Wechsler Intelligence Scale Research Articles

Qualitative and quantitative pretend play and their predictors in children with autism spectrum disorder: A path-analysis study

Children with autistic spectrum disorder (ASD) often have difficulties in both qualitive and quantitative pretend play. Theory of mind (ToM), symptom severity, and verbal comprehension appear to be potential correlates of pretend play. However, the underlying relationships of these correlates to pretend play remain unclear. Therefore, we applied path analysis to explore the relationships among these variables in children with ASD. A total of 151 children with ASD aged 3 to 12 years and their caregivers participated in this study. Children’s pretend play, ToM, verbal comprehension, and symptom severity were respectively assessed with Child Initiated Pretend Play Assessment, Theory of Mind Task Battery, The verbal comprehension index of Wechsler Intelligence Scale for children–Fourth Edition or Wechsler Preschool and Primary Scale of Intelligence–Fourth Edition, and Childhood Autism Rating Scale. The results showed that the SEM model fit well. The quality and quantity of pretend play were correlated to each other. ToM was positively related to qualitive and quantitative pretend play. Moreover, symptom severity was directly related to quality of pretend play; verbal comprehension was indirectly linked to quantity and quality of pretend play through ToM and symptom severity. In conclusion, our study reveals the underlying relationships of ToM, symptom severity, and verbal comprehension to quantitative and qualitative pretend play in children with ASD. This study both clarifies the important factors of qualitative and quantitative pretend play and provides suggestions to improve pretend play in children with ASD.

Immediate and repeat interrogative suggestibility in a sample of adolescents with fetal alcohol spectrum disorder

AbstractIndividuals with fetal alcohol spectrum disorders (FASD) are more likely to be involved with the criminal justice system (CJS) than neurotypical individuals. Interrogative suggestibility is theorised to be a weakness in this population; this is the first experimental evidence of interrogative suggestibility in adolescents with FASD. Fifty‐two participants (aged 11–16 years) completed the Gudjonsson Suggestibility Scale immediately and after 1 week; the Wechsler Intelligence Scale for Children; and the Behavioural Rating of Executive Function. Compared to the control group, individuals with FASD were more vulnerable to leading questions, negative feedback and evidenced significantly higher suggestibility, immediately and after 1 week. A significant correlation was found between immediate and repeat suggestibility at 1‐week follow‐up. Poorer memory recall, lower intelligence quotient and higher impulsivity were also observed in the FASD population. The results indicate the importance for the CJS to establish whether suspects, witnesses, and victims of crimes may have been impacted by prenatal alcohol exposure since this is a significant source of vulnerability that could lead to false confessions or miscarriage of justice.

Mentalizing can be Impaired in Patients with Meningiomas Originating in the Anterior Skull Base

Mentalizing is an essential function of our social lives. Impairment of mentalizing due to meningiomas has not received attention since most patients return to their social lives after surgical treatment. We investigated the influence of meningiomas and their surgical resection on mentalizing. Low- and high-level mentalizing were retrospectively examined in 61 patients with meningiomas and 14 healthy volunteers. Mentalizing was assessed using the facial expression recognition test and picture arrangement test of the Wechsler Adult Intelligence Scale, third edition, before and after surgery. We examined the influence of tumor localization on mentalizing and recovery from mentalizing disorders after tumor resection. Voxel-based lesion-symptom mapping (VLSM) was performed to investigate the relationship between impairments in mentalizing and tumor location. Before surgery, mentalizing was impaired significantly in patients with meningiomas compared to those in the control group (low-level: p=0.015, high-level: p=0.011). This impairment was associated with contact between the tumor and frontal lobe (low-level: p=0.036, high-level: p=0.047) and was severe in patients with tumors arising in the anterior skull base (low-level: p=0.0045, high-level: p=0.043). VLSM revealed that when the basal cortex of the frontal lobe was compressed by the tumor, the risk of impaired mentalizing was high. The region responsible for high-level mentalizing was located deeper than that responsible for low-level mentalizing. After the surgical removal of the tumor, the test scores significantly improved (low-level: p=0.035, high-level: p=0.045). Mentalizing was impaired by meningiomas arising from the anterior skull base, but it can improve after surgical resection of the tumors.

Maternal social support during and after pregnancy and child cognitive ability: examining timing effects in two cohorts.

