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Ayaz A, Nisar I, Muhammad A, Ahmed K, Chand P, Jehan F. Structural Changes in the Brain on Magnetic Resonance Imaging in Malnourished Children: A Scoping Review of the Literature. Pediatr Neurol 2023; 149:151-158. [PMID: 37890309 DOI: 10.1016/j.pediatrneurol.2023.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 06/10/2023] [Accepted: 08/14/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND This review was conducted to summarize the current evidence on the structural findings seen in brain magnetic resonance imaging (MRI) in malnourished children and the effect of optimized nutritional supplementation on brain development as studied through MRI. METHODS A systematic search was carried out in PubMed, Embase, The Cochrane Library, Web of Science (Clarivate Analytics), WHO ICTRP Clinical Trials in Children, and ClinicalTrials.gov using a predefined search criterion for relevant literature from inception to January 2022. The primary outcome of the study was structural changes observed in the brain on MRI. RESULTS The most common abnormal findings on MRI in malnourished infants were cerebral atrophy and dilated ventricles. Furthermore, a higher proportion of breast milk, calorie, and lipid intake in the diet was significantly associated with increased brain volumes; this also increased the likelihood of normal MRI scores at term. When followed till adolescence, it was observed that these infants had increased neonatal weight gain and a higher intelligence quotient when compared with the group. CONCLUSIONS In conclusion, most children with moderate/severe malnutrition had abnormal MRI findings, mostly cerebral atrophy with or without ventricular dilatation. Since none of the studies measured the degree of atrophy or ventricular dilatation, it was not possible to assess the effect of the severity of malnutrition on brain atrophy. A universal measurement or scoring system for assessing the degree of brain atrophy is needed to help correlate the severity of malnutrition with the degree of brain atrophy and monitor the effects of nutritional rehabilitation over time.
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Affiliation(s)
- Ahmed Ayaz
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Imran Nisar
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | | | - Kheezran Ahmed
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Prem Chand
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Fyezah Jehan
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan.
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Hilabi BS, Alghamdi SA, Almanaa M. Impact of Magnetic Resonance Imaging on Healthcare in Low- and Middle-Income Countries. Cureus 2023; 15:e37698. [PMID: 37081900 PMCID: PMC10112545 DOI: 10.7759/cureus.37698] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2023] [Indexed: 04/22/2023] Open
Abstract
Magnetic resonance imaging (MRI) played a significant role in the digital health platforms that influenced and supported modern medicine. However, there is a shortage of MRI in low- and middle-income countries (LMICs). The International Society of Radiology offers a detailed plan for LMICs to advance imaging quality in the global health agenda. The overarching objective of this scoping review was to determine the impact of MRI in healthcare in LMICs. This scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify available evidence. We systematically searched four academic databases for peer-reviewed literature published between 2018 and 2021, namely, Medline, PubMed, Web of Science, and Scopus, as well as Google Scholar as a source for gray literature. The search identified 54 articles. We identified a range of reasons for introducing MRI in LMICs. Nonetheless, some challenges to accepting MRI as a method of healthcare have been reported, including technological, regulatory, and economical challenges. To implement the proposed plan, the involvement of professional and international organizations is considered crucial. The establishment of an International Commission on Medical Imaging under the umbrella of international organizations is suggested and collaboration with other diagnostic disciplines is encouraged to raise awareness of the importance of upscale diagnostics at large and to foster its integration into the care pathway globally.
