeneous group in the more heterogeneous group of patients presenting with EM. Further clinical and, more probably, genetic studies will clarify whether this condition could be considered a specific and homogeneous condition in the more heterogeneous group of patients presenting with EM.