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Heyn PC, Tagawa A, Pan Z, Reistetter T, Ng TKS, Lewis M, Carollo JJ. The association between isometric strength and cognitive function in adults with cerebral palsy. Front Med (Lausanne) 2023; 10:1080022. [PMID: 37181370 PMCID: PMC10170265 DOI: 10.3389/fmed.2023.1080022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 04/03/2023] [Indexed: 05/16/2023] Open
Abstract
Background The literature supports quantifying the maximum force/tension generated by one's forearm muscles such as the hand grip strength (HGS) to screen for physical and cognitive frailty in older adults. Thus, we postulate that individuals with cerebral palsy (CP), who are at higher risk for premature aging, could benefit from tools that objectively measure muscle strength as a functional biomarker to detect frailty and cognitive decline. This study assesses the clinical relevancy of the former and quantifies isometric muscle strength to determine its association with cognitive function in adults with CP. Methods Ambulatory adults with CP were identified from a patient registry and were enrolled into this study. Peak rate of force development (RFD) and maximum voluntary isometric contraction of the quadriceps were measured using a commercial isokinetic machine, while HGS was collected with a clinical dynamometer. Dominant and non-dominant side were identified. Standardized cognitive assessments, including the Wechsler Memory and Adult Intelligence Scales IV, Short Test of Mental Status, and the Patient-Reported Outcomes Measurement Information System (PROMIS®) were used to evaluate cognitive function. Results A total of 57 participants (32 females; mean age 24.3 [SD 5.3]; GMFCS levels I-IV) were included in the analysis. Although dominant and non-dominant RFD and HGS measures were associated with cognitive function, non-dominant peak RFD showed the strongest associations with cognitive function. Conclusion RFD capacity may reflect age-related neural and physical health and could be a better health indicator than HGS in the CP population.
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Affiliation(s)
- Patricia C. Heyn
- Center for Optimal Aging (COA), Marymount University, Arlington, VA, United States
- Physical Medicine & Rehabilitation Department, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Alex Tagawa
- Center for Gait and Movement Analysis (CGMA), Children’s Hospital Colorado, Aurora, CO, United States
- Musculoskeletal Research Center (MRC), Orthopedics Institute, Children’s Hospital Colorado, Aurora, CO, United States
| | - Zhaoxing Pan
- Center for Gait and Movement Analysis (CGMA), Children’s Hospital Colorado, Aurora, CO, United States
- Musculoskeletal Research Center (MRC), Orthopedics Institute, Children’s Hospital Colorado, Aurora, CO, United States
| | - Timothy Reistetter
- University of Texas Health Science Center San Antonio, San Antonio, TX, United States
| | - Ted Kheng Siang Ng
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, United States
| | - Meredith Lewis
- Center for Gait and Movement Analysis (CGMA), Children’s Hospital Colorado, Aurora, CO, United States
- Musculoskeletal Research Center (MRC), Orthopedics Institute, Children’s Hospital Colorado, Aurora, CO, United States
| | - James J. Carollo
- Physical Medicine & Rehabilitation Department, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- Center for Gait and Movement Analysis (CGMA), Children’s Hospital Colorado, Aurora, CO, United States
- Musculoskeletal Research Center (MRC), Orthopedics Institute, Children’s Hospital Colorado, Aurora, CO, United States
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MacCarthy M, Heyn P, Tagawa A, Carollo J. Walking speed and patient-reported outcomes in young adults with cerebral palsy. Dev Med Child Neurol 2022; 64:1281-1288. [PMID: 35366333 DOI: 10.1111/dmcn.15225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 02/03/2022] [Accepted: 02/28/2022] [Indexed: 11/27/2022]
Abstract