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Turesky TK, Shama T, Kakon SH, Haque R, Islam N, Someshwar A, Gagoski B, Petri WA, Nelson CA, Gaab N. Brain morphometry and diminished physical growth in Bangladeshi children growing up in extreme poverty: A longitudinal study. Dev Cogn Neurosci 2021; 52:101029. [PMID: 34801857 PMCID: PMC8605388 DOI: 10.1016/j.dcn.2021.101029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 09/14/2021] [Accepted: 10/24/2021] [Indexed: 11/25/2022] Open
Abstract
Diminished physical growth is a common marker of malnutrition and it affects approximately 200 million children worldwide. Despite its importance and prevalence, it is not clear whether diminished growth relates to brain development and general cognitive ability. Further, diminished growth is more common in areas of extreme poverty, raising the possibility that it may mediate previously shown links between socioeconomic status (SES) and brain structure. To address these gaps, 79 children growing up in an extremely poor, urban area of Bangladesh underwent MRI at age six years. Structural brain images were submitted to Mindboggle software, a Docker-compliant and high-reproducibility tool for tissue segmentation and regional estimations of volume, surface area, cortical thickness, sulcal depth, and mean curvature. Diminished growth predicted brain morphometry and mediated the link between SES and brain morphometry most consistently for subcortical and white matter subcortical volumes. Meanwhile, brain volume in left pallidum and right ventral diencephalon mediated the relationship between diminished growth and full-scale IQ. These findings offer malnutrition as one possible pathway through which SES affects brain development and general cognitive ability in areas of extreme poverty.
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Affiliation(s)
- Ted K Turesky
- Laboratories of Cognitive Neuroscience, Division of Developmental Medicine, Department of Medicine, Boston Children's Hospital, Boston, MA, United States; Harvard Graduate School of Education, Cambridge, MA, United States; Harvard Medical School, Boston, MA, United States.
| | - Talat Shama
- The International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | | | - Rashidul Haque
- The International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Nazrul Islam
- National Institute of Neuroscience and Hospital, Dhaka, Bangladesh
| | - Amala Someshwar
- Laboratories of Cognitive Neuroscience, Division of Developmental Medicine, Department of Medicine, Boston Children's Hospital, Boston, MA, United States
| | - Borjan Gagoski
- Harvard Graduate School of Education, Cambridge, MA, United States; Fetal-Neonatal Neuroimaging and Development Science Center, Boston Children's Hospital, Boston, MA, United States
| | - William A Petri
- Division of Infectious Diseases and International Health, Department of Medicine, School of Medicine, University of Virginia, Charlottesville, VA, United States
| | - Charles A Nelson
- Laboratories of Cognitive Neuroscience, Division of Developmental Medicine, Department of Medicine, Boston Children's Hospital, Boston, MA, United States; Harvard Graduate School of Education, Cambridge, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Nadine Gaab
- Laboratories of Cognitive Neuroscience, Division of Developmental Medicine, Department of Medicine, Boston Children's Hospital, Boston, MA, United States; Harvard Graduate School of Education, Cambridge, MA, United States; Harvard Medical School, Boston, MA, United States
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Coley EJL, Hsiao EY. Malnutrition and the microbiome as modifiers of early neurodevelopment. Trends Neurosci 2021; 44:753-764. [PMID: 34303552 DOI: 10.1016/j.tins.2021.06.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 05/23/2021] [Accepted: 06/11/2021] [Indexed: 01/16/2023]
Abstract
Malnutrition refers to a dearth, excess, or altered differential ratios of calories, macronutrients, or micronutrients. Malnutrition, particularly during early life, is a pressing global health and socioeconomic burden that is increasingly associated with neurodevelopmental impairments. Understanding how perinatal malnutrition influences brain development is crucial to uncovering fundamental mechanisms for establishing behavioral neurocircuits, with the potential to inform public policy and clinical interventions for neurodevelopmental conditions. Recent studies reveal that the gut microbiome can mediate dietary effects on host physiology and that the microbiome modulates the development and function of the nervous system. This review discusses evidence that perinatal malnutrition alters brain development and examines the maternal and neonatal microbiome as a potential contributing factor.
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Affiliation(s)
- Elena J L Coley
- Department of Integrative Biology and Physiology, University of California, Los Angeles, Los Angeles, CA 90095, USA.
