Interactions of Biomedical and Environmental Risk Factors for Cognitive Development

Abstract

Sickle cell disease (SCD) is associated with a number of biopsychosocial risk factors for cognitive development. Understanding how these risk factors may interact is important for developing interventions for cognitive functioning. The authors assessed the cognitive abilities of children with SCD (n = 50) and related their performance to anemia severity, socioeconomic status (SES), and their interaction. Demographically matched peers without SCD (n = 36) served as a comparison group. Four areas of cognitive weakness were identified among children with SCD: general cognitive ability, crystallized ability, short-term memory, and processing speed. Anemia severity predicted general cognitive ability, crystallized ability, and processing speed. Interactions between anemia severity and SES were found for general cognitive ability and short-term memory. Disease effects in SCD appear to vary depending on the child's level of socioenvironmental risk. Biomedical interventions to benefit cognitive functioning may have different effects depending on whether additional socioenvironmental risk factors are present.

Neurocognitive deficits in children with sickle cell disease: a comprehensive profile

“…These deficits have previously been observed in children with SCD [14,16,34], although findings in this area have been remarkably inconsistent [3,12,38]. In the present study, a visual working memory measurewas chosenthat is relatively independentofmotor-functioning (N-Back task) and an instrument to assess visuo-motor functioning was included as well (Beery VMI), as was recently recommended [16].…”

Neuroimaging abnormalities in adults with sickle cell anemia

“…Neurocognitive deficits among children with sickle cell anemia (SCA) have been reported in a variety of domains, [1][2][3][4][5][6] but deficiencies in intellectual function (IQ) have been the most consistently documented. 3,[6][7][8][9][10] Cognitive dysfunction in SCA appears to worsen with age, 7,11 and individuals with SCA are now living longer.…”

“…3,[6][7][8][9][10] Cognitive dysfunction in SCA appears to worsen with age, 7,11 and individuals with SCA are now living longer. 12 Unfortunately, few studies have evaluated cognitive functioning or associated structural brain abnormalities in adults with SCA.…”

White Matter Damage in Asymptomatic Patients with Sickle Cell Anemia: Screening with Diffusion Tensor Imaging

“…Ischemic injury to the brain is one of the most devastating complications of SCA, with overt stroke occurring at an overall prevalence of 5% 1 and subclinical infarction occurring in 24%-35% of children on screening MR imaging. 2 While several studies have demonstrated neurocognitive deficits in the presence of overt [3][4][5] and silent stroke, [6][7][8] recent studies of large numbers of neurologically asymptomatic children and adults with SCA have demonstrated that cognitive impairment occurs even in the absence of brain abnormalities on conventional MR imaging. [9][10][11][12] Even though the method of neurocognitive assessment varied in these studies, the shared evidence supports both global IQ deficits, as well as domain specific deficits, in executive function and visual-spatial memory.…”