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Soltani A, Schworer EK, Altaye M, Fidler DJ, Beebe DW, Wiley S, Hoffman EK, Voth K, Esbensen AJ. Psychometric properties of inhibitory control measures among youth with Down syndrome. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2023; 67:753-769. [PMID: 37218393 PMCID: PMC10524385 DOI: 10.1111/jir.13043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 04/24/2023] [Accepted: 04/26/2023] [Indexed: 05/24/2023]
Abstract
BACKGROUND Inhibitory control measures have been commonly used when assessing individuals with Down syndrome. However, minimal attention has been devoted to evaluating the appropriateness of specific assessments for use in this population, potentially leading to erroneous conclusions. This study aimed to examine the psychometric properties of measures of inhibitory control among youth with Down syndrome. We sought to examine the feasibility, presence of floor or practice effects, test-retest reliability, convergent validity and correlations with broader developmental domains of a set of inhibitory control tasks. METHODS A sample of 97 youth with Down syndrome aged 6 to 17 years old participated in verbal and visuospatial tasks of inhibitory control including the Cat/dog Stroop, Neuropsychological Assessment Second Edition (NEPSY-II) Statue, National Institutes of Health (NIH) Toolbox Cognition Battery (TCB) Flanker, Leiter-3 Attention Sustained, and the Test of Attentional Performance for Children (KiTAP) Go/No-go and Distractibility subtests. Youth also completed standardised assessments of cognition and language, and caregivers completed rating scales. Psychometric properties on the tasks of inhibitory control were evaluated against a priori criteria. RESULTS Apart from demonstrating negligible practice effects, adequate psychometric properties were not observed for any inhibitory control measure within the current sample's age range. One task with low working memory demands (NEPSY-II Statue) generally had better psychometric properties than the other tasks assessed. Subgroups of participants with an IQ greater than 30 and age more than 8 years were shown to be more likely to be able to complete the inhibition tasks. CONCLUSIONS Findings suggest better feasibility for analogue tasks rather than computerised assessments of inhibitory control. Given the weak psychometrics of several common measures, future studies are required to evaluate other inhibitory control measures, specifically those with reduced working memory demands for youth with Down syndrome. Recommendations for use of the inhibitory control tasks among youth with Down syndrome are provided.
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Affiliation(s)
- Amanallah Soltani
- Department of Educational Psychology, Kerman Branch, Islamic Azad University, Kerman, Iran
| | - Emily K. Schworer
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- Waisman Center, University of Wisconsin-Madison, Madison, WI, USA
| | - Mekibib Altaye
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital, Cincinnati, OH, USA
| | - Deborah J. Fidler
- Department of Human Development and Family Studies, Colorado State University, Fort Collins, CO, USA
| | - Dean W. Beebe
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Susan Wiley
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Emily K. Hoffman
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Kellie Voth
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Anna J. Esbensen
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Tristão RM, Scafutto Marengo LA, Costa JFDD, Pires ALDS, Boato EM. The use of the cambridge neuropsychological test automated battery for people born with Down syndrome and those born premature: A comparative systematic review. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2023; 27:539-567. [PMID: 35166595 DOI: 10.1177/17446295211050460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
This review aimed to investigate the use of the Cambridge Neuropsychological Automated Testing Battery (CANTAB) for people at risk of cognitive impairment, especially those born with Down syndrome and those born preterm. Six databases were searched according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards, in addition to the bibliography index listed in the CANTAB site. Twenty four studies regarding Down syndrome and 17 regarding prematurity were reviewed and are here described. Both cognitive profiles were described, and their performance was compared on specific tasks and CANTAB tests. In this battery of tests, people with Down syndrome usually present impaired key cognitive domains, such as episodic memory and recognition memory. Results were presented considering general aspects described in the studies, specific findings such as dementia, the role of genetics, and cognitive profile, among other descriptions. Comparability between both populations in future studies is discussed.
