A Pilot Study of Neuroplasticity Based Cognitive Remediation in Early Onset Psychosis

Introduction – Neuroplasticity based auditory and visual training programs appear to improve neurocognitive function in adults with schizophrenia, but use in younger individuals has not been determined. We hypothesized that adolescents might play more often and respond better than adults to training using a game-like laptop in their home environment. Methods -- Youth 10-19 years with Early Onset Psychosis (EOP) were provided a laptop and randomly assigned to play games to enhance basic auditory, visual and social processing neuroplasticity games (NPG) or assigned to control games with cognitive components, such as Sudoku or hangman or (CG). All received neurocognitive assessments at baseline, intervention completion and 4 months post treatment. Results — 12 youth (15.5 +3.2 yrs) were assigned to NPG and 10 participants (16.2 +2.1 years) were assigned to CG. More NPG than CG participants completed the prescribed hours of game play (block 1 - 92% vs. 70% over the first 40 hours), with both groups engaged less over time. Although most neurocognitive functions did not change, the NPG group did show improvements in WRAML Visual Learning, WISC Digit Span Forward, Spatial Span Backwards and CPT omission errors. Surprisingly, satisfaction was lower for NPG than CG. Conclusions — Groups were well matched for baseline illness characteristics. On the global measures of cognition, both EOP groups showed improvement over time but those improvements were generally greater in the CG than in the NPG group, with potentially significant differences favoring the CG evident in the neurocognitive composite score (p=0.072) and BRIEF metacognition (p=.117). Youth did not play as frequently or as long as requested despite providing a laptop for their home use and stipends for playing

Effects of resuscitation fluid on neurologic physiology after cerebral trauma and hemorrhage

BACKGROUND: The current standard of care for fluid resuscitation of hemorrhagic hypotensive patients involves the use of crystalloid solutions. Traumatic brain injury (TBI) is often associated with hemorrhage and hypotension, which can contribute significantly to morbidity and mortality. Guidelines for the choice of fluid resuscitation and the use of red blood cell transfusions are not yet clear in the context of brain injury. METHODS: Various fluid resuscitation strategies were evaluated in Sprague-Dawley rats using fresh blood, normal saline, hypertonic saline, and albumin fluid resuscitation protocols. Mean arterial blood pressure (MAP) and cerebral oximetry were assessed in hemorrhaged groups and the mean population spike amplitudes (PSA) from the hippocampus were examined in fluid percussion injured (FPI) animals subject to hemorrhage and fluid resuscitation. RESULTS: MAP in control animals, hemorrhage and hemorrhage + albumin treated groups was 82.4 ± 1.5 mm Hg, 55.7 ± 1.5 mm Hg, and 97.0 ± 3.4 mm Hg, respectively. Arterial PaO2 was higher in albumin-treated animals relative to other fluid alternatives. Regional tissue oxygen tension (PbrO2) levels in hemorrhaged animals reached significantly higher levels in albumin treated group compared with in normal saline and hypertonic saline (p < 0.001, p = 0.034, respectively). After FPI+hemorrhage, PSA values in albumin- resuscitated animals were significantly higher than in normal saline-resuscitated animals (p = 0.012). CONCLUSIONS: The results of normal saline resuscitation, relative to other fluid alternatives, suggest that a re-evaluation of current treatment strategies in hemorrhagic hypotensive TBI patients is warranted. Albumin demonstrated the greatest beneficial effects on neurophysiology endpoints over crystalloid alternatives. These data suggests that albumin resuscitation may play an important role in the treatment of hemorrhagic hypotension and TBI. © 2008 Lippincott Williams & Wilkins, Inc.link_to_subscribed_fulltex

β2 adrenergic antagonist inhibits cerebral cortical oxygen delivery after severe haemodilution in rats

Background. Haemodilution has been associated with neurological morbidity in surgical patients. This study tests the hypothesis that inhibition of cerebral vasodilatation by systemic β2 adrenergic blockade would impair cerebral oxygen delivery leading to tissue hypoxia in severely haemodiluted rats. Methods. Under general an aesthesia, cerebral tissue probes were placed to measure temperature, regional cerebral blood flow (rCBF) and tissue oxygen tension (PBrO2) in the parietal cerebral cortex or hippocampus. Baseline measurements were established before and after systemic administration of either a β2 antagonist (10 mg kg-1 i.v., ICI 118, 551) or saline vehicle. Acute haemodilution was then performed by simultaneously exchanging 50% of the estimated blood volume (30 ml kg-1) with pentastarch. Arterial blood gases (ABGs), haemoglobin concentration (co-oximetry), mean arterial blood pressure (MAP) and heart rate (HR) were also measured. Data were analysed using a two-way anova and post hoc Tukey's test [mean (sd)]. Results. Haemodilution reduced the haemoglobin concentration comparably in all groups [71 (9) g litre-1]. There were no differences in ABGs, co-oximetry, HR and MAP measurements between control and β2 blocked rats, either before or 60 min after drug or vehicle administration. In rats treated with the β2 antagonist there was a significant reduction in parietal cerebral cortical temperature, regional blood flow and tissue oxygen tension, relative to control rats, 60 min after haemodilution (P<0.05 for each). These differences were not observed when probes were placed in the hippocampus. Conclusion. Systemic β2 adrenergic blockade inhibited the compensatory increase in parietal cerebral cortical oxygen delivery after haemodilution thereby reducing cerebral cortical tissue oxygen tension. © 2006 Oxford University Press.link_to_subscribed_fulltex

