Neonatal hypoxic-ischaemic encephalopathy: Motor impairment beyond cerebral palsy.

BACKGROUND: Research investigating neuromotor function in the absence of cerebral palsy (CP) for children who had neonatal HIE is limited. AIMS: To investigate school-age neurological and neuromotor function, and correlations with attention, neonatal Magnetic Resonance Imaging (MRI), and neuromotor assessments at toddler age. METHODS: Twenty-seven children with neonatal HIE without CP who underwent hypothermia treatment and a comparison group of 20 children were assessed at age 5-7 years for Minor Neurological Dysfunction (MND; simplified Touwen), motor skills (Movement Assessment Battery for Children-2; MABC-2), parental concern over motor function (MABC Checklist), general cognition (Wechsler Preschool and Primary Scale of Intelligence-IV, WPPSI), and attention (DuPaul ADHD Rating Scale). Neurological examination and motor development, using Bayley-3 scales, at age 24-months was extracted from the clinical database. Clinical neonatal MRI was assessed for hypoxic-ischaemic injury. RESULTS: In the HIE group, MND was more prevalent (p = 0.026) and M-ABC performance (total score p = 0.006; balance subtest p = 0.008) was worse; parents were more concerned about children's motor function (p = 0.011). HIE group inattention scores were higher (p = 0.032), which correlated with lower MABC-2 scores (rs = -0.590, p = 0.004). Neurological examination at 24-months correlated with MND (rs = 0.437, p = 0.033); Bayley-3 motor scores did not correlate with M-ABC-2 scores (rs = 368, p = 0.133). Neonatal MRI findings were not associated with school-age MND (rs = 0.140, p = 0.523) or MABC-2 (rs = 0.300, p = 0.165). CONCLUSIONS: Children with neonatal HIE, without CP, treated with hypothermia may be more likely to develop MND and motor difficulties than typically developing peers. Inattention may contribute to motor performance. In the absence of CP, neonatal MRI and toddler age assessment of motor development have limited predictive value for school-age outcome. Since this was an exploratory study with a small sample size, findings should be confirmed by a definite larger study.

Children with neonatal Hypoxic Ischaemic Encephalopathy (HIE) treated with therapeutic hypothermia are not as school ready as their peers.

AIM: We aimed to determine whether children with neonatal Hypoxic Ischaemic Encephalopathy (HIE) treated with therapeutic hypothermia (TH) differ from their peers on measures of fine motor skills, executive function, language and general cognitive abilities, factors that are important for school readiness. METHODS: We compared school readiness in 31children with HIE treated with TH (without Cerebral Palsy; mean age 5 years 4 months) with 20 typically developing children without HIE (mean age 5 years 6 months). RESULTS: Children with HIE scored significantly lower than typically developing children on fine motor skills, executive functions, memory and language. CONCLUSION: While general cognitive abilities and attainment were in the normal range, our findings suggest those scores mask specific underlying difficulties identified by more focussed assessments. Children with HIE treated with TH may not be as 'school ready' as their typically developing classmates and may benefit from long-term follow-up until starting school.

Dehydration in older people: A systematic review of the effects of dehydration on health outcomes, healthcare costs and cognitive performance.

OBJECTIVE: To systematically examine the effect of dehydration on health outcomes, identify associated financial costs and consider impacts on cognitive performance in older adults. DESIGN: A systematic review of English-language articles via OVID using MEDLINE, PsychINFO, EMBASE, and others, to March 2018. Included studies examined the relationship between hydration status and health, care costs or cognitive outcome. SETTING: Cross sectional and cohort data from studies reporting on dehydration in older adults. PARTICIPANTS: Adults aged 60 years and older. MEASUREMENTS: Independent quality ratings were assessed for all extracted articles. RESULTS: Of 1684 articles screened, 18 papers (N = 33,707) met inclusion criteria. Participants were recruited from hospital settings, medical long-term care centres and the community dwelling population. Data were synthesised using a narrative summary. Mortality rates were higher in dehydrated patients. Furthermore, health outcomes, including frailty, bradyarrhythmia, transient ischemic attacks, oral health and surgery recovery are linked to and worsened by dehydration. Length of hospital stay, either as a principal or secondary diagnosis, is greater in those with dehydration, compared to those who are euhydrated. Finally, neurocognitive functioning may be impacted by dehydration. There are issues with study design, inconsistency in hydration status measurement and different measures used for outcome assessment. CONCLUSION: Dehydration in older people is associated with increased mortality, poorer course of illness and increased costs for health services. In addition, there is some, but sparse evidence that dehydration in older people is linked to poorer cognitive performance. Intervention studies should test strategies for reducing dehydration in older adults.