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Affiliation(s)
- Rosana M Tristão
- Faculty of Medicine and University Hospital, Medicine of the Child and Adolescent, University of Brasilia, Brasilia, Brazil
| | | | | | - Ana Luísa Dos Santos Pires
- Faculty of Medicine and University Hospital, Medicine of the Child and Adolescent, University of Brasilia, Brasilia, Brazil
| | - Elvio M Boato
- Center for Science and Technology, CogniAction Lab, Catholic University of Brasilia, Brasilia, Brazil
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Schworer EK, Altaye M, Fidler DJ, Beebe DW, Wiley S, Hoffman EK, Esbensen AJ. Evaluating Processing Speed and Reaction Time Outcome Measures in Children and Adolescents with Down Syndrome. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5202. [PMID: 36982110 PMCID: PMC10049659 DOI: 10.3390/ijerph20065202] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 03/06/2023] [Accepted: 03/13/2023] [Indexed: 06/18/2023]
Abstract
Reliable and valid cognitive outcome measures, including examiner-administered and computer-facilitated assessments of processing speed and reaction time, are necessary for future clinical trials that include individuals with Down syndrome (DS). The current study evaluated the score distributions and psychometric properties of four examiner-administered and three computerized processing speed and reaction time measures. Participants included 97 individuals with DS, aged 6 to 17 (M = 12.6, SD = 3.3). Two examiner-administered measures (Differential Ability Scales-II Rapid Naming and Cat/dog Stroop Congruent) met most predetermined psychometric criteria. Other assessments demonstrated good test-retest reliability and had negligible practice effects but lacked adequate feasibility. Recommendations for using processing speed and reaction time assessments in research and suggestions for modifications of measures are discussed.
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Affiliation(s)
- Emily K. Schworer
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
- Waisman Center, University of Wisconsin-Madison, Madison, WI 53705, USA
| | - Mekibib Altaye
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital, Cincinnati, OH 45229, USA
| | - Deborah J. Fidler
- Human Development and Family Studies, Colorado State University, Fort Collins, CO 80523, USA
| | - Dean W. Beebe
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Susan Wiley
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| | - Emily K. Hoffman
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Anna J. Esbensen
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
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Brozzetti L, Scambi I, Bertoldi L, Zanini A, Malacrida G, Sacchetto L, Baldassa L, Benvenuto G, Mariotti R, Zanusso G, Cecchini MP. RNAseq analysis of olfactory neuroepithelium cytological samples in individuals with Down syndrome compared to euploid controls: a pilot study. Neurol Sci 2023; 44:919-930. [PMID: 36394661 PMCID: PMC9925603 DOI: 10.1007/s10072-022-06500-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 11/05/2022] [Indexed: 11/18/2022]
Abstract
Down syndrome is a common genetic disorder caused by partial or complete triplication of chromosome 21. This syndrome shows an overall and progressive impairment of olfactory function, detected early in adulthood. The olfactory neuronal cells are located in the nasal olfactory mucosa and represent the first sensory neurons of the olfactory pathway. Herein, we applied the olfactory swabbing procedure to allow a gentle collection of olfactory epithelial cells in seven individuals with Down syndrome and in ten euploid controls. The aim of this research was to investigate the peripheral gene expression pattern in olfactory epithelial cells through RNAseq analysis. Validated tests (Sniffin' Sticks Extended test) were used to assess olfactory function. Olfactory scores were correlated with RNAseq results and cognitive scores (Vineland II and Leiter scales). All Down syndrome individuals showed both olfactory deficit and intellectual disability. Down syndrome individuals and euploid controls exhibited clear expression differences in genes located in and outside the chromosome 21. In addition, a significant correlation was found between olfactory test scores and gene expression, while a non-significant correlation emerged between olfactory and cognitive scores. This first preliminary step gives new insights into the Down syndrome olfactory system research, starting from the olfactory neuroepithelium, the first cellular step on the olfactory way.
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Affiliation(s)
- Lorenzo Brozzetti
- Department of Neurosciences, Biomedicine and Movement Sciences, Neurology Unit, University of Verona, Verona, Italy
| | - Ilaria Scambi
- Department of Neurosciences, Biomedicine and Movement Sciences, Anatomy and Histology Section, University of Verona, Strada Le Grazie 8, 37134, Verona, Italy
| | | | - Alice Zanini
- Department of Neurosciences, Biomedicine and Movement Sciences, Anatomy and Histology Section, University of Verona, Strada Le Grazie 8, 37134, Verona, Italy
| | | | - Luca Sacchetto
- Department of Surgery, Dentistry, Paediatrics and Gynaecology, Otolaryngology Section, University of Verona, Verona, Italy
| | - Lucia Baldassa
- AGBD, Associazione Sindrome di Down, Onlus, Verona, Italy
| | | | - Raffaella Mariotti
- Department of Neurosciences, Biomedicine and Movement Sciences, Anatomy and Histology Section, University of Verona, Strada Le Grazie 8, 37134, Verona, Italy
| | - Gianluigi Zanusso
- Department of Neurosciences, Biomedicine and Movement Sciences, Neurology Unit, University of Verona, Verona, Italy
| | - Maria Paola Cecchini
- Department of Neurosciences, Biomedicine and Movement Sciences, Anatomy and Histology Section, University of Verona, Strada Le Grazie 8, 37134, Verona, Italy.