Maternal anxiety, depression, and stress during and after pregnancy are negatively associated with child cognitive development. However, the contribution of positive maternal experiences, such as social support, to child cognitive development has received less attention. Furthermore, how maternal experience of social support during specific developmental periods impacts child cognitive development is largely unknown. Using data from the Avon Longitudinal Study of Parents and Children (ALSPAC; n = 5784) and the Prediction and Prevention of Preeclampsia and Intrauterine Growth Restriction study (PREDO; n = 420), we investigated the associations between maternal perceived social support during and after pregnancy and child's general cognitive ability at 8 years of age, assessed with the Wechsler Intelligence Scale for Children (WISC). Bayesian relevant life course modeling was used to investigate timing effects of maternal social support on child cognitive ability. In both cohorts, higher maternal perceived social support during pregnancy was associated with higher performance on the WISC, independent of sociodemographic factors and concurrent maternal symptoms of depression and anxiety. In ALSPAC, pregnancy emerged as a sensitive period for the effects of perceived social support on child cognitive ability, with a stronger effect of social support during pregnancy than after pregnancy on child cognitive ability. Our findings, supported from two prospective longitudinal cohorts, suggest a distinct role of maternal perceived social support during pregnancy for cognitive development in children. Our study suggests that interventions aimed at increasing maternal social support during pregnancy may be an important strategy for promoting maternal and child well-being.

The influence of interoceptive accuracy on the verbalization of emotions

Interoception, which pertains to the physiological state of the body, is associated with subjective emotional experiences. In particular, the accuracy of perceiving interoceptive signals (interoceptive accuracy [IAcc]) is linked to the intensity of emotional arousal, known as arousal focus (AF). IAcc is believed to influence the granularity of emotional experiences. Here, we examined the relationship between IAcc and assessment and verbalisation of one's own or others' emotions. Study I demonstrated that individuals with higher IAcc exhibited significantly greater AF when evaluating their own positive emotions. Furthermore, although no correlation between IAcc and AF was found in free descriptions of emotions, a significant positive correlation was found between IAcc and the number of emotion-related words. Study II showed that individuals with higher IAcc displayed significantly higher AF when assessing the positive emotions of characters in videos. Additionally, in free descriptions of these characters, a significant positive correlation was observed between predicted verbal IQ and the number of emotion-related words. These findings support the notion that interoception is associated with AF during assessment of one's own or others' positive emotions as well as the abundance of emotion-related words. This study demonstrates the relationship between bodily sensations and social aspects of human embodiment.

Increased white matter fibre dispersion and lower IQ scores in adults born preterm.

Preterm birth has been associated with altered microstructural properties of the white matter and lower cognitive ability in childhood and adulthood. Due to methodological limitations of the diffusion tensor model, it is not clear whether alterations in myelination or variation in fibre orientation are driving these differences. Novel models applied to multi-shell diffusion imaging have been used to disentangle these effects, but to date this has not been used to study the preterm brain in adulthood. This study investigated whether novel advanced diffusion MRI metrics such as microscopic anisotropy and orientation dispersion are altered in adults born preterm, and whether this was associated with cognitive performance. Seventy-two preterm born participants (<37 weeks gestational age) were recruited from a 1982-1984 cohort (33 males, mean age 33.5 ± 1.0 years). Seventy-two term born (>37 weeks gestational age) controls (34 males, mean age 30.9 ± 4.0 years) were recruited from the general population. Tensor FA was calculated with FSL, while microscopic FA and orientation dispersion entropy (ODE) were estimated using the Spherical Mean Technique (SMT). Estimated Full Scale IQ (FSIQ), Verbal Comprehension Index (VCI) and Perceptual Reasoning Index (PRI) were obtained from the WASI-II (abbreviated) IQ test. Voxel-wise comparisons using FSL's tract-based spatial statistics were performed to test between-group differences in diffusion MRI metrics as well as within-group associations of diffusion MRI metrics and IQ outcomes. The preterm group had significantly lower FSIQ, VCI and PRI scores. Preterm subjects demonstrated widespread decreases in ODE reflecting increased fibre dispersion, but no differences in microscopic FA. Tensor FA was increased in a small area in the anterior corona radiata. Lower FA values in the preterm population were associated with lower FSIQ and PRI scores. An increase in fibre dispersion in white matter and lower IQ scores after preterm birth exist in adulthood. Advanced diffusion MRI metrics such as the orientation dispersion entropy can be used to monitor white matter alterations across the lifespan in preterm born individuals. Although not significantly different between preterm and term groups, tensor FA values in the preterm group were associated with cognitive outcome.