At what stage in the drinking process does drinking water affect attention and memory? Effects of mouth rinsing and mouth drying in adults.

Drinking water is important for health and there is an agreement that drinking water facilitates certain cognitive processes. However, the mechanism underlying the effect of drinking water on cognition is unknown. While attention performance is improved by even a very small drink, memory performance seems to require larger drinks for performance enhancement. This suggests that attention could be affected earlier in the drinking process than memory. We aimed to elucidate further the mechanism involved by investigating the stage during the drinking process influencing performance on cognitive tasks. To this end, we compared mouth rinsing and mouth drying. Mouth rinsing was expected to result in improved attention performance and would suggest that the mechanism responsible is located in the mouth and occurs early in the drinking process, before swallowing. Eighty-seven adults participated in either a treatment (mouth rinsing or mouth drying) or control (no intervention) condition. They were assessed at baseline and 20 min later after intervention on measures of visual attention, short-term memory, subjective thirst and mood. Our results showed that mouth rinsing improved visual attention, but not short-term memory, mood or subjective thirst. Mouth drying did not affect performance. Our results support the hypothesis that different mechanisms underlie the effect of drinking water on different cognitive processes. They suggest that merely sipping water, as opposed to having a large drink, can improve attention.

Minor neurological signs and behavioural function at age 2 years in neonatal hypoxic ischaemic encephalopathy (HIE).

BACKGROUND: Neurodevelopmental follow-up in Neonatal Hypoxic Ischaemic Encephalopathy (HIE) typically focusses on major neuromotor (cerebral palsy, CP) and severe cognitive impairment. Outcomes in those without major neuromotor impairment are less well explored. OBJECTIVES: To examine behavioural, cognitive and neurological outcomes after neonatal HIE, in a clinical cohort of children without CP, at age 2 years. METHODS: Clinical routine outcome data from children admitted to a tertiary centre with neonatal HIE for hypothermia treatment between 05/08/09-30/05/2016. Children were assessed for neuromotor status - particularly minor neurological signs (MNS), with Bayley Scales of Infant and Toddler Development III (Bayley III) or Ages and Stages Questionnaire-3 (ASQ), Child Behavior Checklist 1.5-5 (CBCL), Quantitative Checklist for Autism in Toddlers (Q-CHAT). RESULTS: Of 107 children, 75.5% had normal neurology, 12.1% CP, 12.1% MNS. Children with CP were excluded from analyses. For those without CP, Bayley-III scores were in the average range for the majority; mild cognitive delay observed in 5%, 4.2% language, 1.3% motor development; severe delay in 1.3% for cognitive, 4.2% for language. More than in the normative population scored in clinical ranges for CBCL externalising, sleep, and other problems. No significant difference was seen for Q-CHAT. Children with MNS were significantly more likely to have impaired Bayley-III scores, parent-reported internalising, sleep, and other problems. CONCLUSIONS: In this clinical cohort, the majority of children had favourable outcome at 2 years. However, children with MNS were at risk for cognitive and behavioural difficulties and will benefit from enhanced clinical follow-up and support.

School Age Neurological and Cognitive Outcomes of Fetal Growth Retardation or Small for Gestational Age Birth Weight.

Children who were growth restricted in utero (FGR) and are born small for gestational age (SGA) may experience poorer long term neurological and cognitive outcomes. Those also born preterm may have particular difficulties. The objective of this paper was to review the literature on school age neurocognitive outcome for term and preterm children that was published in the last 15 years. Considering term born children first, there is evidence that these children are at higher risk for Cerebral Palsy (CP) than those born appropriate for gestational age (AGA); information on neuromotor function in the absence of CP is somewhat contradictory. With regards to cognitive outcome, the most common finding was that being born SGA and/or FGR at term does not impact negatively on general intellectual functioning, commonly assessed by IQ scores. There was some indication that they may experience particular problems with attention. With regards to children born preterm, the risk of CP appears not to be increased compared to those preterms born AGA. For preterm children who do not develop CP, motor outcome is more affected by post-natal and post-neonatal brain growth than intrauterine growth. In contrast to term born children, preterm SGA and/or FGR children are at increased risk of cognitive and behavioral difficulties, and in common with term born children, are at higher risk than their AGA counterparts of difficulties with attentional control. In conclusion, preterm born SGA and/or FGR children are at higher risk of neurodevelopmental problems in the school years. It is important to continue to follow up children into the school age years because these difficulties may take time to emerge, and may be more visible in the more demanding school environment.

The impact of water consumption on hydration and cognition among schoolchildren: Methods and results from a crossover trial in rural Mali.

