[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.

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

Introducción. La hemorragia intraventricular (HIV) se ha asociado a un déficit o retraso en el desarrollo cognitivo en niños y adolescentes con antecedentes de prematuridad. Sin embargo, no existe un estudio detallado sobre el rendimiento cognitivo específico de estos sujetos en la etapa adolescente. Objetivo. Explorar el rendimiento cognitivo general y específico de adolescentes que nacieron prematuros con HIV diagnosticada en el período neonatal, mediante una evaluación neuropsicológica exhaustiva que abarque diversos dominios cognitivos. Sujetos y métodos. Las funciones cognitivas de 16 sujetoscon antecedentes de prematuridad y HIV neonatal se compararon con las de 30 sujetos control. Se evaluó el cociente de inteligencia, el aprendizaje, la memoria, las habilidades visuoespaciales y visuoconstructivas, y las funciones frontales. Resultados. Se observaron diferencias significativas en el cociente de inteligencia total y manipulativo, así como en diversas variables cognitivas específicas. Tras controlar por el cociente de inteligencia total, y comparar con los prematuros sin HIV, se mantuvieron las diferencias en aprendizaje verbal y memoria verbal. Los sujetos con HIV grados III-IV rendían significativamentepeor en aprendizaje verbal, memoria de la vida cotidiana y habilidades visuoespaciales y visuoconstructivas respecto a los sujetos con HIV grados I-II. Conclusiones. Los adolescentes con antecedentes de prematuridad y HIV neonatal presentan disfunciones en el rendimiento cognitivo general, así como específico, que podrían explicar los problemas de rendimientoacadémico frecuentemente descritos en esta población

Introduction. Intraventricular hemorrhage (IVH) in the neonatal period has been associated to developmentalimpairment 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, visuospatialand visuoperceptive abilities, and frontal functions were evaluated. Results. Significant differences were observed forfull 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 inverbal 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.

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

Introducción. Los efectos de la prematuridad sobre el funcionamiento cognitivo a largo plazo son poco conocidos. En población española no existe un estudio detallado del rendimiento cognitivo de los adolescentes nacidos prematuros. Objetivo. Explorar el rendimiento en las escalas de inteligencia de Wechsler en una amplia muestra de adolescentes con antecedentes de prematuridad, describir la significación clínica de este rendimiento y analizar la capacidad discriminativa de los distintos subtests. Pacientes y métodos. Se evaluó el coeficiente de inteligencia de 62 sujetos pretérmino y 62 controles a través de la administración completa de las escalas de inteligencia Wechsler. Además, se evaluaron diversas funciones neuropsicológicas específicas. Resultados. Se observaron diferencias significativas en los cocientes de inteligencia total, verbal y manipulativo, así como en la mayoría de subtests, aunque menos del 30% de los sujetos prematuros presentaron un rendimiento alterado. Los subtests más sensibles al bajo rendimiento de los prematuros fueron: vocabulario, claves e historietas. Las diferencias significativas en aprendizaje, memoria, flexibilidad cognitiva y fluidez verbal, no se mantuvieron al controlar por el rendimiento cognitivo general. Conclusiones. Los adolescentes con antecedentes de prematuridad como grupo presentan un bajo rendimiento en la escala de inteligencia de Wechsler, aunque la mayoría de ellos obtienen puntuaciones dentro del intervalo de la normalidad. Los distintos subtests que componen esta escala no presentan el mismo grado de sensibilidad al evaluar las posibles dificultades de rendimiento cognitivo de los adolescentes pretérmino

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.

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

Introducción. El daño cerebral difuso (DCD) secundario al traumatismo craneoencefálico (TCE) puede estudiarse a través de la evaluación volumétrica de diversas estructuras, entre las cuales destacan el cuerpo calloso, el hipocampo y los ganglios basales. Asimismo, el volumen de líquido cefalorraquídeo es también una buena medida de pérdida de masa encefálica. Objetivo. Evaluar el DCD producido por un TCE cerrado infantil y observar los efectos que éste tiene a largo plazo sobre el rendimiento cognitivo general. Pacientes y métodos. Se partió inicialmente de una muestra de 27 pacientes con TCE cerrado infantil, moderado o grave, de la cual se seleccionaron 15 sujetos, por carecer de lesiones focales, o en su caso, que éstas fueran inferiores a 2.600 mm3. En los 15 sujetos estudiados se realizó un análisis volumétrico del líquido cefalorraquídeo, del cuerpo calloso, del hipocampo y del núcleo caudado y se comparó con un grupo control. Además, se evaluó su deterioro cognitivo general mediante test de inteligencia, de memoria, y de la evaluación de las funciones frontales y motoras. Resultados. Los resultados mostraron que los pacientes con antecedentes de traumatismo presentaban atrofia en todas las estructuras medidas y que la atrofia del cuerpo calloso fue la variable que mejor explicaba el deterioro cognitivo general. Conclusiones. El daño difuso causado por TCE moderado-grave en la infancia persiste a largo plazo y comporta déficit cognitivos; la atrofia del cuerpo calloso es la que mejor predice el deterioro cognitivo general de los afectados, con relación a otras estructuras indicadoras de DCD (AU)