| | - Elaine Y Hsiao
- Department of Integrative Biology and Physiology, University of California, Los Angeles, Los Angeles, CA 90095, USA
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Tekin M, Simsek A, Bilak S, Konca C, Almis H, Bilen A. Evaluation Using Spectral-Domain Optical Coherence Tomography of the Effects of Malnutrition on Ocular Parameters in Pediatric Patients. Optom Vis Sci 2021; 97:154-161. [PMID: 32168237 DOI: 10.1097/opx.0000000000001490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
SIGNIFICANCE We determined decreases in choroidal thickness and retinal nerve fiber layer (RNFL) thickness in all quadrants. Our findings show that the choroid and RNFL are affected before the emergence of ocular symptoms in malnourished children. PURPOSE We aimed to determine whether the RNFL, a component of the neuronal structure, and the choroid, supplying the retina, are affected in children with malnutrition using spectral-domain optical coherence tomography. METHODS One hundred twenty-six malnourished patients without ocular symptoms, aged between 5 and 10 years, and 116 healthy children were included in the study. Age, sex, weight-for-age (WFA) z score, height-for-age z score, body mass index-for-age z score, and spectral-domain optical coherence tomography data were recorded. RESULTS Average RNFL thickness was 96.5 μm (82.0 to 128.0 μm) in the malnutrition group and 111.0 μm (95.0 to 128.0 μm) in the control group (P < .001). Retinal nerve fiber layer thickness was statistically significantly lower in all quadrants in malnourished patients compared with the control group. Median choroidal thickness in the foveal center was 304.0 μm (250.0 to 375.0 μm) in the malnutrition group and 345.0 μm (280.0 to 403.0 μm) in the control group (P < .001). Choroidal thickness in all quadrants was also statistically significantly lower in malnourished patients. Positive correlation was determined between average RNFL thicknesses and WFA z score. Average RNFL thickness decreased as WFA z score decreased (r = 0.730 and P < .001). Positive correlation was also observed between choroidal thickness in the foveal center and WFA z score. Foveal center choroidal thickness decreased in line with WFA z score (r = 0.786 and P < .001). CONCLUSIONS Our results show that the retinal nerve fiber layer and choroidal thickness decreased in malnourished children without clinically reported ocular symptoms. A decreased retinal nerve fiber layer and choroidal thickness may be an important clue to the prevention of retinal pathologies that may develop at later ages if the malnutrition is not addressed.
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Affiliation(s)
| | - Ali Simsek
- Department of Ophthalmology, School of Medicine, Adiyaman University, Adiyaman, Turkey
| | - Semsettin Bilak
- Department of Ophthalmology, School of Medicine, Adiyaman University, Adiyaman, Turkey
| | - Capan Konca
- Department of Pediatrics, School of Medicine, Adiyaman University, Adiyaman, Turkey
| | - Habip Almis
- Department of Pediatrics, School of Medicine, Adiyaman University, Adiyaman, Turkey
| | - Abdurrahman Bilen
- Department of Ophthalmology, School of Medicine, Adiyaman University, Adiyaman, Turkey
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Structural changes in the brain on cranial magnetic resonance imaging in severely malnourished children before and after treatment. Nutrition 2020; 74:110753. [DOI: 10.1016/j.nut.2020.110753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 12/19/2019] [Accepted: 12/19/2019] [Indexed: 11/23/2022]
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Brain MRI and cognitive function seven years after surviving an episode of severe acute malnutrition in a cohort of Malawian children. Public Health Nutr 2018; 22:1406-1414. [PMID: 30501662 PMCID: PMC6411134 DOI: 10.1017/s1368980018003282] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Objective To assess differences in cognition functions and gross brain structure in children seven years after an episode of severe acute malnutrition (SAM), compared with other Malawian children. Design Prospective longitudinal cohort assessing school grade achieved and results of five computer-based (CANTAB) tests, covering three cognitive domains. A subset underwent brain MRI scans which were reviewed using a standardized checklist of gross abnormalities and compared with a reference population of Malawian children. Setting Blantyre, Malawi. Participants Children discharged from SAM treatment in 2006 and 2007 (n 320; median age 9·3 years) were compared with controls: siblings closest in age to the SAM survivors and age/sex-matched community children. Results SAM survivors were significantly more likely to be in a lower grade at school than controls (adjusted OR = 0·4; 95 % CI 0·3, 0·6; P < 0·0001) and had consistently poorer scores in all CANTAB cognitive tests. Adjusting for HIV and socio-economic status diminished statistically significant differences. There were no significant differences in odds of brain abnormalities and sinusitis between SAM survivors (n 49) and reference children (OR = 1·11; 95 % CI 0·61, 2·03; P = 0·73). Conclusions Despite apparent preservation in gross brain structure, persistent impaired school achievement is likely to be detrimental to individual attainment and economic well-being. Understanding the multifactorial causes of lower school achievement is therefore needed to design interventions for SAM survivors to thrive in adulthood. The cognitive and potential economic implications of SAM need further emphasis to better advocate for SAM prevention and early treatment.