Adequate provision of safe water, basic sanitation, and hygiene (WASH) facilities and behavior change can reduce pupil absence and infectious disease. Increased drinking water quantity may also improve educational outcomes through the effect of hydration on attention, concentration, and short-term memory. A pilot study was conducted to adapt field measures of short-term cognitive performance and hydration, to evaluate levels of hydration, and to investigate the impact of providing supplementary drinking water on the cognitive performance of pupils attending water-scarce schools in rural Mali. Using a cross-over trial design, data were collected under normal school conditions (control condition) on one visit day; on the other, participants were given a bottle of water that was refilled throughout the day (water condition). Morning and afternoon hydration was assessed using specific gravity and urine color. Cognitive performance was evaluated using six paper-based tests. Three percent of pupils were dehydrated on the morning of each visit. The prevalence of dehydration increased in the afternoon, but was lower under the water condition. Although there was a trend indicating drinking water may improve cognitive test performance, as has been shown in studies in other settings, results were not statistically significant and were masked by a "practice effect."

How does drinking water affect attention and memory? The effect of mouth rinsing and mouth drying on children's performance.

There is general consensus that drinking water facilitates certain cognitive processes. However, it is not yet known what mechanism underlies the effect of drinking on performance and these may be different for different cognitive processes. We sought to elucidate the mechanisms involved by establishing at what stage of the drinking process cognitive performance is influenced. We examined the effect of mouth rinsing and mouth drying on subjective thirst and mood, visual attention and short term memory in children. Data are reported from 24 children aged 9- to 10-years. Children's performance was assessed in three conditions - mouth drying, mouth rinsing and a control (no intervention). In each condition they were assessed twice - at baseline, before intervention, and 20 min later at test. Mouth rinsing improved visual attention performance, but not short term memory, mood or subjective thirst. The effects of mouth drying were more equivocal. The selective nature of the results is consistent with suggestions that different domains of cognition are influenced by different mechanisms.

'Spontaneous' visual perspective-taking mediated by attention orienting that is voluntary and not reflexive.

Experiments revealing 'spontaneous' visual perspective-taking are conventionally interpreted as demonstrating that adults have the capacity to track simple mental states in a fast and efficient manner ('implicit mentalising'). A rival account suggests that these experiments can be explained by the general purpose mechanisms responsible for reflexive attentional orienting. Here, we report two experiments designed to distinguish between these competing accounts. In Experiment 1, we assessed whether reflexive attention orienting was sufficient to yield findings interpreted as spontaneous perspective-taking in the 'avatar task' when the protocol was adapted so that participants were unaware that they were taking part in a perspective-taking experiment. Results revealed no evidence for perspective-taking. In Experiment 2, we employed a Posner paradigm to investigate the attentional orienting properties of the avatar stimuli. This revealed cue-validity effects only for longer stimulus onset asynchronies, which indicates a voluntary rather than reflexive shift in spatial attention. Taken together, these findings suggest that attentional orienting does indeed contribute to performance in the Samson et al. avatar task. However, attention orienting appears to be voluntary rather than reflexive, indicating that the perspective-taking phenomenon measured may be less spontaneous than first reported.

Implicit Mentalising during Level-1 Visual Perspective-Taking Indicated by Dissociation with Attention Orienting.

Experiments demonstrating level-1 visual perspective-taking have been interpreted as providing important evidence for 'implicit mentalising'-the ability to track simple mental states in a fast and efficient manner. However, this interpretation has been contested by a rival 'submentalising' account that proposes that these experiments can be explained by the general purpose mechanisms responsible for attentional orienting. Here, we aim to discriminate between these competing accounts by examining whether a gaze aversion manipulation expected to enhance attention orienting would have similar effects on both perspective-taking and attention orienting tasks. Gaze aversion was operationalised by manipulating head position relative to torso of the avatar figures employed in two experiments (gaze-averted vs. gaze-maintained). Experiment 1 used a Posner cueing task to establish that gaze aversion enhanced attention orienting cued by these avatars. Using the avatar task, Experiment 2 revealed level-1 visual perspective-taking effects of equivalent magnitude for gaze-averted and gaze-maintained conditions. These results indicate that gaze aversion moderated attention orienting but not perspective-taking. This dissociation in performance favours implicit mentalising by casting doubt on the submentalising account. It further constrains theorising by implying that attention orienting is not integral to the system permitting the relatively automatic tracking of mental states.

Dose-response effects of water supplementation on cognitive performance and mood in children and adults.

