Executive functions and their relationship with intellectual capacity and age in schoolchildren with intellectual disability

Background: There is certain empirical evidence of, on the one hand, a positive correlation between executive functions (EFs) and intelligence in people with intellectual disability (ID) and, on the other hand, a slower rate of development of EFs in these people relative to people without ID. This evidence is not, however, unequivocal, and further studies are required. Methods: We analysed the relationship between development of EFs and both age and intellectual capacity, in a sample of 106 students with either ID or borderline intellectual functioning (BIF) at a special education centre [63 boys and 43 girls, 11-18 years old, mean total intelligence quotient (TIQ) of 59.6]. We applied nine instruments to evaluate both neuropsychological development (working memory, inhibitory control, cognitive flexibility, planning, processing speed and verbal fluency) and behavioural development [teachers' perceptions of the EFs of their students by Behavior Rating Inventory of Executive Function - Second Edition (BRIEF-2) School]. ID and BIF groups were statistically compared in terms of mean performance measures in EF tests. We looked at the correlation between EFs and age, and correlations between EFs and intelligence: TIQ, fluid intelligence [measured by the perceptual reasoning (PR) sub-index of Wechsler Intelligence Scale for Children-IV (WISC-IV)] and crystallised intelligence (measured by the verbal comprehension (VC) sub-index of WISC-IV). Regression models were built for variables with strong correlation. Results: In most of the tests used to evaluate EFs, the ID subgroup performed significantly worse than the subgroup with BIF. In general, teachers' thought that participants had 'medium-low' levels of EFs. TIQ, by WISC-IV scale, correlated significantly with scores in all tests for all EFs. The PR sub-index correlated significantly with 14 of the tests for EFs; 35% of the variation in PR can be explained by variation in performance in Picture Span (working memory) and Mazes (planning). The VC sub-index correlated weakly with seven of the EF tests. We found significant correlations in the ID group between age and scores in all tests of working memory and inhibitory control. Age - considering all participants - did not correlate with any of the variables of teachers' perception except for working memory, and this correlation was not strong. Conclusions: The results of our study are consistent with descriptions of the typical population: (1) fluid intelligence is more related to EFs than crystallised intelligence is; and (2) working memory capacity is the EF most strongly related with general, fluid and crystallised forms of intelligence. The results suggest that as children and adolescents with ID/BIF get older, their capacities for working memory and inhibitory control increase; development of the other EFs studied was less evident. Teachers' perceptions of the EFs of children with ID or BIF were independent of intellectual capacity and age. More research is needed to delve further into the development of EFs in people with ID/BIF

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio

Executive functions and their relationship with intellectual capacity and age in schoolchildren with intellectual disability

Background: There is certain empirical evidence of, on the one hand, a positive correlation between executive functions (EFs) and intelligence in people with intellectual disability (ID) and, on the other hand, a slower rate of development of EFs in these people relative to people without ID. This evidence is not, however, unequivocal, and further studies are required. Methods: We analysed the relationship between development of EFs and both age and intellectual capacity, in a sample of 106 students with either ID or borderline intellectual functioning (BIF) at a special education centre [63 boys and 43 girls, 11-18 years old, mean total intelligence quotient (TIQ) of 59.6]. We applied nine instruments to evaluate both neuropsychological development (working memory, inhibitory control, cognitive flexibility, planning, processing speed and verbal fluency) and behavioural development [teachers' perceptions of the EFs of their students by Behavior Rating Inventory of Executive Function - Second Edition (BRIEF-2) School]. ID and BIF groups were statistically compared in terms of mean performance measures in EF tests. We looked at the correlation between EFs and age, and correlations between EFs and intelligence: TIQ, fluid intelligence [measured by the perceptual reasoning (PR) sub-index of Wechsler Intelligence Scale for Children-IV (WISC-IV)] and crystallised intelligence (measured by the verbal comprehension (VC) sub-index of WISC-IV). Regression models were built for variables with strong correlation. Results: In most of the tests used to evaluate EFs, the ID subgroup performed significantly worse than the subgroup with BIF. In general, teachers' thought that participants had 'medium-low' levels of EFs. TIQ, by WISC-IV scale, correlated significantly with scores in all tests for all EFs. The PR sub-index correlated significantly with 14 of the tests for EFs; 35% of the variation in PR can be explained by variation in performance in Picture Span (working memory) and Mazes (planning). The VC sub-index correlated weakly with seven of the EF tests. We found significant correlations in the ID group between age and scores in all tests of working memory and inhibitory control. Age - considering all participants - did not correlate with any of the variables of teachers' perception except for working memory, and this correlation was not strong. Conclusions: The results of our study are consistent with descriptions of the typical population: (1) fluid intelligence is more related to EFs than crystallised intelligence is; and (2) working memory capacity is the EF most strongly related with general, fluid and crystallised forms of intelligence. The results suggest that as children and adolescents with ID/BIF get older, their capacities for working memory and inhibitory control increase; development of the other EFs studied was less evident. Teachers' perceptions of the EFs of children with ID or BIF were independent of intellectual capacity and age. More research is needed to delve further into the development of EFs in people with ID/BIF