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Hou X, Wu N, Ren S, Wang X, Mu Q, Zhang Y, Wang S, Yu W, Guo J. Profiling Blautia at high taxonomic resolution reveals correlations with cognitive dysfunction in Chinese children with Down syndrome. Front Cell Infect Microbiol 2023; 13:1109889. [PMID: 36844413 PMCID: PMC9950735 DOI: 10.3389/fcimb.2023.1109889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 01/30/2023] [Indexed: 02/12/2023] Open
Abstract
Introduction Down syndrome (DS), the presence of a supernumerary chromosome 21, is associated with cognitive dysfunction caused by early neurodegenerative processes. Alterations in the gut microbiota were observed in Chinese children with DS, and the genus Blautia was associated with cognitive function in these children. Therefore, it is crucial to understand the detailed composition of this group at the species level and to explore the effect of specific species on cognitive function. Methods In this study, Blautia-specific amplicon sequencing was conducted to identify the specific Blautia species in 15 children with DS and 15 matched healthy children. Results The taxonomic analyses suggested that the Blautia taxa were clustered by disease status. The diversity of Blautia at the species level differed between DS patients and healthy controls, with the abundances of Blautia massiliensis and Blautia argi decreasing in DS children, while Blautia faecis was increased. Acetic acid, one of the metabolites of Blautia, was significantly reduced in the DS group. Of particular interest, Kyoto Encyclopaedia of Genes and Genomes analysis revealed decreased modules related to starch and sucrose metabolism and glycolysis. In addition, B. argi was positively related to DS cognitive scores, and B. faecis was negatively related to cognitive function, implying its role on the DS cognitive impairments. Discussion Our study has important implications for understanding the important effects of specific species of Blautia on cognitive function and thus possibly provides a new strategy for future studies of cognitive improvement in individuals with DS.
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Affiliation(s)
- Xueyu Hou
- Department of Pediatrics, Peking University People’s Hospital, Beijing, China
| | - Na Wu
- Department of Central Laboratory & Institute of Clinical Molecular Biology, Peking University People’s Hospital, Beijing, China
| | - Shimeng Ren
- Department of Pediatrics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xinjuan Wang
- Department of Central Laboratory & Institute of Clinical Molecular Biology, Peking University People’s Hospital, Beijing, China
| | - Qing Mu
- Department of Central Laboratory & Institute of Clinical Molecular Biology, Peking University People’s Hospital, Beijing, China
| | - Yang Zhang
- Department of Pediatrics, Peking University People’s Hospital, Beijing, China
| | - Shan Wang
- Beijing Municipal Key Laboratory of Child Development and Nutriomics, Capital Institute of Pediatrics, Beijing, China
| | - Weidong Yu
- Department of Central Laboratory & Institute of Clinical Molecular Biology, Peking University People’s Hospital, Beijing, China,*Correspondence: Jingzhu Guo, ; Weidong Yu,
| | - Jingzhu Guo
- Department of Pediatrics, Peking University People’s Hospital, Beijing, China,*Correspondence: Jingzhu Guo, ; Weidong Yu,
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Schworer EK, Soltani A, Altaye M, Fidler DJ, Esbensen AJ. Cognitive flexibility assessment in youth with Down syndrome: Reliability, practice effects, and validity. RESEARCH IN DEVELOPMENTAL DISABILITIES 2023; 133:104416. [PMID: 36603310 PMCID: PMC9852016 DOI: 10.1016/j.ridd.2022.104416] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 12/14/2022] [Accepted: 12/30/2022] [Indexed: 05/31/2023]
Abstract
