Severity Of Intellectual Impairment Research Articles

Evaluation of the efficiency of the hepatoprotector glucuronate in toxic hepatitis of various etiology

The objective was to study the effectiveness of the use of hepatoprotector glucuronate at the early stage of intensive therapy of toxic hepatitis of various etiologies.Materials and methods. We studied 120 patients with toxic hepatitis who were treated at the Republican research center for emergency medicine in 2022–2023. The study was carried out in two groups of patients. Group I – 60 patients admitted in 2023, who, in addition to traditional therapy, received a complex hepatoprotector glucuronate (Jetepar®)*. Group II (comparison group) – 60 patients who applied in 2022 and received only traditional therapy. Biochemical blood parameters were studied upon admission and over time on day 5. The severity of intellectual impairment was assessed using cognitive scales and the Reitan test on days 2 and 5 from the start of treatment.Results. Upon admission, both groups showed signs of toxic liver damage. In dynamics by the 5th day in patients of group I, there was a decrease in ALT by 63.7%, AST by 66.4%, alkaline phosphatase by 54.2% from the initial values, which was 3.9 and 2.6, 2. 1 lower than in the comparison group. The level of free ammonia in patients of group I on the 5th day decreased by 52%, and lactate by 57% from the initial level, almost to the physiological norm, while in the comparison group (II) only by 24.8% and 38.1%, which was 2.2 and 1.5 times worse than in the main group. Screening of the level of intelligence using two cognitive scales and the Reitan test showed that in patients in the comparison group, cognitive function indicators on the 5th day were 1.4, 1.5 and 1.2 times lower than in the main group.Conclusion. The use of the hepatoprotector glucuronate improves liver parameters and cognitive functions in patients with toxic hepatitis.

Assessment of effect of chronic alcohol intoxication on certain parameters of the autonomic nervous system and cognitive functions

The objective of the study:to study certain parameters of the autonomic nervous system (ANS) and cognitive functions in patients with acute alcohol intoxication of different severity degrees.Subjects and methods.312 patients with acute alcohol intoxication and chronic alcohol abuse were enrolled in the study. Manifestations, medical history, the duration of drinking bout, ethanol blood level were assessed. Blood panel included ALT, AST, LDH, and blood levels of free ammonia, lactate, and medium molecules. The subjects were divided into three groups: Group I - 78 patients with severe alcohol intoxication, Group II – 166 patients with moderate alcohol intoxication, and Group III – 68 patients with mild alcohol intoxication. The state of ANS was assessed according to the following indicators: heart rate, systolic and diastolic blood pressure, Kerdo vegetative index, and results of cardiointervalography by R.M. Baevsky (1986). The severity of intellectual impairment was assessed using the ММSE scale for 10 positions, the FAB scale for 6 positions, as well as the Reitan test in seconds on the 1st day.Results.In patients of Group I, the alcohol level was 1.5 and 1.35 times lower versus patients in Groups II and III. All patients with severe intoxication had symptoms of toxic hepatitis, which was manifested by a significant increase in ALT, AST, LDH and bilirubin, exceeding the normal limits by 5.4, 5.4, 1.8, and 1.7 times, respectively. Ammonia blood levels in patients with severe intoxication exceeded the norm by 5.6 times, in patients with moderate severity of intoxication – by 3 times, and even in patients with a mild degree – by 1.5 times. The lactic acid level in patients of Group I was 3.2 times above the norm, in patients of Groups II and III – 2.0 and 1.4 times, respectively. In patients with severe intoxication, there was an increase in blood levels of medium molecules over 0.6 units of optical density which reflected severe endogenous intoxication. Assessment of ANS parameters in patients of three groups revealed development of hypersympathicotonia due to the increased tone of the sympathetic department of ANS in proportion to intoxication severity. Cognitive functions at admission were inhibited in proportion to the severity of the patient's condition. Intelligence level as per MMSE scale: at admission, patients of Groups III and II demonstrated mild and moderate cognitive impairment (25.8 ± 2.1 and 23.31 ± 1.80 points); in Group I, indicators for all items were 1.5 times lower versus Groups II and III. Intelligence as per the FAB scale: in patients with severe intoxication, deviations in conceptualization and dynamic praxis were noted. The Reitan test results were best in patients from Group III. Subsequently, 63 (80.7%) patients with severe alcohol intoxication developed alcoholic delirium.Conclusion.Patients with alcohol intoxication demonstrated a decrease in cognitive functions and impaired intelligence proportional to the severity of intoxication and levels of lactate and free ammonia. Increased tone of the sympathetic division of the ANS is typical of acute alcohol intoxication during drinking bout. Cardiointervalography parameters can be used to assess the severity of alcohol intoxication.