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Ogbole GI, Adeyomoye AO, Badu-Peprah A, Mensah Y, Nzeh DA. Survey of magnetic resonance imaging availability in West Africa. Pan Afr Med J 2018; 30:240. [PMID: 30574259 PMCID: PMC6295297 DOI: 10.11604/pamj.2018.30.240.14000] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 06/18/2018] [Indexed: 11/11/2022] Open
Abstract
Introduction The availability and utilization of MRI units across sub-Saharan Africa countries remain poor and its distribution is largely unknown. A cross-sectional survey was conducted to determine the distribution and utilization of MRI facilities across the West African sub-region. Methods An interview and online search survey was conducted from September 2015 to September 2016, to determine the MRI facilities (Government/Public and Private) available in the West African sub-region. In Nigeria and Ghana, face-to-face interviews were conducted while for other West African countries, telephone interviews with radiologists and other health professionals as well as a Google online search were conducted to ascertain the distribution of the MRI facilities in the region. The number of MRI units in West Africa per million population was calculated and compared with other parts of the world from available published data. Results Eighty-four MRI units serve a combined population of 372,551,411 in the West African sub-region at the time of this report. Nigeria accounted for more than two-thirds (58 (69%)) of the available units. Of these, 45 (77.6%) of the units were low-field strength systems. Ghana's 14 MRI units were fairly equally distributed between the private (57%) and the public sectors (43%). Ghana with 0.48 units/million population had the highest number of MRI units/ million population followed by Nigeria with 0.30 units/million population. Conclusion Though there is an increase in the number of available MRI units in the West African sub region in the last decade, the numbers remain appallingly small for the population. Infrastructural and maintenance limitations constitute a major impediment to the use of high filed systems in the region. There may be need for greater cooperation between public and private enterprises for future improvement of MRI utilization in the region.
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Affiliation(s)
| | | | | | - Yaw Mensah
- Korle Bu Teaching Hospital Accra, Accra, Ghana
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9
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Abstract
The main forms of childhood malnutrition occur predominantly in children <5 years of age living in low-income and middle-income countries and include stunting, wasting and kwashiorkor, of which severe wasting and kwashiorkor are commonly referred to as severe acute malnutrition. Here, we use the term 'severe malnutrition' to describe these conditions to better reflect the contributions of chronic poverty, poor living conditions with pervasive deficits in sanitation and hygiene, a high prevalence of infectious diseases and environmental insults, food insecurity, poor maternal and fetal nutritional status and suboptimal nutritional intake in infancy and early childhood. Children with severe malnutrition have an increased risk of serious illness and death, primarily from acute infectious diseases. International growth standards are used for the diagnosis of severe malnutrition and provide therapeutic end points. The early detection of severe wasting and kwashiorkor and outpatient therapy for these conditions using ready-to-use therapeutic foods form the cornerstone of modern therapy, and only a small percentage of children require inpatient care. However, the normalization of physiological and metabolic functions in children with malnutrition is challenging, and children remain at high risk of relapse and death. Further research is urgently needed to improve our understanding of the pathophysiology of severe malnutrition, especially the mechanisms causing kwashiorkor, and to develop new interventions for prevention and treatment.