BACKGROUND Cognitive flexibility refers to the ability to switch between different mental sets, tasks, or strategies and is challenging for some individuals with Down syndrome (DS). The lack of reliable and valid cognitive flexibility measures for individuals with DS is a major barrier to clinical trials and intervention studies designed to address cognitive challenges specific to DS. To avoid measurement limitations that could confound interpretations of performance in clinical trials in children with DS, it is critical to use phenotype-sensitive and psychometrically sound measures of cognitive flexibility. AIM This study aimed to evaluate the psychometric properties of three measures of cognitive flexibility including Rule-Shift, Weigl Sorting, and KiTAP Flexibility in a sample of 97 youth with DS aged 6-17 years old. METHOD Data were collected at two time points with a two-week interval. Parents also completed adaptive behavior and cognitive flexibility questionnaires. Child cognitive and language abilities were also assessed. RESULTS The Weigl Sorting met the most psychometric criteria, with adequate feasibility (≥ 80 %) and significant correlations with most of the broader developmental domains; however, the levels of test-retest reliability, practice effects, and convergent validity did not meet a priori criteria. Rule-Shift and KiTAP Flexibility measures did not have acceptable feasibility; although sensitivity and specificity analyses revealed that Rule-Shift may be appropriate for a subgroup of the participants. CONCLUSION No evaluated measures met all psychometric study criteria and, therefore, additional evaluation of cognitive flexibility measures is needed for use among individuals with DS.
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Affiliation(s)
- Emily K Schworer
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; University of Wisconsin-Madison, Waisman Center, Madison, WI, USA.
| | - Amanallah Soltani
- Department of Educational Psychology, Kerman Branch, Islamic Azad University, Kerman, Iran
| | - Mekibib Altaye
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Deborah J Fidler
- Human Development and Family Studies, Colorado State University, Fort Collins, CO, USA
| | - Anna J Esbensen
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Soltani A, Schworer EK, Esbensen AJ. The Mediatory Role of Executive Functioning on the Association Between Sleep and Both Everyday Memory and ADHD Symptoms in Children and Youth With Down Syndrome. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2023; 128:82-95. [PMID: 36548372 PMCID: PMC9793936 DOI: 10.1352/1944-7558-128.1.82] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 04/12/2022] [Indexed: 06/17/2023]
Abstract
People with Down syndrome (DS) commonly experience challenges with sleep, executive functioning, everyday memory, and symptoms of attention deficit hyperactivity disorder (ADHD). A path analysis was conducted to determine if executive function mediated the relationship between sleep problems and both everyday memory and ADHD symptoms. Parents of 96 children and youth with DS completed questionnaires related to sleep, executive functioning, everyday memory, and ADHD symptoms. Results showed that executive functioning fully mediated the relation between sleep and both everyday memory and ADHD symptoms. Implications for education and intervention for children and youth with DS are discussed.
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Affiliation(s)
- Amanallah Soltani
- Department of Educational Psychology, Kerman Branch, Islamic Azad University, Kerman, Iran
| | - Emily K. Schworer
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Anna J. Esbensen
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Esbensen AJ, Schworer EK, Fidler DJ, Thurman AJ. Considerations for measuring individual outcomes across contexts in Down syndrome: Implications for research and clinical trials. INTERNATIONAL REVIEW OF RESEARCH IN DEVELOPMENTAL DISABILITIES 2022; 62:191-225. [PMID: 36213318 PMCID: PMC9536481 DOI: 10.1016/bs.irrdd.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Individuals with Down syndrome (DS) are increasingly involved in clinical trials that target developmental outcomes, like cognition and behavior. The increased focus on treatment in DS has led to ongoing discussions regarding the selection of outcome measures using syndrome-informed criteria. This discourse is warranted as clinical trials can fail if the outcome measures selected are inappropriate for individuals with DS or do not take into account the behavioral phenotype commonly associated with DS. This review focuses on the challenges present in the measurement of outcomes in DS, with a specific focus on considerations made in evaluating cognitive, language, and behavioral/psychopathology outcomes. This review also provides a summary of recommendations for assessment of outcomes in these domains as well as recommendations for future research. The impact of physical health and assessment psychometrics on the measurement of outcomes is also reviewed.