Water supplementation has been found to facilitate visual attention and short-term memory, but the dose required to improve performance is not yet known. We assessed the dose response effect of water on thirst, mood and cognitive performance in both adults and children. Participants were offered either no water, 25 ml or 300 ml water to drink. Study 1 assessed 96 adults and in Study 2, data are presented from 60 children aged 7-9 years. In both studies, performance was assessed at baseline and 20 min after drinking (or no drink); on thirst and mood scales, letter cancellation and a digit span test. For both children and adults, a large drink (300 ml) was necessary to reduce thirst, while a small drink (25 ml) was sufficient to improve visual attention (letter cancellation). In adults, a large drink improved digit span, but there was no such effect in children. In children, but not adults, a small drink resulted in increased thirst ratings. Both children and adults show dose-response effects of drinking on visual attention. Visual attention is enhanced by small amounts of fluid and appears not to be contingent on thirst reduction. Memory performance may be related to thirst, but differently for children and adults. These contrasting dose-response characteristics could imply cognitive enhancement by different mechanisms for these two domains.

Observed bodies generate object-based spatial codes.

Contemporary studies of spatial and social cognition frequently use human figures as stimuli. The interpretation of such studies may be complicated by spatial compatibility effects that emerge when researchers employ spatial responses, and participants spontaneously code spatial relationships about an observed body. Yet, the nature of these spatial codes - whether they are location- or object-based, and coded from the perspective of the observer or the figure - has not been determined. Here, we investigated this issue by exploring spatial compatibility effects arising for objects held by a visually presented whole-bodied schematic human figure. In three experiments, participants responded to the colour of the object held in the figure's left or right hand, using left or right key presses. Left-right compatibility effects were found relative to the participant's egocentric perspective, rather than the figure's. These effects occurred even when the figure was rotated by 90° to the left or to the right, and the coloured objects were aligned with the participant's midline. These findings are consistent with spontaneous spatial coding from the participant's perspective and relative to the normal upright orientation of the body. This evidence for object-based spatial coding implies that the domain general cognitive mechanisms that result in spatial compatibility effects may contribute to certain spatial perspective-taking and social cognition phenomena.

Strategy modulates spatial perspective-taking: evidence for dissociable disembodied and embodied routes.

Previous research provides evidence for a dissociable embodied route to spatial perspective-taking that is under strategic control. The present experiment investigated further the influence of strategy on spatial perspective-taking by assessing whether participants may also elect to employ a separable "disembodied" route loading on inhibitory control mechanisms. Participants (N = 92) undertook both the "own body transformation" (OBT) perspective-taking task, requiring speeded spatial judgments made from the perspective of an observed figure, and a control task measuring ability to inhibit spatially compatible responses in the absence of a figure. Perspective-taking performance was found to be related to performance on the response inhibition control task, in that participants who tended to take longer to adopt a new perspective also tended to show a greater elevation in response times when inhibiting spatially compatible responses. This relationship was restricted to those participants reporting that they adopted the perspective of another by reversing left and right whenever confronted with a front-view figure; it was absent in those participants who reported perspective-taking by mentally transforming their spatial orientation to align with that of the figure. Combined with previously published results, these findings complete a double dissociation between embodied and disembodied routes to spatial perspective-taking, implying that spatial perspective-taking is subject to modulation by strategy, and suggesting that embodied routes to perspective-taking may place minimal demands on domain general executive functions.

Subjective thirst moderates changes in speed of responding associated with water consumption.

Participants (N = 34) undertook a CANTAB battery on two separate occasions after fasting and abstaining from fluid intake since the previous evening. On one occasion they were offered 500 ml water shortly before testing, and on the other occasion no water was consumed prior to testing. Reaction times, as measured by Simple Reaction Time (SRT), were faster on the occasion on which they consumed water. Furthermore, subjective thirst was found to moderate the effect of water consumption on speed of responding. Response latencies in the SRT task were greater under the "no water" condition than under the "water" condition, but only for those participants with relatively high subjective thirst after abstaining from fluid intake overnight. For those participants with relatively low subjective thirst, latencies were unaffected by water consumption, and were similarly fast as those recorded for thirsty participants who had consumed water. These results reveal the novel finding that subjective thirst moderates the positive effect of fluid consumption on speed of responding. The results also showed evidence that practice also affected task performance. These results imply that, for speed of responding at least, the positive effects of water supplementation may result from an attenuation of the central processing resources consumed by the subjective sensation of thirst that otherwise impair the execution of speeded cognitive processes.

Water consumption, not expectancies about water consumption, affects cognitive performance in adults.