Atopic dermatitis, cognitive function and psychiatric comorbidities across early childhood and adolescence in a population-based UK birth cohort.

Atopic dermatitis (AD) may affect cognitive function, but studies are limited and inconsistent. The effect of AD severity on cognition remains underexplored and few previous studies have examined clinically validated or repeated measures of cognition throughout childhood. To evaluate the relationship of AD activity and severity with validated measures of general cognition in a longitudinal birth cohort. We conducted cross-sectional analyses using data from the Avon Longitudinal Study of Parents and Children (ALSPAC), a UK cohort of 14 975 individuals followed prospectively since their birth in 1991-92. AD was assessed 11 times between the age of 6 and 166 months. Mothers were asked if their child had an 'itchy, dry skin rash in the joints and creases', and AD status was time-updated accordingly as 'never', 'maybe', 'inactive', 'active/mild' or 'active/moderate-severe'. General cognition [i.e. intelligence quotient (IQ)] was measured at 18, 49, 103 and 186 months of age using the Griffiths Mental Development Scales (GMDS), Wechsler Preschool and Primary Scale of Intelligence (WPPSI), Wechsler Intelligence Scale for Children (WISC) and Wechsler Abbreviated Scale of Intelligence (WASI), respectively. Multivariable linear regression was used to compare IQ with respect to nearest time-updated AD status. Secondary analyses were stratified by the presence or absence of psychiatric or learning disorders. An exploratory longitudinal analysis of IQ across all four outcome assessments was conducted using generalized estimating equations. No significant associations between AD status and full-scale IQ scores on the GMDS, WPPSI, WISC and WASI were observed after adjustment for sociodemographic factors, atopic comorbidities and sleep characteristics. However, at 8 years of age, WISC Performance IQ was slightly, although statistically significantly, lower among children with active/moderate-severe AD [β coefficient -2.16, 95% confidence interval (CI) -4.12 to -0.19] and Verbal IQ was slightly, but statistically significantly, higher among those with inactive AD (β coefficient 1.31, 95% CI 0.28-2.34) compared with those without AD. Analyses stratified by psychiatric or learning disorders, and exploratory longitudinal analyses of cognition revealed similar findings. We did not find any clinically meaningful associations between AD activity and severity and general cognitive function during early childhood and adolescence. Future studies should incorporate objective measures of AD severity and investigate outcomes beyond IQ.

Comprehensive analyses of neurodevelopmental outcomes and quality of life of children with biliary atresia.

To holistically evaluate neurodevelopmental outcomes and quality of life (QOL) of Japanese patients with biliary atresia (BA) and to investigate the factors associated with the outcomes. This study enrolled patients with BA aged 5-18 years who visited Osaka University Hospital in 2021. Neurodevelopmental assessments were performed to evaluate intellectual ability, cognitive functions and adaptive skill levels. Furthermore, emotional and behavioral issues, characteristics of attention deficit hyperactivity disorder, and QOL were concomitantly assessed in the same cohort. Biochemical and social factors associated with the results were examined. Fifty-three patients, with a median age of 11.2 years were included in the analyses. Patients with BA had a significantly lower Full-Scale Intelligence Quotient or developmental quotient (FSIQ/DQ) score and Vineland Adaptive Behavior Scale (VABS) composite score than the general Japanese population. Household education level and short stature were associated with low and borderline FSIQ/DQ and VABS composite scores, respectively. Among patients with low and borderline FSIQ/DQ scores, those with average or high VABS composite scores received significantly less neuroeducational care than those with low and borderline VABS composite scores. Despite the low FSIQ/DQ and VABS composite scores, the total QOL scores were higher than those of the general population. Patients with BA had intellectual and behavioral impairments. Notably, patients with intellectual impairments are overlooked and not followed up, especially if adaptive skills are maintained.

Sustained Cognitive Improvement in Patients over 65 Two Years after Cochlear Implantation.

This study aimed to evaluate the long-term benefits of cochlear implantation (CI) on cognitive performance, speech perception, and psychological status in post-lingually deafened patients older than 65 (n = 33). Patients were consecutively enrolled in this prospective study and assessed before, one year after, and two years after CI for speech perception, depressive symptoms, perceived stress, and working memory and processing speed. The Wechsler Adult Intelligence Scale (WAIS) was used for the latter. Thirty-three patients (fourteen men and nineteen women) were included. The scores indicating "hearing in quiet" and "hearing with background noise" improved significantly one year after CI and remained so two years after CI. The sound localization scores improved two years after CI. The depressive symptoms and perceived stress scores were low at the study's onset and remained unchanged. Working memory improved significantly two years after CI, while processing speed improved significantly one year after CI and was maintained after that. The improvement in working memory and processing speed two years after CI suggests there is a sustained positive effect of auditory rehabilitation with CI on cognitive abilities.