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Affiliation(s)
- Zulfiqar A Bhutta
- Centre for Global Child Health, Hospital for Sick Children, Peter Gilgan Centre for Research &Learning, 686 Bay Street, Toronto, Ontario, M5G 0A4, Canada
- Center of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - James A Berkley
- Clinical Research Department, KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
- The Childhood Acute Illness &Nutrition (CHAIN) Network, Nairobi, Kenya
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Robert H J Bandsma
- Centre for Global Child Health, Hospital for Sick Children, Peter Gilgan Centre for Research &Learning, 686 Bay Street, Toronto, Ontario, M5G 0A4, Canada
- The Childhood Acute Illness &Nutrition (CHAIN) Network, Nairobi, Kenya
- Department of Biomedical Sciences, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Marko Kerac
- Department of Population Health, London School of Hygiene &Tropical Medicine, London, UK
| | - Indi Trehan
- Lao Friends Hospital for Children, Luang Prabang, Laos
- Department of Pediatrics, Washington University in St. Louis, St. Louis, Missouri, USA
- Department of Paediatrics and Child Health, University of Malawi, Blantyre, Malawi
| | - André Briend
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
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Abubakar-Abdullateef A, Adedokun B, Omigbodun O. A comparative study of the prevalence and correlates of psychiatric disorders in Almajiris and public primary school pupils in Zaria, Northwest Nigeria. Child Adolesc Psychiatry Ment Health 2017; 11:29. [PMID: 28596800 PMCID: PMC5463351 DOI: 10.1186/s13034-017-0166-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 05/19/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND 'Almajiris' are children and adolescents sent far away from their homes to study in Islamic schools under the care of Muslim scholars. Over the years, there has been a decline in the capacity of the scholars to cater to these pupils. Consequently, Almajiris spend significant periods of time on the streets begging and carrying out menial jobs to earn a living thereby increasing their risk for physical and mental disorders. The aim of this study was to compare the prevalence of psychiatric disorders among Almajiris and public primary school pupils in Zaria. METHODS A comparative cross-sectional design was utilized to compare 213 Almajiris and 200 public primary school children and adolescents aged between 5 and 19 years. All participants were administered a Socio-demographic questionnaire and the Schedule for Affective Disorders and Schizophrenia for School-aged Children Present and Lifetime Version (K-SADS-PL). Data were analyzed using Chi square tests and logistic regression. RESULTS The current prevalence of psychiatric disorders among Almajiris and public school pupils was 57.7 and 37.0% respectively. After adjusting for age and family characteristics, Almajiris were significantly more likely to have any psychiatric diagnosis, depression, enuresis, substance use, and post traumatic stress disorder but less likely to have separation anxiety disorder than the public school pupils. CONCLUSION Psychiatric disorders are more prevalent among Almajiris and public primary school pupils in Northwest Nigeria than found in other prevalence studies with a significantly higher rate among the Almajiris. Joint efforts need to be made by the Government and Civil Society organizations including religious groups towards reforming the Almajiri education system and the provision of programmes aimed at reducing the prevalence of psychiatric disorders in both Almajiris and the school pupils.
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Affiliation(s)
- Aishatu Abubakar-Abdullateef
- 0000 0004 4688 7583grid.413221.7Department of Psychiatry, Ahmadu Bello University Teaching Hospital Zaria, Zaria, Nigeria ,0000 0004 1794 5983grid.9582.6Centre for Child and Adolescent Mental Health, University of Ibadan, Ibadan, Nigeria
| | - Babatunde Adedokun
- 0000 0004 1794 5983grid.9582.6Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Olayinka Omigbodun
- 0000 0004 1794 5983grid.9582.6Centre for Child and Adolescent Mental Health, University of Ibadan, Ibadan, Nigeria ,0000 0004 1794 5983grid.9582.6Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
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Andronikou S, Ackermann C, Laughton B, Cotton M, Tomazos N, Spottiswoode B, Mauff K, Pettifor JM. Corpus callosum thickness on mid-sagittal MRI as a marker of brain volume: a pilot study in children with HIV-related brain disease and controls. Pediatr Radiol 2015; 45:1016-25. [PMID: 25620244 DOI: 10.1007/s00247-014-3255-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2014] [Revised: 07/24/2014] [Accepted: 11/25/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Corpus callosum thickness measurement on mid-sagittal MRI may be a surrogate marker of brain volume. This is important for evaluation of diseases causing brain volume gain or loss, such as HIV-related brain disease and HIV encephalopathy. OBJECTIVE To determine if thickness of the corpus callosum on mid-sagittal MRI is a surrogate marker of brain volume in children with HIV-related brain disease and in controls without HIV. MATERIALS AND METHODS A retrospective MRI analysis in children (<5 years old) with HIV-related brain disease and controls used a custom-developed semi-automated tool, which divided the midline corpus callosum and measured its thickness in multiple locations. Brain volume was determined using volumetric analysis. Overall corpus callosum thickness and thickness of segments of the corpus callosum were correlated with overall and segmented (grey and white matter) brain volume. RESULTS Forty-four children (33 HIV-infected patients and 11 controls) were included. Significant correlations included overall corpus callosum (mean) and total brain volume (P = 0.05); prefrontal corpus callosum maximum with white matter volume (P = 0.02); premotor corpus callosum mean with total brain volume (P = 0.04) and white matter volume (P = 0.02), premotor corpus callosum maximum with white matter volume (P = 0.02) and sensory corpus callosum mean with total brain volume (P = 0.02). CONCLUSION Corpus callosum thickness correlates with brain volume both in HIV-infected patients and controls.