AIM To examine the relationship between quantitative gait measurements and self-reported physical, psychological, cognitive, and social function status in young adults with cerebral palsy (CP). METHOD Seventy-two adults with CP (range 18-48y; median age 23y [interquartile range 21-27y]; 34 males, 38 females), in Gross Motor Function Classification System levels I to IV, who previously underwent an instrumented gait analysis (IGA) at our center as children were recruited. Participants underwent a repeated IGA. National Institutes of Health Patient-Reported Outcomes Information System (PROMIS) instruments including the PROMIS-57, Applied Cognition - General Concerns (Short Form), and Applied Cognition - Executive Function (Short Form) were administered. Data derived from current and prior IGA were compared via non-parametric correlation analysis with PROMIS subscores. RESULTS Subscores for anxiety, depression, sleep, and fatigue did not significantly correlate with any IGA data. Walking speed, adjusted for stature, correlated strongly with multiple subscores: physical function (p<0.001, rs =0.708); participation in social roles (p=0.007, rs =0.319); executive function (p=0.005, rs =0.335). Pain interference correlated with longitudinal change in adjusted walking speed (p=0.032, rs =-0.259). The Applied Cognition - General Concerns (Short Form) correlated with prior absolute walking speed, but not adjusted values. INTERPRETATION This study underscores the importance of walking speed and its association with a variety of functional domains in adults with CP. WHAT THIS PAPER ADDS Patient-Reported Outcomes Information System measures provide useful clinical data in young adults with cerebral palsy. Temporospatial gait parameters have wide-reaching functional influence in this population. Walking speed is strongly correlated with physical, social, and executive function.
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Affiliation(s)
- Matthew MacCarthy
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh and UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.,Department of Pediatrics, University of South Carolina and Prisma Health Children's Hospital, Columbia, SC, USA
| | - Patricia Heyn
- Center for Gait and Movement Analysis, Children's Hospital Colorado, Aurora, CO, USA.,Department of Physical Medicine & Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Alex Tagawa
- Center for Gait and Movement Analysis, Children's Hospital Colorado, Aurora, CO, USA
| | - James Carollo
- Center for Gait and Movement Analysis, Children's Hospital Colorado, Aurora, CO, USA.,Department of Physical Medicine & Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Ng TKS, Heyn PC, Tagawa A, Coughlan C, Carollo JJ. Associations of Circulating Insulin-Growth Factor-1 With Cognitive Functions and Quality of Life Domains in Ambulatory Young Adults With Cerebral Palsy: A Pilot Study. Front Neurol 2022; 13:748015. [PMID: 35832183 PMCID: PMC9271561 DOI: 10.3389/fneur.2022.748015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 05/24/2022] [Indexed: 11/13/2022] Open
Abstract
Objective Adults with cerebral palsy (CP) often have impaired cognitive functions. CP also has deteriorations in multiple quality-of-life (QoL) domains. The bio-psycho-social health psychology model posits that biological factor interacts with social and psychological functions. However, the biological determinant of psycho-social and functional outcomes in CP has been scarcely examined. Circulating Insulin-like growth factor-1 (IGF-1) is associated with cognitive deficits in older adults, we thus aimed to examine the associations of circulating IGF-1 with: (1) objectively measured cognitive functions, (2) self-reported cognitive functions, and (3) QoL measures in adults diagnosed with CP. Methods Seventy-two adults with CP and varying degrees of cognitive functions were recruited from an accredited clinical motion analysis laboratory at a regional Children's Hospital. Circulating IGF-1 was measured using post-fasting serum. The Wechsler Adult Intelligence Scale (WAIS) tests were administered to assess multiple cognitive functions, whereas the Patient-Reported Outcomes Measurement Information System (PROMIS) was used to measure multiple domains of self-reported health, including cognitive complaints and eight QoL domains. Results Sixty-eight participants had complete data [mean age = 25 (SD = 5.3), female = 52.8%]. Controlling for covariates, circulating IGF-1 was associated with multiple cognitive domains, including positively with declarative memory and executive function and inversely with visual-spatial and motor skills, and processing speed, while no association with subjective memory complaint was detected. Circulating IGF-1 was also inversely associated with four QoL domains, including depressive symptoms, executive function, physical function, and social roles and activities. Conclusions In CP, circulating IGF-1 might be a useful biological determinant of objective cognitive functions and several quality-of-life domains commonly impaired in CP.