Research on the Pathogenesis of Cognitive and Neurofunctional Impairments in Patients with Noonan Syndrome: The Role of Rat Sarcoma-Mitogen Activated Protein Kinase Signaling Pathway Gene Disturbances.

Noonan syndrome (NS) is one of the most common genetic conditions inherited mostly in an autosomal dominant manner with vast heterogeneity in clinical and genetic features. Patients with NS might have speech disturbances, memory and attention deficits, limitations in daily functioning, and decreased overall intelligence. Here, 34 patients with Noonan syndrome and 23 healthy controls were enrolled in a study involving gray and white matter volume evaluation using voxel-based morphometry (VBM), white matter connectivity measurements using diffusion tensor imaging (DTI), and resting-state functional magnetic resonance imaging (rs-fMRI). Fractional anisotropy (FA) and mean diffusivity (MD) probability distributions were calculated. Cognitive abilities were assessed using the Stanford Binet Intelligence Scales. Reductions in white matter connectivity were detected using DTI in NS patients. The rs-fMRI revealed hyper-connectivity in NS patients between the sensorimotor network and language network and between the sensorimotor network and salience network in comparison to healthy controls. NS patients exhibited decreased verbal and nonverbal IQ compared to healthy controls. The assessment of the microstructural alterations of white matter as well as the resting-state functional connectivity (rsFC) analysis in patients with NS may shed light on the mechanisms responsible for cognitive and neurofunctional impairments.

Battery for the Assessment of Cognitive Reserve (BARC): development and clinical validation for the Portuguese population

AbstractBackgroundThe Cognitive Reserve (CR) is widely accepted as the active ability to cope with brain damage. The lack of a quantitative method for the assessment of CR including all the proxies commonly used for this purpose, highlight the need for a development of an assessment battery. The present study aims to present the final scores of the Battery for the Assessment of Cognitive Reserve (BARC).MethodThe BARC includes: (i) the Questionnaire of Literacy (QL), (ii) the Questionnaire for the Assessment of Cognitive Demand Level of Professional Activities (QANECAP), (iii) the Cognitive Reserve Questionnaire (CRQ), (iv) the Irregular Word Reading Test (TeLPI), and (v) the Wechsler Adult Intelligence Scale ‐ Vocabulary test(WAIS‐III). This new approach combined new questionnaires specifically developed by our team with other tests already validated for the Portuguese population, which also targeted the CR proxies. The BARC was administrated to 260 elderly participants (healthy controls: 200; dementia spectrum: 60). We also applied to respective available close informants.ResultThe last preliminary psychometric results of the new questionnaires evidenced the reliable and valid use in the Portuguese population. The validation of the QL and QANECAP allow the pursuit of analysis to establish the final score of the BARC, considering the individual weighting of each test/questionnaire.ConclusionWe developed a new battery to assess quantitatively the CR, which combined the several CR proxies in one single score. The BARC can be used in both clinical and research contexts.

Carnosine supplementation improves delayed recall: a systematic review and meta‐analysis