Neurocognitive abilities in individuals with Down syndrome-a narrative review

Down syndrome (DS), or trisomy 21, is the most common genetic syndrome associated with intellectual disability. Despite the variability in expression, there is a distinct developmental phenotype characterized by deficits in learning/memory, executive functions, and language skills accompanying the psychomotor delay. The severity of intellectual impairment has the dominant effect on functioning, other influences such as parental and societal attitudes, supports available and social opportunities also play a role in the attainment of skills.

Étude des comportements-problèmes de 148 adultes atteints de troubles du spectre autistiques institutionnalisés

ObjectivesWe studied adults with autism spectrum disorder living in a specialized residential care home (n=148). The participants’ behavioral problems were assessed using the French-language Scale for the Observation of Behavioral Problems in Adults with Autism (Échelle Pour l’Observation des Comportements-problèmes d’Adultes avec Autisme, EPOCAA; Recordon-Gaboriaud & Granier-Deferre). The study's main objectives were to (i) replicate the data from the EPOCAA reference group in a new sample of institutionalized adults, and (ii) study the impact of intellectual disability and medication on the EPOCAA scale. Our first hypothesis was that the severity of intellectual impairment would be associated with a greater likelihood of major behavioural problems. Our second hypothesis was that treatment (or the absence of treatment) with psychotropic and/or anti-epileptic medications would interact with the behavioural problems evaluated on the EPOCAA. MethodWe first used Cohen's d to compare the results from our sample with those given in the EPOCAA. Next, we performed a multivariate analysis of covariance with intellectual impairment, sex, the use of anti-epileptic medications (as a yes/no binary variable), and the use of psychotropic medications (as a yes/no binary variable) as fixed factors, and age as a covariate. ResultsAll patients suffered from profound to severe intellectual impairment and low autonomy, which justified their permanent residence in a care home. A behavioral assessment of the study participants showed that the overall EPOCAA scores were much lower in the study sample than in the scale's reference sample. The combination of profound intellectual disability and autism was associated with more behavioral problems than severe intellectual impairment. The residents’ intellectual impairments were predominantly related to two domains (object use and sensorimotor activities/stereotypy) and to the severity of difficulties in the social interactions domain. The second hypothesis was not confirmed: the presence or absence of the various medications did not appear to influence behavioral problems. These results are discussed with a view to improving the residents’ quality of life.

Health status of children with cerebral palsy living in Europe: a multi‐centre study

The aim of this report is to describe the health status of 8-12-year-old children with cerebral palsy (CP) of all severities in Europe using the Child Health Questionnaire (CHQ). A total of 818 children with CP from nine centres in defined geographical areas participated. CP type, gross and fine motor function, additional impairments were classified and family data were obtained. The CHQ was used to measure the parent's perception of their child's physical (PHY) and psychosocial (PSY) health. PHY scores were lower than the reference samples with a median of 46. The severity of gross motor function influenced the CHQ scores significantly in the PHY scale with the lowest scores for children with least gross motor function. There were significant differences between the CP types in PHY with the higher scores for children with unilateral spastic and the lowest scores for children with bilateral spastic and dyskinetic CP type. Fine motor function severity significantly affected both the PHY and PSY scales. The severity of intellectual impairment was significantly associated with CHQ scores in most dimensions with higher scores for higher IQ level in PHY and PSY. Children with seizures during the last year had a significantly lower health compared with children without seizures. The results of the multivariate regression analyses (forward stepwise regression) of CHQ scores on CP subtype, gross and fine motor function, cognitive function, additional impairments, seizures, parental education and employment revealed gross motor function, cognitive level and type of school attended were significant prognostic factors. This report is based on the largest sample to date of children with CP. Health status as measured using the CHQ was affected in all children and was highly variable. Gross motor function level correlates with health from the PHY well-being perspective but the PSY and emotional aspects do not appear to follow the same pattern.

