Prognostic value of brain abnormalities for cognitive functioning in cerebral palsy: A prospective cohort study
Moll, Irene; Voorman, Jeanine M; Ketelaar, Marjolijn; van Schie, Petra E; Gorter, Jan Willem; Lequin, Maarten H; de Vries, Linda S; Vermeulen, R Jeroen
(2021) European Journal of Paediatric Neurology, volume 32, pp. 56 - 65
(Article)
Abstract
INTRODUCTION: Brain abnormalities in cerebral palsy (CP) are known to relate to motor outcome; however, their association with cognitive functioning is less clear. AIM OF THE STUDY: 1) To investigate the prognostic value of brain abnormalities for cognitive functioning; 2) To explore the added value of prognostic variables across ICF
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domains: motor function, epilepsy, gestational age, birthweight and educational level of the parents. METHODS: We retrospectively analyzed brain MRI scans of 75 children with CP (GMFCS level I-V, 36% born preterm), as part of a longitudinal study. MRI classification: qualitative classification of brain abnormality pattern and semi-quantitative grading of the extent of damage. Cognitive functioning, measured as non-verbal intelligent quotient (IQ), was dichotomized into 'impaired cognition' (IQ ≤ 70) and 'normal' (IQ > 70). Multivariable logistic regression produced odds ratios (OR) with 95% confidence interval (C.I.) of risk factors for impaired cognition. RESULTS: Overall, 27% of the tested participants had a non-verbal IQ below 70 and 36% of the participants was classified as 'having impaired cognition'. At a young age, a higher degree of white matter damage (OR 1.6, 95% C.I. 0.97-2.67) and a more severe GMFCS level (OR 3.2, 95% C.I. 1.70-5.98) are risk factors for impaired cognition at school-age (4-7 years of age). This model correctly predicts 89% of the cases. Brain damage alone predicts the presence of impaired cognition in 71% of the cases. INTERPRETATION: Brain MRI characteristics and GMFCS level at a young age can each help identify children with CP at risk for impaired cognition at school age and together have a strong predictive value.
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Keywords: Cerebral palsy, Cognitive function, Cognitive impairment, MRI, Neuroimaging, Clinical Neurology, Pediatrics, Perinatology, and Child Health, Journal Article
ISSN: 1090-3798
Publisher: W.B. Saunders Ltd
Note: Funding Information: This research has been performed as part of the PERRIN (Pediatric Rehabilitation Research in the Netherlands) research program and has been supported by the Netherlands Organization for Health Research and Development (grant numbers 1435.0011 and 1435.0028). The Hague, The Netherlands. The authors would like to thank the children and parents for their participation, and thank the university medical centers and rehabilitation centers for their collaboration in data collection. We thank D.W. Smits (De Hoogstraat Rehabilitation and University Medical Center Utrecht) for preparing the data, and the PERRIN consortium for their contribution to the program; A.J. Dallmeijer (Amsterdam UMC, Vrije Universiteit Amsterdam); M.E. Roebroeck (Erasmus MC, University Medical Center and Rijndam Rehabilitation, Rotterdam); M. Ketelaar, J.M. Voorman (University Medical Center Utrecht and Rehabilitation Center De Hoogstraat, Utrecht); H.A. Reinders-Messelink (Revalidatie Friesland and University Medical Center Groningen); J.W. Gorter (McMaster University, Hamilton, Canada), and J. Verheijden, BOSK (Association of Physically Disabled Persons and their Parents). Funding Information: This research has been performed as part of the PERRIN (Pediatric Rehabilitation Research in the Netherlands) research program and has been supported by the Netherlands Organization for Health Research and Development (grant numbers 1435.0011 and 1435.0028 ). The Hague, The Netherlands. The authors would like to thank the children and parents for their participation, and thank the university medical centers and rehabilitation centers for their collaboration in data collection. We thank D.W. Smits (De Hoogstraat Rehabilitation and University Medical Center Utrecht) for preparing the data, and the PERRIN consortium for their contribution to the program; A.J. Dallmeijer (Amsterdam UMC, Vrije Universiteit Amsterdam); M.E. Roebroeck (Erasmus MC, University Medical Center and Rijndam Rehabilitation, Rotterdam); M. Ketelaar, J.M. Voorman (University Medical Center Utrecht and Rehabilitation Center De Hoogstraat, Utrecht); H.A. Reinders-Messelink (Revalidatie Friesland and University Medical Center Groningen); J.W. Gorter (McMaster University, Hamilton, Canada), and J. Verheijden, BOSK (Association of Physically Disabled Persons and their Parents). Publisher Copyright: © 2021 The Authors Copyright: Copyright 2021 Elsevier B.V., All rights reserved.
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