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Affiliation(s)
- Savvas Andronikou
- Department of Radiology, Faculty of Health Sciences, University of the Witwatersrand, South Africa, 700 Harbouredge, 10 Hospital Str. Greenpoint, Cape Town, 8005, South Africa,
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Waber DP, Bryce CP, Fitzmaurice GM, Zichlin ML, McGaughy J, Girard JM, Galler JR. Neuropsychological outcomes at midlife following moderate to severe malnutrition in infancy. Neuropsychology 2014; 28:530-40. [PMID: 24635710 DOI: 10.1037/neu0000058] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE To compare neuropsychological profiles of adults who had experienced an episode of moderate to severe protein-energy malnutrition confined to the first year of life with that of a healthy community comparison group. METHOD We assessed neuropsychological functioning in a cohort of Barbadian adults, all of whom had birth weight >2268 g. The previously malnourished group (N = 77, mean age = 38 years, 53% male) had been hospitalized during the first year of life for moderate to severe protein energy malnutrition and subsequently enrolled in a program providing nutrition education, home visits and subsidized foods to 12 years of age. They also had documented, adequate nutrition throughout childhood and complete catch-up in growth by the end of adolescence. The healthy comparison group (N = 59, mean age = 38 years, 54% male) were recruited as children from the same classrooms and neighborhoods. RESULTS Adjusted for effects of standard of living during childhood and adolescence and current intellectual ability level, there were nutrition group differences on measures of cognitive flexibility and concept formation, as well as initiation, verbal fluency, working memory, processing speed, and visuospatial integration. Behavioral and cognitive regulation were not affected. CONCLUSIONS Postnatal malnutrition confined to the first year of life is associated with neurocognitive compromise persisting into midlife. Early malnutrition may have a specific neuropsychological signature, affecting response initiation to a somewhat greater extent than response inhibition.
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Affiliation(s)
| | | | | | | | - Jill McGaughy
- Department of Psychology, University of New Hampshire
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Abstract
Neurodevelopmental delay, neurodisability, and malnutrition interact to contribute a significant burden of disease in global settings. Assessments which are well integrated with plans of management or advice are most likely to improve outcomes. Assessment tools used in clinical research and programming to evaluate outcomes include developmental and cognitive tools that vary in complexity, sensitivity, and validity as well as the target age of assessment. Few tools have been used to measure socioemotional outcomes and fewer to assess the disabled child with malnutrition. There is a paucity of tools used clinically which actually provide families and professionals with advice to improve outcomes. Brain imaging, electroencephalography, audiology, and visual assessment can also be used to assess the effect of malnutrition on brain structure and function. The interaction of neurodisability and malnutrition is powerful, and both need to be considered when assessing children. Without an integrated approach to assessment and management, we will not support children and families to reach their best potential outcomes.