Predictors of academic attainments of young people with Down's syndrome

Earlier studies of young people with Down's syndrome have investigated a relatively limited range of variables which may influence their academic attainment. The relative strength of such influences and how they may vary during the school career, has also been under-researched. The aim of the paper is to identify the contemporary and antecedent predictors of the level of academic attainment achieved by a representative sample of young people with Down's syndrome. Sample The paper reports data from three studies of 71 young people with Down's syndrome and their families. Mean IQ at the time of the first study (t1) was 40.4. Mean chronological age was 9 years at t1, 14 at t2, and 21 at t3, when all the young people had left school. The outcome measure was the 58-item Academic Attainments Index (AAI), comprising three sub-scales covering reading, writing and numeracy. Predictors of the outcome were derived from questionnaires and interviews from tutors, mothers and fathers. A path analysis approach was used to investigate the pattern of predictors of the outcome over the three studies. Factors predicting greater progress in this measure between t2 and t3 were lower chronological age and attendance at mainstream school. Progress from t1 to t2 was also associated with attendance at mainstream school, as well as with higher t1 mental age, mother's practical coping style and higher child attentiveness. Background factors predicting higher t1 AAI scores were higher mental age, attendance at mainstream school and father's internal locus of control. The path analysis model predicted 48% of the variance in t3 outcome scores. Severity of intellectual impairment was by far the most significant predictor. Limitations to the study include evidence of attrition bias towards more able children, and the need to obtain the t3 outcome measure from tutors for some young people and parents for others. Parents may have over-estimated abilities. Results are broadly in agreement with other studies, and confirm the pattern reported earlier with this group. Mainstream school attendance had a modest beneficial effect on AAI scores throughout the school career of the children, independently of level of intellectual disability. Identification of predictors of attainment levels and of improvement over time may help parents, teachers and other professionals involved with families of children and young people with Down's syndrome optimise the attainment of such skills.

What influences physiotherapy use by children with cerebral palsy?

To investigate factors that influence the frequency of physiotherapy currently used by a population of children with moderate to severe cerebral palsy (CP). A survey using a postal questionnaire was sent to 212 parents of children with moderate to severe CP. The families were identified from a geographically defined case register of children with CP in Northern Ireland (the Northern Ireland Cerebral Palsy Register). Eighty-five per cent of parents responded. One-third of parent responses regarding their child's use of physiotherapy were validated with their child's physiotherapist and the level of agreement was high. Ninety-four per cent (169/180) of children received conventional physiotherapy from a statutory source during the school term. Of these, 61% (104/169) used 'intense' levels of physiotherapy (defined as at least twice a week). A higher proportion of intense users were children with severe CP compared with moderate CP (69% vs. 47%; P < 0.01); with moderate intellectual impairment (IQ </= 70 > 50) compared with severe (IQ </= 50) or no intellectual impairment (IQ > 70) (81% vs. 64% vs. 39% respectively; P < 0.01) and at schools for physical disability (PD) compared with severe learning disability (SLD) or mainstream (MS) schools (82% vs. 66% vs. none respectively; P < 0.001). After controlling for severity of motor impairment and the presence and severity of intellectual impairment, children with CP at MS schools used on average significantly less physiotherapy compared with children with similar levels of motor impairment at PD schools (P < 0.001). Children with CP in MS schools use less physiotherapy compared with children with similar levels of disability in special schools. Organizing services around special schools may limit the degree to which children with CP and other disabilities are successfully integrated into MS education.

Correlation Between Working Capacity and APDL in Middle-Aged and Elderly People with Intellectual Impairment.

In this study we investigated the correlation between working capacity and APDL of middle-aged and elderly residents of welfare homes for the intellectually retarded. The subjects were 313 intellectually retarded people over 35 years old. The subjects were chosen from residents of four welfare institutions and job-placement centers for intellectually retarded people in Otaru, Hokkaido. Personal attributes, working capacity, and APDL were investigated in each subject. The items of personal attributes were: gender, chronological age, severity of intellectual impairment, and presence/absence of Down's syndrome. Working capacity was evaluated according to the 6 items. APDL was evaluated according to the 51 items. For statistical analysis of the working capacity of the subjects, the variables were summarized using principal component analysis and scored. Next, a search was made for the common factors in the 51 items of APDL using the principal component method. Finally, the correlation between working capacity and APDL was investigated by multiple regression analysis, with the obtained composite scores as dependent variables and the scores of APDL factors extracted by principal component analysis as independent variables. The following three factors were selected for the subjects: health management, outdoor movement and social activity. The multiple correlation coefficient using these three factors was R=0.63 (F=55.20, p<0.01). This indicates the necessity, from the viewpoints of prevention of senility, to focus not only on the decrease in working capacity of aging residents with intellectual impairment in welfare institutions but to establish various countermeasures based on the interrelationship between working capacity and APDL.