AbstractBackgroundCarnosine is a histidine‐containing dipeptide found in human muscle tissue and other organs like the brain. Data in rodents and humans indicate that administration of exogenous carnosine improved cognitive performance. However, RCTs results RCTs vary.MethodsWe searched OVID Medline, Medline, EBM Reviews, Embase, and Cumulative Index to Nursing and Allied Health Literature databases from 1/1/1965 to 1/6/2022 for all RCT of carnosine and other histidine‐containing dipeptides. 2653 abstracts were screened, identifying ninety‐four full‐text articles which were assessed for eligibility. 11 articles reporting use of carnosine supplementation were meta‐analysed. The random effects model has been applied using the DerSimonian‐Laird method.ResultsCarnosine treatment significantly increased performance on Wechsler Memory Scale (WMS) ‐2 Delayed recall (Z = 3.28, p&lt;0.01). Treatment with carnosine had no effect on Alzheimer’s Disease Assessment Scale‐Cognitive (Weighted mean difference (WMD) (95% CI) = ‐0.2 (‐1.1, 0.7), P = 0.65, I2 = 0%), Mini‐Mental State Examination (WMD (95% CI) = 0.7 (‐0.2, 1.5), P = 0.14, I2 = 42%), The Wechsler Adult Intelligence Scale (WAIS) Digit span Backward (95% CI) = 0.1 (‐0.3, 0.5), P = 0.51, I2 = 0%), WAIS digit span Forward (WMD (95% CI) = 0.0 (‐0.3, 0.4), P = 0.85, I2 = 33%) and the WMS‐1 Immediate recall (WMD (95% CI) = 0.7 (‐0.2, 1.5), P = 0.11, I2 = 0%). The effect on delayed recall remained in subgroup meta‐analysis performed on studies of patients without mild cognitive impairment (MCI), and in those without MCI where average age in the study was above 65.ConclusionsCarnosine supplementation improved scores on the Delayed recall examination, a neuropsychological test affected early in Alzheimer’s disease. Further studies are needed in people with early cognitive impairment with longer follow‐up duration and standardisation of carnosine doses to delineate the true effect.

Cognitive functioning in schizophrenia: a lifespan perspective

Cognitive disorders are now well known in schizophrenia, but their evolution over time and particularly during aging remains poorly described. Current evidence indicates that cognitive deficits including attention, working memory, verbal learning and memory, and executive functions are present in 80% of individuals with schizophrenia, which, on average, are around two standard deviations below that in healthy controls. Cognitive impairments are important predictors of functioning in daily life, including quality of life, inability to live independently and unemployment. From a lifespan perspective, they are evident in infancy (18months) and continually increase between infancy and adulthood (20 years) in full-scale IQ and most of cognitive domains, accelerating during the prodromal phase. Cognitive deficits are significant predictor of the psychotic transition, and they stabilize after the first psychotic episode until the age of fifty suggesting that cognitive deficits are mainly established before the prodromal phases of psychosis. Time course of cognitive impairments in elderly patients with schizophrenia appears to be more heterogeneous. While the data suggest that they are stable with advancing age, a subgroup of institutionalized older patients stands out for a significant cognitive decline, without it being possible to determine the causal direction of this association. The twofold increased risk of developing neurodegenerative dementia in this population, combined with institutionalization, could partly explain this cognitive decline in some patients. Long-term longitudinal studies in older adults with schizophrenia are clearly needed, particularly in France. Protective factors such as recovery-focused and psychosocial approaches need to be studied in this population, which has a 15-year shorter life expectancy than the general population.

The mismatch negativity as an index of cognitive impairment in adults with Down syndrome

AbstractBackgroundPeople with Down syndrome (DS) have a high risk of developing Alzheimer’s disease (AD; Zis and Strydom 2018). The mismatch negativity (MMN) is an event‐related potential that can be used to index cognitive decline (Näätänen et al., 2011). Given its relative independence from attentional processes (Naatanen and Näätänen 1992), the MMN may be particularly useful when studying populations with intellectual disability, who may find sustained attention tasks challenging. We therefore investigated the MMN in people with DS and its association with cognitive abilities.MethodsMMN responses to a passive auditory oddball task were recorded from 27 adults with DS (aged 18 to 59) without any hearing impairments. Associations between MMN and age, as well as memory, language, IQ, and attention scores were examined.ResultsThe MMN was present only in young adults up to the age of 40 and the latency was prolonged. Attenuation of MMN amplitude was associated with poorer memory scores. Finally, longer MMN latencies were associated with increased inter‐individual performance variability and worse performance on memory, verbal, and general IQ tasks.ConclusionOverall, our results indicate that MMN amplitude may be associated with AD‐related memory loss, while increased MMN latency seems to reflect verbal abilities in people with DS. Furthermore, the association between MMN latency and inter‐individual performance variability may suggest the presence of AD‐driven white matter degenerations affecting the brian’s frontal lobe. Therefore, the MMN may represent a valuable tool for studying cognitive abilities and AD pathology in DS.

Does psychological distress impact Wechsler Adult Intelligence Scale performance in adults with intellectual disabilities? A systematic review

BackgroundAvailable guidance states that psychological distress may impact on intellectual functioning assessment performance. Less clear is how clinicians should proceed when assessing an adult with a suspected intellectual disability (ID) presenting with psychological distress.MethodA systematic review was performed, that examined psychological distress and performance on the Weschler’s Adult Intelligence Scale (WAIS; all versions) in adults with ID.ResultsFrom 17,358 articles identified, one study was relevant. This study suggested psychological distress is associated with WAIS performance but had methodological issues.ConclusionThere is a dearth of evidence investigating this issue. Questions remain over the evidence base guiding clinical decision making.