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14
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Chaudhary R, Chugh M, Darokhan Z, Katreddi RR, Ramachandra R, Rema V. Physiological slowing and upregulation of inhibition in cortex are correlated with behavioral deficits in protein malnourished rats. PLoS One 2013; 8:e76556. [PMID: 24098531 PMCID: PMC3789706 DOI: 10.1371/journal.pone.0076556] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Accepted: 08/27/2013] [Indexed: 11/19/2022] Open
Abstract
Protein malnutrition during early development has been correlated with cognitive and learning disabilities in children, but the neuronal deficits caused by long-term protein deficiency are not well understood. We exposed rats from gestation up to adulthood to a protein-deficient (PD) diet, to emulate chronic protein malnutrition in humans. The offspring exhibited significantly impaired performance on the 'Gap-crossing' (GC) task after reaching maturity, a behavior that has been shown to depend on normal functioning of the somatosensory cortex. The physiological state of the somatosensory cortex was examined to determine neuronal correlates of the deficits in behavior. Extracellular multi-unit recording from layer 4 (L4) neurons that receive direct thalamocortical inputs and layers 2/3 (L2/3) neurons that are dominated by intracortical connections in the whisker-barrel cortex of PD rats exhibited significantly low spontaneous activity and depressed responses to whisker stimulation. L4 neurons were more severely affected than L2/3 neurons. The response onset was significantly delayed in L4 cells. The peak response latency of L4 and L2/3 neurons was delayed significantly. In L2/3 and L4 of the barrel cortex there was a substantial increase in GAD65 (112% over controls) and much smaller increase in NMDAR1 (12-20%), suggesting enhanced inhibition in the PD cortex. These results show that chronic protein deficiency negatively affects both thalamo-cortical and cortico-cortical transmission during somatosensory information processing. The findings support the interpretation that sustained protein deficiency interferes with features of cortical sensory processing that are likely to underlie the cognitive impairments reported in humans who have suffered from prolonged protein deficiency.
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Affiliation(s)
| | - Manisha Chugh
- National Brain Research Centre, Manesar, Haryana, India
| | | | | | | | - V. Rema
- National Brain Research Centre, Manesar, Haryana, India
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Clinical, neurological, and electrophysiological features of nodding syndrome in Kitgum, Uganda: an observational case series. Lancet Neurol 2013; 12:166-74. [PMID: 23305742 DOI: 10.1016/s1474-4422(12)70321-6] [Citation(s) in RCA: 100] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND Nodding syndrome is an unexplained illness characterised by head-bobbing spells. The clinical and epidemiological features are incompletely described, and the explanation for the nodding and the underlying cause of nodding syndrome are unknown. We aimed to describe the clinical and neurological diagnostic features of this illness. METHODS In December, 2009, we did a multifaceted investigation to assess epidemiological and clinical illness features in 13 parishes in Kitgum District, Uganda. We defined a case as a previously healthy child aged 5-15 years with reported nodding and at least one other neurological deficit. Children from a systematic sample of a case-control investigation were enrolled in a clinical case series which included history, physical assessment, and neurological examinations; a subset had electroencephalography (EEG), electromyography, brain MRI, CSF analysis, or a combination of these analyses. We reassessed the available children 8 months later. FINDINGS We enrolled 23 children (median age 12 years, range 7-15 years) in the case-series investigation, all of whom reported at least daily head nodding. 14 children had reported seizures. Seven (30%) children had gross cognitive impairment, and children with nodding did worse on cognitive tasks than did age-matched controls, with significantly lower scores on tests of short-term recall and attention, semantic fluency and fund of knowledge, and motor praxis. We obtained CSF samples from 16 children, all of which had normal glucose and protein concentrations. EEG of 12 children with nodding syndrome showed disorganised, slow background (n=10), and interictal generalised 2·5-3·0 Hz spike and slow waves (n=10). Two children had nodding episodes during EEG, which showed generalised electrodecrement and paraspinal electromyography dropout consistent with atonic seizures. MRI in four of five children showed generalised cerebral and cerebellar atrophy. Reassessment of 12 children found that six worsened in their clinical condition between the first evaluation and the follow-up evaluation interval, as indicated by more frequent head nodding or seizure episodes, and none had cessation or decrease in frequency of these episodes. INTERPRETATION Nodding syndrome is an epidemic epilepsy associated with encephalopathy, with head nodding caused by atonic seizures. The natural history, cause, and management of the disorder remain to be determined. FUNDING Division of Global Disease Detection and Emergency Response, US Centers for Disease Control and Prevention.
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