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Affiliation(s)
- Anna J Esbensen
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Emily K Schworer
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Deborah J Fidler
- Human Development and Family Studies, Colorado State University, Fort Collins, CO, USA
| | - Angela John Thurman
- University of California Davis Health, MIND Institute and Department of Psychiatry and Behavioral Sciences, Sacramento, CA, USA
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Smeyne CN, Esbensen AJ, Schworer EK, Belizaire S, Hoffman EK, Beebe DW, Wiley S. Evaluating Verbal Fluency Outcome Measures in Children With Down Syndrome. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2022; 127:328-344. [PMID: 36122330 PMCID: PMC9487840 DOI: 10.1352/1944-7558-127.4.328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 09/28/2021] [Indexed: 05/26/2023]
Abstract
This study evaluates the psychometric properties of a verbal fluency task for potential use as an outcome measure in future clinical trials involving children with Down syndrome. Eighty-five participants attempted a modified version of the Neuropsychological Assessment of Children, Second Edition Word Generation Task at two time points. In the full sample, the measure fell below a priori reliability and feasibility criteria, though feasibility of the semantic trials were higher than feasibility of the phonemic trials. Performance on the measure correlated with chronological age and IQ scores, and no sex-related effects were found. Additional analyses suggested that the semantic verbal fluency trials might be appropriate for children with Down syndrome 10 years of age and older.
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Affiliation(s)
- Catelyn N. Smeyne
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children’s Hospital Medical Center
| | - Anna J. Esbensen
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children’s Hospital Medical Center
- Department of Pediatrics, University of Cincinnati College of Medicine
| | - Emily K. Schworer
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children’s Hospital Medical Center
| | - Shequanna Belizaire
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children’s Hospital Medical Center
| | - Emily K. Hoffman
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children’s Hospital Medical Center
| | - Dean W. Beebe
- Department of Pediatrics, University of Cincinnati College of Medicine
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center
| | - Susan Wiley
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children’s Hospital Medical Center
- Department of Pediatrics, University of Cincinnati College of Medicine
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Evidence of Energy Metabolism Alterations in Cultured Neonatal Astrocytes Derived from the Ts65Dn Mouse Model of Down Syndrome. Brain Sci 2022; 12:brainsci12010083. [PMID: 35053826 PMCID: PMC8773919 DOI: 10.3390/brainsci12010083] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/01/2022] [Accepted: 01/04/2022] [Indexed: 12/10/2022] Open
Abstract
For many decades, neurons have been the central focus of studies on the mechanisms underlying the neurodevelopmental and neurodegenerative aspects of Down syndrome (DS). Astrocytes, which were once thought to have only a passive role, are now recognized as active participants of a variety of essential physiological processes in the brain. Alterations in their physiological function have, thus, been increasingly acknowledged as likely initiators of or contributors to the pathogenesis of many nervous system disorders and diseases. In this study, we carried out a series of real-time measurements of oxygen consumption rate (OCR) and extracellular acidification rate (ECAR) in hippocampal astrocytes derived from neonatal Ts65Dn and euploid control mice using a Seahorse XFp Flux Analyzer. Our results revealed a significant basal OCR increase in neonatal Ts65Dn astrocytes compared with those from control mice, indicating increased oxidative phosphorylation. ECAR did not differ between the groups. Given the importance of astrocytes in brain metabolic function and the linkage between astrocytic and neuronal energy metabolism, these data provide evidence against a pure “neurocentric” vision of DS pathophysiology and support further investigations on the potential contribution of disturbances in astrocytic energy metabolism to cognitive deficits and neurodegeneration associated with DS.
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Schworer EK, Voth K, Hoffman EK, Esbensen AJ. Short-term memory outcome measures: Psychometric evaluation and performance in youth with Down syndrome. RESEARCH IN DEVELOPMENTAL DISABILITIES 2022; 120:104147. [PMID: 34922089 PMCID: PMC8724458 DOI: 10.1016/j.ridd.2021.104147] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 12/01/2021] [Accepted: 12/05/2021] [Indexed: 05/12/2023]
Abstract
BACKGROUND Improving short-term memory (STM) performance for individuals with Down syndrome (DS) has been a target of recent clinical trials. Validation of STM outcome measures is essential for research rigor in trials among children and adolescents with DS. AIMS The current study investigated the psychometric properties of four direct STM assessments and one everyday memory parent form. METHODS AND PROCEDURES Measures were administered to a sample of 74 youth with DS at two visits, two weeks apart. Overall cognitive abilities were also assessed. OUTCOMES AND RESULTS The OMQ-PF had good feasibility and distribution of scores, but floor effects were prominent for direct measures. Test-retest reliability was poor to moderate for all measures and practice effects were problematic for the NEPSY-II List Memory and DAS-II Recall of Objects subtests. Commonalities in responses were observed, including primacy/recency effects, and some STM scores were correlated with overall cognitive abilities. CONCLUSIONS AND IMPLICATIONS The OMQ-PF met most study criteria, but no direct measure met sufficient criteria to be strongly recommended for future clinical trials. Because higher cognitive abilities were related to assessment completion, STM measures may require adaptation for use in broader samples of youth with DS across all levels of cognitive ability.
