[Long-term cognitive dysfunctions in preterm subjects with intraventricular haemorrhage]. / Disfunciones cognitivas a largo plazo en sujetos prematuros con hemorragia intraventricular.

INTRODUCTION: Intraventricular hemorrhage (IVH) in the neonatal period has been associated to developmental impairment or delay in preterm born children and adolescents. To our knowledge there is no study in literature which describes the effects of neonatal IVH in preterm subjects on different specific cognitive functions in adolescent samples. AIM. To explore general as well as specific cognitive performance in preterm adolescents with neonatal IVH, through a comprehensive neuropsychological assessment. SUBJECTS AND METHODS: Sixteen preterm born adolescents with IVH in the newborn period and thirty matched controls were recruited for neuropsychological testing. The intelligence quotient, learning, memory, visuospatial and visuoperceptive abilities, and frontal functions were evaluated. RESULTS: Significant differences were observed for full and performance intelligence quotient, as well as for several specific cognitive functions. After controlling for full intelligence quotient, and compared with preterm adolescents without IVH, differences remained significant for verbal learning and verbal memory. Subjects with IVH grades III-IV scored significantly lower than those with IVH grades I-II in verbal learning, everyday memory and visuoconstructive and visuospatial abilities. CONCLUSIONS: The present study suggests that long-term difficulties are evident for general cognitive performance as well as for specific cognitive abilities in preterm subjects with IVH in the newborn period. These data could explain the academic problems shown by these individuals and may suggest concrete intervention programs to minimize the effects of such deficits.

[Long-term cognitive dysfunctions related to prematurity]. / Disfunciones cognitivas a largo plazo relacionadas con la prematuridad.

INTRODUCTION: Little is understood about the effects of prematurity on long-term cognitive functioning. No detailed studies have been carried out in a Spanish population to investigate the cognitive performance of adolescents who were born preterm. AIMS: To utilise the Wechsler intelligence scales to examine the performance of a broad sample of adolescents who were born preterm, to describe the clinical significance of this performance and to analyse the discriminatory powers of the different subtests. SUBJECTS AND METHODS: The intelligence quotients of 62 preterm subjects and 62 controls were evaluated by administering the full Wechsler intelligence scales. A number of specific neuropsychological functions were also assessed. RESULTS: Significant differences were observed in the overall, verbal and manipulative intelligence quotients, as well as in most of the subtests, although less than 30% of the preterm subjects displayed any alterations in their performance. The subtests that were most sensitive to the poor performance of the preterm subjects were vocabulary, coding and picture arrangement. The significant differences in learning, memory, cognitive flexibility and verbal fluency were not upheld on controlling for general cognitive performance. CONCLUSIONS: Adolescents with a history of prematurity as a group offer low performance on the Wechsler intelligence scale, although most of them achieve scores within the range of what can be considered to be normal. The different subtests that make up this scale do not exhibit the same degree of sensitivity when evaluating the possible difficulties preterm adolescents have in cognitive performance.

[A neuropsychological study of triplets with a history of prematurity]. / Estudio neuropsicologico de trillizas con antecedentes de prematuridad.

INTRODUCTION AND AIMS: Prematurity has often been associated with a general intellectual deficit and with different structural brain disorders which can be revealed by volumetric measurements performed by magnetic resonance imaging (MRI). In turn, perinatal asphyxia, even when it is not accompanied by neurological disorders, is related to a deficit in specific neuropsychological functions. CASE REPORT: This study describes the case of three 13 year old female triplets, with a history of extreme prematurity and perinatal asphyxia, the long term effects of which are evaluated in terms of cognitive performance. We studied their performance in the neuropsychological functions of intelligence, memory, and visual perceptual, visual constructive, visual spatial and frontal functions. In two of the subjects, structural MRI and volumetric analysis of the hippocampuses were performed. In all the subjects, intelligence was found to be above average, the most notable result being the superior score in case 1. Verbal learning and the long term retention of verbal material were altered in case 3, where there was also a smaller hippocampal volume. CONCLUSIONS: In the context of a multiple birth, we have seen that extreme prematurity, accompanied by non severe perinatal asphyxia without hypoxic ischemic encephalopathy, can exert very diverse effects on neurocognitive development. It can be normal, and even superior, or show a deficit in some skill. In our case, the functions that were most liable to suffer these antecedents are long term memory and verbal learning. This disorder is accompanied by bilateral involvement of the hippocampus, which can be observed using MRI.

[Evaluation of diffuse cerebral atrophy in patients with a history of traumatic brain injury and its relation to cognitive deterioration]. / Evaluación de la atrofia cerebral difusa en pacientes con antecedentes de traumatismo craneoencefálico y su relación con el deterioro cognitivo.

INTRODUCTION: Diffuse damage secondary to traumatic brain injury (TBI) can be studied through volumetric analysis of several structures that are sensible to this kind of injury, such as corpus callosum, ventricular system, hippocampus, basal ganglia and the volume of cerebrospinal fluid spaces. OBJECTIVE: Our aim is to describe how closed head injury (CHI) occurred in early years produce diffuse damage, and how this damage affects general cognitive functioning at long term. PATIENTS AND METHODS: Initially the group of subjects was composed of 27 head injured children and adolescents following paediatric moderate to severe TBI. From this initial group we selected 15 patients without focal lesion, or in case of having suffered focal lesion, this was smaller than 2,600 mm3. These subjects were assessed by means of volumetric analysis of cerebrospinal fluid spaces, corpus callosum, hippocampus and caudate nucleus, comparing the results with a matched control group. We calculated the degree of general cognitive ability of these subjects through tests of intellectual, memory, frontal lobe and motor speed functioning. RESULTS: This study demonstrates that early CHI produce a volume decrease in all measured structures. Corpus callosum atrophy is the factor that better explains general cognitive impairment. CONCLUSIONS: Diffuse damage secondary to moderate to severe peadiatric TBI has long term effects on several cerebral structures and on cognitive performance. Corpus callosum atrophy is the best predictor for general cognitive impairment, compared with other affected structures.