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Affiliation(s)
- Ted Kheng Siang Ng
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- Edson College of Nursing and Health Innovation, Arizona State University, Tempe, AZ, United States
- *Correspondence: Ted Kheng Siang Ng
| | - Patricia C. Heyn
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- Center for Gait and Movement Analysis (CGMA), Children's Hospital Colorado, Aurora, CO, United States
| | - Alex Tagawa
- Center for Gait and Movement Analysis (CGMA), Children's Hospital Colorado, Aurora, CO, United States
| | - Christina Coughlan
- Center for Gait and Movement Analysis (CGMA), Children's Hospital Colorado, Aurora, CO, United States
- University of Colorado Alzheimer's and Cognition Center, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - James J. Carollo
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- Center for Gait and Movement Analysis (CGMA), Children's Hospital Colorado, Aurora, CO, United States
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Ng TKS, Tagawa A, Ho RCM, Larbi A, Kua EH, Mahendran R, Carollo JJ, Heyn PC. Commonalities in biomarkers and phenotypes between mild cognitive impairment and cerebral palsy: a pilot exploratory study. Aging (Albany NY) 2021; 13:1773-1816. [PMID: 33497355 PMCID: PMC7880365 DOI: 10.18632/aging.202563] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 12/18/2020] [Indexed: 11/30/2022]
Abstract
Clinically, individuals with cerebral palsy (CP) experience symptoms of accelerated biological aging. Accumulative deficits in both molecular underpinnings and functions in young adults with CP can lead to premature aging, such as heart disease and mild cognitive impairment (MCI). MCI is an intermediate stage between healthy aging and dementia that normally develops at old age. Owing to their intriguingly parallel yet “inverted” disease trajectories, CP might share similar pathology and phenotypes with MCI, conferring increased risk for developing dementia at a much younger age. Thus, we examined this hypothesis by evaluating these two distinct populations (MCI= 55, CP = 72). A total of nine measures (e.g., blood biomarkers, neurocognition, Framingham Heart Study Score (FHSS) were compared between the groups. Compared to MCI, upon controlling for covariates, delta FHSS, brain-derived neurotrophic factor (BDNF) levels, and systolic blood pressure were significantly lower in CP. Intriguingly, high-sensitivity CRP, several metabolic outcomes, and neurocognitive function were similar between the two groups. This study supports a shared biological underpinning and key phenotypes between CP and MCI. Thus, we proposed a double-hit model for the development of premature aging outcomes in CP through shared biomarkers. Future longitudinal follow-up studies are warranted to examine accelerated biological aging.
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Affiliation(s)
- Ted Kheng Siang Ng
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Alex Tagawa
- Children's Hospital Colorado, Center for Gait and Movement Analysis (CGMA), Aurora, CO 80045, USA.,University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Roger Chun-Man Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Psychological Medicine, National University Hospital, Singapore, Singapore.,Biomedical Global Institute of Healthcare Research and Technology (BIGHEART), National University of Singapore, Singapore, Singapore.,Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam.,Faculty of Education, Huaibei Normal University, Huaibei, China
| | - Anis Larbi
- Singapore Immunology Network, Agency for Science, Technology and Research, Singapore, Singapore
| | - Ee Heok Kua
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Psychological Medicine, National University Hospital, Singapore, Singapore
| | - Rathi Mahendran
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Psychological Medicine, National University Hospital, Singapore, Singapore.,Academic Development Department, Duke-NUS Medical School, Singapore, Singapore
| | - James J Carollo
- Children's Hospital Colorado, Center for Gait and Movement Analysis (CGMA), Aurora, CO 80045, USA.,University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Patricia C Heyn
- Children's Hospital Colorado, Center for Gait and Movement Analysis (CGMA), Aurora, CO 80045, USA.,University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
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