Intellectual disability is associated with increased risk for obesity in a nationally representative sample of U.S. children

BACKGROUND: Data on obesity prevalence in children with intellectual disability (ID) are scarce. OBJECTIVE: We estimated rates of obesity among children aged 10-17 years with and without ID in a nationally representative dataset that included measures of child weight and ID status, as well as family meal frequency, physical activity, and sedentary behavior. METHODS: Chi-square tests compared prevalence of obesity, demographic and behavioral characteristics between children with and without ID as reported in the 2011 National Survey of Children\u27s Health. Tests for interaction in logistic regression models determined whether associations between obesity and behavioral characteristics were different between children with/without ID. RESULTS: Obesity prevalence for children with ID was 28.9% and 15.5% for children without ID. After adjusting for age, sex, race/ethnicity and poverty level, the odds ratio was significantly 1.89 times greater among children with ID than among those without ID (95% CI: 1.14 to 3.12). Among children with ID, 49.8% ate at least one meal with family members every day compared to 35.0% without ID (p \u3c 0.002), and 49.5% with ID participated in frequent physical activity compared to 62.9% (p \u3c 0.005). Prevalence of obesity was higher among all children who ate family meals every day compared to fewer days per week, and the effect was significantly more pronounced among those with ID (p = 0.05). CONCLUSIONS: Prevalence of obesity among youth with ID was almost double that of the general population. Prospective studies are needed in this population to examine the impact of consistent family mealtimes and infrequent physical activity

Parental concern regarding obesity in children with autism spectrum disorder in the United States: National Survey of Children\u27s Health 2016

BACKGROUND: The prevalence of obesity in children with autism spectrum disorder (ASD) exceeds that of the general population, but the level of parental concern about obesity in these children is unexplored. OBJECTIVE: We estimate the prevalence of obesity in children 10-17 years in the redesigned National Survey of Children\u27s Health (NSCH) 2016, and compare parental concern about obesity between parents of children with and without ASD. METHODS: The nationally representative NSCH 2016 oversampled parents of children with parent-report of special health care needs, including ASD. Parents opted to complete the survey via the web or surface mail. Following report of their child\u27s height and weight, parents were asked Are you concerned about their weight? Response options included: Yes, it\u27s too high, Yes, it\u27s too low, or No, I am not concerned. Obesity ( \u3e 95th percentile BMI) was defined using the 2000 CDC growth reference. We used logistic regression to compare odds of obesity, and odds of parental concern, between children with and without ASD. RESULTS: In 24,251 children, ASD (n=699) increased obesity risk after adjusting for age, sex, and race/ethnicity (OR=1.54, 95%CI: 1.11, 2.14). ASD medication did not significantly affect obesity. ASD increased obesity concern (OR=2.17, 95%CI: 1.53, 4.81) among parents with obese children. Parents of boys with obesity and ASD had less obesity concern if he was taking medication for ASD (OR=0.258, 95%CI: 0.09, 0.78). CONCLUSION: While the prevalence of obesity is elevated in children with ASD, parental obesity concern is high, suggesting opportunities for the development of parent-focused obesity prevention and treatment interventions for this population

The Effect of Age on the Prevalence of Obesity among US Youth with Autism Spectrum Disorder

BACKGROUND: We sought to assess the association between age and the prevalence of obesity among children with and without autism spectrum disorder (ASD) in the 2011-2012 National Survey of Children\u27s Health. METHODS: Analyses were restricted to 43,777 children, ages 10-17, with valid measures of parent-reported weight, height, and ASD status. Exploratory analyses describe the impact of sex, race/ethnicity, and household income on the relationship between age and obesity in ASD. RESULTS: Although the overall prevalence of obesity among children with ASD was significantly (p \u3c 0.001) higher than among children without ASD (23.1% vs. 14.1%, 95% confidence interval for difference 3.6 to 14.4), child age significantly (p = 0.035) modified this difference. In a multivariable logistic regression analysis, adjusted for sex, race/ethnicity, and household income, the odds of obesity among children with ASD compared with children without ASD increased monotonically from ages 10 to 17 years. This pattern arose due to a consistently high prevalence of obesity among children with ASD and a decline in prevalence with advancing age among children without ASD. These findings were replicated using a propensity score analysis. Exploratory analyses suggested that the age-related change in obesity disparity between children with and without ASD may be further modified by sex, race/ethnicity, and household income. CONCLUSIONS: The patterns of prevalence observed with increasing age among children with and without ASD were unexpected. A better understanding of the etiological and maintenance factors for obesity in youth with ASD is needed to develop interventions tailored to the specific needs of these children