Investigating the sensitivity coefficient of the fifth version of the Wechsler children's intelligence scale in students with attention deficit disorder in Tehran cities

In this research, the "examination of the sensitivity coefficient of the fifth version of the Wechsler intelligence scale for children in students with attention deficit disorder in Tehran cities" has been discussed. The current research method is located in the field of psychometric studies, which is a subset of the methodological research method. The research community consists of all the students with attention deficit disorder in Tehran cities who have referred to psychology and counseling centers, who are covered by educational-therapeutic services (having a diagnostic file as attention deficit and using the available targeted sampling method, 120 people were selected as a statistical sample. The measurement tool in this research is the fifth version of the Wechsler IQ scale for children, which has good validity and reliability. The statistical model used in this research to determine the diagnostic validity is the scatter diagram method (Davis method), the confidence interval method, and the sensitivity coefficient method. Finally, the findings of the research showed that all tests of "Working memory" and "processing speed" scales have a sensitivity coefficient. Therefore, the tests of " Working memory" and "processing speed" scales have diagnostic validity and can distinguish students with attention deficit disorder from normal students.

Hydroxyurea Improves Intelligence Quotient Scores in Children with Sickle Cell Anemia and Elevated Transcranial Doppler Velocity

Introduction: Structural brain abnormalities resulting from sickle cell disease because of strokes, silent cerebral infarcts (SCI) and other biophysical characteristics of parenchymal damage from repeated sickling affect cognitive functioning. Hydroxyurea therapy reduces transcranial Doppler (TCD) velocities and improves SCI and other neurological outcomes in children with sickle cell anaemia. Hence the objectives of EXpanding Treatment for Existing Neurological Disease (EXTEND, NCT02556099), a phase 2 clinical trial, was to determine whether hydroxyurea titrated to maximum tolerated dose was effective in lowering transcranial Doppler (TCD) velocities and improving cognitive function in Jamaican children with sickle cell anemia (SCA) with increased stroke risk. Methods: Full-Scale Intelligence Quotient (FSIQ), verbal and nonverbal IQ were measured with the Wechsler Abbreviated Scale of Intelligence (WASI-II) at baseline and after 18 months of hydroxyurea treatment in 30 of the 43 enrolled children. Verbal Comprehension Index (VCI) was assessed using the Vocabulary and Similarities subtests. Perceptual Reasoning Index (PRI) was scored with the Block Design and Matrix Reasoning subtests. Members of the team conducting the tests were trained and test results were verified by an experienced member of the Epidemiology Research Unit, Caribbean Institute for Health Research. Participants were enrolled in the EXTEND trial based on a pre-treatment conditional or abnormal TCD velocity. They were assigned to one of three risk categories according to treatment status and stroke history at study enrollment: Group 1 (low stroke risk: no previous stroke, on hydroxyurea treatment n= 12), Group 2 (medium stroke risk: no previous stroke, no hydroxyurea, n=10) and Group 3 (High stroke risk: previous stroke, no hydroxyurea n=8). Anthropometric variables, including height and weight, were recorded as well as oxygen saturation and hematological variables. Differences in post treatment outcome were modelled using mixed linear regression. A p-value of &amp;lt;0.05 was considered statistically significant. Results: There was no difference in mean anthropometric values or gender distribution at baseline by stroke risk category groups (Table 1). The mean(sd) age in years of participants in Group 1 was 8.2(1.7), while for Group 2 the average age was 7.7(2.1) and for Group 3 it was 10.5(2.8). The mean age of Group 3 was significantly greater than Group 1. After 18 months of hydroxyurea treatment, participants were taking an average dose of 25 mg/kg/d, range 13.7 to 34.9 mg/kg/d. On treatment TCD velocities decreased by mean(sd) of 29.5 cm/sec (31.5). Hemoglobin (Hb) concentration was lowest in Group 3 but all groups showed increases during treatment with the rate of increase in Groups 2 and 3 being greater than Group 1 (p&amp;lt;0.001). Absolute neutrophil counts and absolute reticulocyte counts were not different by group, and both decreased significantly post treatment (p&amp;lt;0.001) (Table 1). At both time points, the VCI, PRI and FSIQ mean scores in Group 3 were low [Overall means(sd); 71(11.7), 71(12.6),69(11.6), respectively] and were significantly lower compared with Group 1 (p&amp;lt;0.001) (Table 1). While there was no significant effect of treatment on VCI and PRI scores, the mean FSIQ score increased on average by 2.9 units (95%CI 0.3, 5.4) post treatment among participants. Adjusting for age at enrollment had no effect on the improvement on FSIQ, however adjusting for changes in hemoglobin resulted in an increase in FSIQ by 3.3 units (95%CI -0.4, 7.0) which approached statistical significance (p=0.079). Conclusion: Participants treated with hydroxyurea at maximum tolerated dose for 18 months with or without a previous stroke had significant improvement in hematological variables and neuropsychological scores. Children with sickle cell anemia with high risk of stroke may benefit from routine neuropsychological testing, hydroxyurea treatment in addition to educational interventions.