Research has shown that water supplementation positively affects cognitive performance in children and adults. The present study considered whether this could be a result of expectancies that individuals have about the effects of water on cognition. Forty-seven participants were recruited and told the study was examining the effects of repeated testing on cognitive performance. They were assigned either to a condition in which positive expectancies about the effects of drinking water were induced, or a control condition in which no expectancies were induced. Within these groups, approximately half were given a drink of water, while the remainder were not. Performance on a thirst scale, letter cancellation, digit span forwards and backwards and a simple reaction time task was assessed at baseline (before the drink) and 20 min and 40 min after water consumption. Effects of water, but not expectancy, were found on subjective thirst ratings and letter cancellation task performance, but not on digit span or reaction time. This suggests that water consumption effects on letter cancellation are due to the physiological effects of water, rather than expectancies about the effects of drinking water.

Sex differences in components of imagined perspective transformation.

Little research to date has examined whether sex differences in spatial ability extend to the mental self rotation involved in taking on a third party perspective. This question was addressed in the present study by assessing components of imagined perspective transformations in twenty men and twenty women. Participants made speeded left-right judgements about the hand in which an object was held by front- and back- facing schematic human figures in an "own body transformation task." Response times were longer when the figure did not share the same spatial orientation as the participant, and were substantially longer than those made for a control task requiring left-right judgements about the same stimuli from the participant's own point of view. A sex difference in imagined perspective transformation favouring males was found to be restricted to the speed of imagined self rotation, and was not observed for components indexing readiness to take a third party point of view, nor in left-right confusion. These findings indicate that the range of spatial abilities for which a sex difference has been established should be extended to include imagined perspective transformations. They also suggest that imagined perspective transformations may not draw upon those empathic social-emotional perspective taking processes for which females show an advantage.

Empathic and non-empathic routes to visuospatial perspective-taking.

The present study examined whether strategy moderated the relationship between visuospatial perspective-taking and empathy. Participants (N=96) undertook both a perspective-taking task requiring speeded spatial judgements made from the perspective of an observed figure and the Empathy Quotient questionnaire, a measure of trait empathy. Perspective-taking performance was found to be related to empathy in that more empathic individuals showed facilitated performance particularly for figures sharing their own spatial orientation. This relationship was restricted to participants that reported perspective-taking by mentally transforming their spatial orientation to align with that of the figure; it was absent in those adopting an alternative strategy of transposing left and right whenever confronted with a front-view figure. Our finding that strategy moderates the relationship between empathy and visuospatial perspective-taking enables a reconciliation of the apparently inconclusive findings of previous studies and provides evidence for functionally dissociable empathic and non-empathic routes to visuospatial perspective-taking.

Expectation of having consumed caffeine can improve performance and mood.

We explored whether caffeine, and expectation of having consumed caffeine, affects attention, reward responsivity and mood using double-blinded methodology. 88 participants were randomly allocated to 'drink-type' (caffeinated/decaffeinated coffee) and 'expectancy' (told caffeinated/told decaffeinated coffee) manipulations. Both caffeine and expectation of having consumed caffeine improved attention and psychomotor speed. Expectation enhanced self-reported vigour and reward responsivity. Self-reported depression increased at post-drink for all participants, but less in those receiving or expecting caffeine. These results suggest caffeine expectation can affect mood and performance but do not support a synergistic effect.

Aluminium exposure from parenteral nutrition in preterm infants and later health outcomes during childhood and adolescence.

Aluminium is the most common metallic element, but has no known biological role. It accumulates in the body when protective gastrointestinal mechanisms are bypassed, renal function is impaired, or exposure is high - all of which apply frequently to preterm infants. Recognised clinical manifestations of aluminium toxicity include dementia, anaemia and bone disease. Parenteral nutrition (PN) solutions are liable to contamination with aluminium, particularly from acidic solutions in glass vials, notably calcium gluconate. When fed parenterally, infants retain >75% of the aluminium, with high serum, urine and tissue levels. Later health effects of neonatal intravenous aluminium exposure were investigated in a randomised trial comparing standard PN solutions with solutions specially sourced for low aluminium content. Preterm infants exposed for >10 d to standard solutions had impaired neurologic development at 18 months. At 13-15 years, subjects randomised to standard PN had lower lumbar spine bone mass; and, in non-randomised analyses, those with neonatal aluminium intake above the median had lower hip bone mass. Given the sizeable number of infants undergoing intensive care and still exposed to aluminium via PN, these findings have contemporary relevance. Until recently, little progress had been made on reducing aluminium exposure, and meeting Food and Drug Administration recommendations (<5 µg/kg per d) has been impossible in patients <50 kg using available products. Recent advice from the UK Medicines and Healthcare regulatory Authority that calcium gluconate in small volume glass containers should not be used for repeated treatment in children <18 years, including preparation of PN, is an important step towards addressing this problem.