Traumatic brain injury (TBI) causes heterogeneous patterns of neurocognitive deficits. In an attempt to identify homogenous subgroups within this heterogeneity, cluster analysis was used to examine memory and attention abilities as measured by the Test of Memory and Learning (TOMAL) in 300 children, 150 with TBI and 150 matched nonbrain injured controls (standardization sample [SS]). Significant differences were present between the TBI and the SS groups on all TOMAL subscale and index scores, with the TBI groups performing approximately 1.3 SD below the SS. Factor analysis of the TOMAL indicated six factors that assessed various aspects of verbal and nonverbal learning and memory, as well as attention/concentration. Cluster analyses of TOMAL factor scores indicated that a four-cluster solution was optimal for the SS group, and a five-cluster solution for the TBI group. For the TBI clusters, differences were present for clinical, achievement, neurocognitive, and behavioral variables, providing some support for the validity of the cluster solution. These findings suggest that TBI results in unique patterns of neurocognitive impairment that are not accounted for by individual differences in test performance commonly observed in normal populations. Additionally, neurocognitive profiles identified using cluster analysis may prove useful for identifying homogeneous subgroups of children with TBI that are differentiated by a number of important clinical, cognitive, and behavioral variables associated with treatment and outcomes.
Mucolipidosis type IV (MLIV) is an autosomal recessive disorder resulting from mutations in the MCOLN1 gene. This gene encodes the endosomal/lysosomal transient receptor potential channel protein mucolipin-1 (TRPML1). Affected patients suffer from neurodevelopmental abnormalities and progressive retinal dystrophy. In a prospective natural history study we hypothesized the presence of an additional slow cerebral neurodegenerative process. We have recruited 5 patients, tested their neurodevelopmental status, and measured cerebral regional volumes and white matter integrity using MRI yearly. Over a period of up to 3 years, MLIV patients remained neurologically stable. There was a trend for increased cortical and subcortical gray matter volumes, and increased ventricular size, while white matter and cerebellar volumes decreased. Mean diffusivity (MD) was increased and fractional anisotropy (FA) values were below normal in all analyzed brain regions. There was a positive correlation between motor scores of the Vineland scale and the FA values in the corticospinal tract (corr coef 0.39) and a negative correlation with the MD values (corr coef. −0.50) in the same brain region. We conclude from these initial findings that deficiency in mucolipin-1 affects the entire brain but that there might be a selective regional cerebral neurodegenerative process in MLIV. In addition, these data suggest that diffusion-weighted imaging might be a good biomarker for following patients with MLIV. Therefore, our findings may be helpful for designing of future clinical trials.
Key PointsQuestionDo children with previously normal neurocognitive function who survive an episode of acute respiratory failure requiring intensive care and invasive mechanical ventilation have worse long-term neurocognitive function than their matched siblings?FindingsIn this cohort study that included 121 sibling pairs, children discharged from intensive care hospitalization for respiratory failure without severe cognitive dysfunction compared with their matched siblings had a mean IQ score of 101.5 vs 104.3, a difference that was statistically significant.MeaningAcute respiratory failure in early childhood was associated with a slightly, but statistically significant, lower subsequent IQ score.
The Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV; D. Wechsler, 2003a) is often utilized to assess children with traumatic brain injury (TBI), although little information is available regarding its psychometric properties in these children. The current study examined WISC-IV performance in a sample of 61 children with TBI. As compared to the standardization sample, results indicated that the TBI group exhibited relative deficits on all subtest and index scores, with the greatest deficits on the Processing Speed Index (PSI) and Coding subtest scores. However, the Perceptual Reasoning Index score was not uniquely sensitive to brain injury, and the Cognitive Processing Index score was less sensitive to TBI than the PSI score. Also, the PSI did not uniquely predict learning and memory abilities, as had been reported in previous studies of the Wechsler Intelligence Scale for Children-Third Edition (WISC-III; D. Wechsler, 1991). The present findings indicate substantive differences between the WISC-III and WISC-IV profiles of children with TBI.
Traumatic brain injury (TBI) is a common cause of disability among children in the United States, and attention deficits are frequently observed in both the acute and chronic phases of injury. The current study investigated models of attention in children with TBI and examined differential sensitivity of various components of these attention models to the severity of the brain injury. Participants included 151 children and adolescents (mean age 12.9 years, SD=2.6) who had suffered TBI, and 50 normal controls (mean age 12.5 years old, SD=2.2). All children were administered neuropsychological tests of attention as part of a comprehensive neuropsychological battery for brain injury (TBI group) or for the purposes of the current investigation (normal controls). Confirmatory factor analysis (CFA) of the attention tests indicated that a four-factor model of attention composed of Shift, Focus, Encode, and Sustain factors provided the best fit of the TBI group data. Factor scores were subsequently created and used to predict the severity of brain injury. All four factors were sensitive to TBI in that those with TBI performed significantly worse than the controls, but regression analysis indicated that only the Shift and Focus factors were significant predictors of TBI severity. These findings support the utility of a multicomponent model of attention to understand attention deficits resulting from TBI, and may be useful in determining those aspects of attention that are differentially impacted by TBI, in order to assist in assessment and rehabilitation planning.
Traumatic brain injury (TBI) leads the causes of death and disability among children and adolescents. Despite the prevalence of TBI among children, few studies have examined memory in children. The purpose of this study was to compare memory functioning, as measured by the Test of Memory and Learning (TOMAL), of children with and without TBI and with moderate and severe TBI to determine if differences existed. Of the 140 participants, 70 had sustained a head trauma and 70 served as controls. The results indicated that, when the TBI and control group were compared, significant differences were found on all of the TOMAL indexes. With the exception of the verbal delayed recall items, significant differences were demonstrated on all the TOMAL subtests. No differences were identified when moderate and severe groups were compared. These findings further the understanding of memory following pediatric TBI, as well as have implications for interventions with this population.
Gender differences among children and adolescents were examined on 14 separate measures of short-term memory. A nationally stratified sample of 1,279 children and adolescents, 637 males and 642 females, ranging in age between 5 and 19 years, were assessed on the 14 subtests of the Test of Memory and Learning (TOMAL). Factor structure of the TOMAL was determined to be invariant as a function of gender. Using age-corrected deviation scaled scores calculated at 1-year intervals, results of a one-way multivariate analysis of variance (MANOVA) revealed only two significant differences in absolute scores across gender on the 14 memory subtests. A profile of normal variations in patterns of memory test performance across gender revealing relative strengths for females on verbal tasks and males on spatial tasks is presented for clinical use and future normative comparisons.
Research suggests that IQ profiles identify subgroups of children with traumatic brain injury (TBI) based on sparing and impairment of cognitive abilities, but little information is available regarding whether these subgroups are differentiated on variables that are important for TBI outcome, such as behavioral functioning. The current study examined behavioral disturbances in 123 children with TBI in association with profiles of intellectual abilities identified using cluster analysis. On the basis of prior research, four clusters were hypothesized. Consistent with the hypothesis, cluster analysis identified four IQ clusters in the current sample. Comparisons among the clusters on behavior variables assessed from the Behavioral Assessment System for Children parent ratings indicated significant differences among the four IQ clusters, with the most impaired cluster exhibiting the severest disturbances. Results of the current study indicate that subgroups of children with TBI can be identified using IQ tests and that these subgroups are stable across different samples, and more importantly are moderately associated with behavioral disturbances that persist during the recovery period.
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