Global White Matter Changes and Associations with Cognition in Pediatric Sickle Cell Disease

Introduction: Sickle cell disease (SCD) is a genetic blood disorder affecting multiple organ systems, particularly the brain (Pinto, V.M. et al 2019). Neurocognitive deficits can occur in the presence or absence of overt brain injury, such as stroke or silent cerebral infarction (SCI). Using diffusion tensor imaging (DTI) metrics, multiple studies have identified widespread white matter alterations in individuals with SCD. DTI abnormalities, such as decreased fractional anisotropy (FA) and increased mean diffusivity (MD), have been associated with decreased processing speed in this population (Stotesbury et al. 2018). The goals of this study are to 1) define developmental differences in diffuse (brain-wide) white matter microstructure between SCD and control pediatric participants and 2) determine medical and neurocognitive characteristics of pediatric participants with SCD and abnormal DTI metrics. Methods: Thirty-eight participants between 8 to 12 years of age with no prior known history of stroke, SCI, or seizures were recruited for a prospective longitudinal study. Study groups consisted of 28 participants with SCD and 10 sibling or unrelated control participants. This study was a cross-sectional analysis of participants who completed DTI scans and neuropsychological testing at study entry (n=35). DTI was obtained on a 3T Philips research scanner 2.2mm nominal isotropic resolution; 32 diffusion directions obtained at b=700 s/mm 2. Preprocessing, tensor estimation, and calculation of FA and MD maps were performed using DTI Studio/MRICloud and its pediatric DTI atlas. Neurocognitive evaluation was performed and interpreted by a trained psychology associate with supervision from a board-certified neuropsychologist and included intelligence testing (Weschler Intelligence Scale for Children, WISC-5). Statistical analyses were performed using STATA 18 and MATLAB 2022a. We examined cohort-level demographics using chi-square tests, T-tests, and Wilcoxon rank sum tests (Table 1). To examine diffuse differences in white matter microstructure development, we used 19 bilateral white matter regions of interest [ROIs] shown in prior research to be important in patients with SCD with and without SCI. We examined MD and FA values within ANOVA models (each in terms of Group*Age + ROI) to assess group-level differences (SCD vs. control) and group x age interactions. We used ANOVA loadings to compute global MD and FA scores and computed 95% prediction intervals by age based on control participants. We identified participants with SCD with global scores suggestive of white matter microstructural differences (high MD and/or low FA) and compared their overall neurocognitive profiles. Results: The SCD and control participants were similar with regards to age, sex, and full-scale IQ. SCD participants had significantly lower median hemoglobin levels than control participants. There was one control participant who met criteria for SCI. SCD vs. control group status, age, and group x age interactions all significantly impacted our MD model (explaining 0.8%, 1.1%, and 0.8% of total variance, respectively; all p&amp;lt;0.001). MD decreased with age in the combined cohort (β=-9.3±1.6e-7/month) with significant flattening of this trend in children with SCD (group x age interaction: β=+7.9±2.0e-7/month). In contrast, only age significantly impacted our FA model (p&amp;lt;0.001, explaining 1.1% of variance); group status and group x age interactions each explained &amp;lt;0.2% of variance in FA. Four children with SCD had global DTI metrics suggestive of white matter injury (one with high MD and low FA; two with high MD only; one with low FA only). All 4 participants with abnormal DTI metrics had abnormal MRIs, three of whom had SCI and one of whom had lesions that did not meet the size criteria for SCI. Three participants had full scale IQs 1 standard deviation below the expected mean of 100 (&amp;lt;85). Conclusion: We identified differences in global white matter microstructural indices between SCD and control participants with an apparent blunting of expected decreases in mean diffusivity with age. Our continuing longitudinal study will explicitly assess DTI trajectories and implications for neurocognitive functioning in children with SCD.

Comparing neuropsychological functioning in Turkish patients with right and left temporal lobe epilepsy

We compared neuropsychiatric evaluations in temporal lobe epilepsy according to the lateralized hemisphere. Forty-one (68.3%) left-sided temporal lobe epilepsy (LTLE) were compared to 19 right-sided temporal lobe epilepsy (RTLE) (31.7%) (p < 0.001). RTLE mean age was 37 (22–46) years, and LTLE mean age 38 was (30–42). RTLE disease duration was 10 (6–20) years, and LTLE was 22 (10–33) (p < 0.013). Gender (man/woman) for RTLE was 7/12, and for LTLE was 18/23. LTLE scored poorer on the Wechsler Memory Scale (WMS)-III's Mental Control Months-error, WMS-V's “Forward Number Range” and “Backward Number Range” than RTLE (p < 0.017, p < 0.023, p < 0.004). There were differences between hemispheres for “Number of Items Remembered with a Hint” and “Total number of Recalled Items” (WMS-IV) (p < 0.038, p < 0.045). LTLE had lower scores in the Verbal Fluency -K-A-S letters words and WAIS (Wechsler Adult Intelligence Scale) similarity than RTLE (p < 0.019, p < 0.024, p < 0.033, p < 0.026). Oktem and Boston-number of Self-Named Items Tests were poorer in LTLE than RTLE (p < 0.05, p < 0.043). Mental Control Months-error (WMS-III), “Total Number of Recalled Items”, “Number of Items Remembered with Hint” (WMS-IV), forward and backward number range (WMS-V), Oktem, Verbal Fluency -K,-A,-S letters words, WAIS similarity, and Boston-number of Self-Named Items tests, can help identify lateralization, particularly in LTLE.

Histidine-containing dipeptide supplementation improves delayed recall: a systematic review and meta-analysis.

Histidine-containing dipeptides (carnosine, anserine, beta-alanine and others) are found in human muscle tissue and other organs like the brain. Data in rodents and humans indicate that administration of exogenous carnosine improved cognitive performance. However, RCTs results vary. To perform a systematic review and meta-analysis of randomized controlled trials (RCTs) of histidine-containing dipeptide (HCD) supplementation on cognitive performance in humans to assess its utility as a cognitive stabiliser. OVID Medline, Medline, EBM Reviews, Embase, and Cumulative Index to Nursing and Allied Health Literature databases from 1/1/1965 to 1/6/2022 for all RCT of HCDs were searched. 2653 abstracts were screened, identifying 94 full-text articles which were assessed for eligibility. Ten articles reporting the use of HCD supplementation were meta-analysed. The random effects model has been applied using the DerSimonian-Laird method. HCD treatment significantly increased performance on Wechsler Memory Scale (WMS) -2 Delayed recall (Weighted mean difference (WMD) (95% CI (CI)) = 1.5 (0.6, 2.5), P < .01). Treatment with HCDs had no effect on Alzheimer's Disease Assessment Scale-Cognitive (WMD (95% CI) = -0.2 (-1.1, 0.7), P = .65, I2 = 0%), Mini-Mental State Examination (WMD (95% CI) = 0.7 (-0.2, 1.5), P = .14, I2 = 42%), The Wechsler Adult Intelligence Scale (WAIS) Digit span Backward (WMD (95% CI) = 0.1 (-0.3, 0.5), P = .51, I2 = 0%), WAIS digit span Forward (WMD (95% CI) = 0.0 (-0.3, 0.4), P = .85, I2 = 33%) and the WMS-1 Immediate recall (WMD (95% CI) = .7 (-.2, 1.5), P = .11, I2 = 0%). The effect on delayed recall remained in subgroup meta-analysis performed on studies of patients without mild cognitive impairment (MCI), and in those without MCI where average age in the study was above 65. HCD, supplementation improved scores on the Delayed recall examination, a neuropsychological test affected early in Alzheimer's disease. Further studies are needed in people with early cognitive impairment with longer follow-up duration and standardization of carnosine doses to delineate the true effect. PROSPERO registration no. CRD42017075354.