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Affiliation(s)
- Emily K Schworer
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
| | - Kellie Voth
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Emily K Hoffman
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Anna J Esbensen
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Onnivello S, Colaianni S, Pulina F, Locatelli C, Marcolin C, Ramacieri G, Antonaros F, Vione B, Piovesan A, Lanfranchi S. Executive functions and adaptive behaviour in individuals with Down syndrome. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2022; 66:32-49. [PMID: 34750907 PMCID: PMC9299024 DOI: 10.1111/jir.12897] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 08/02/2021] [Accepted: 10/12/2021] [Indexed: 05/31/2023]
Abstract
BACKGROUND Previous research has explored executive functions (EFs) and adaptive behaviour in children and adolescents with Down syndrome (DS), but there is a paucity of research on the relationship between the two in this population. This study aims to shed light on the profile of EFs and adaptive behaviour in DS, exploring the differences by age and investigating the relationship between these two domains. METHOD Parents/caregivers of 100 individuals with DS from 3 to 16 years old participated in the study. The sample was divided into preschoolers (3-6.11 years old) and school-age children (7-16 years old). Parents/caregivers completed either the Preschool Version of the Behaviour Rating Inventory of Executive Function (for children 2-6.11 years old) or the Second Edition of the same Inventory (for individuals 7 + years old). Adaptive behaviour was assessed with the Vineland Adaptive Behaviour Scale - Interview, Second Edition. RESULTS Findings suggest that individuals with DS have overall difficulties, but also patterns of strength and weakness in their EFs and adaptive behaviour. The preschool-age and school-age children's EF profiles differed slightly. While both age groups showed Emotional Control as a relative strength and Working Memory as a weakness, the school-age group revealed further weaknesses in Shift and Plan/Organise. As concerns adaptive behaviour, the profiles were similar in the two age groups, with Socialisation as a strength, and Communication and Daily Living Skills as weaknesses, but with a tendency for preschoolers to obtain intermediate scores for the latter. When the relationship between EFs and adaptive behaviour was explored, Working Memory predicted Communication in the younger group, while in the older group the predictors varied, depending on the adaptive domains: Working Memory was a predictor of Communication, Inhibit of Daily Living Skills, and Inhibit and Shift of Socialisation. CONCLUSION As well as elucidating the EF profiles and adaptive behaviour in individuals with DS by age, this study points to the role of EFs in adaptive functioning, providing important information for targeted interventions.
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Affiliation(s)
- S. Onnivello
- Department of Developmental Psychology and SocialisationUniversity of PadovaPadovaItaly
| | - S. Colaianni
- Department of Developmental Psychology and SocialisationUniversity of PadovaPadovaItaly
| | - F. Pulina
- Department of Developmental Psychology and SocialisationUniversity of PadovaPadovaItaly
| | - C. Locatelli
- Neonatology UnitSt. Orsola‐Malpighi PolyclinicBolognaItaly
| | - C. Marcolin
- Department of Developmental Psychology and SocialisationUniversity of PadovaPadovaItaly
| | - G. Ramacieri
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Unit of Histology, Embryology and Applied BiologyUniversity of BolognaBolognaItaly
| | - F. Antonaros
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Unit of Histology, Embryology and Applied BiologyUniversity of BolognaBolognaItaly
| | - B. Vione
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Unit of Histology, Embryology and Applied BiologyUniversity of BolognaBolognaItaly
| | - A. Piovesan
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Unit of Histology, Embryology and Applied BiologyUniversity of BolognaBolognaItaly
| | - S. Lanfranchi
- Department of Developmental Psychology and SocialisationUniversity of PadovaPadovaItaly
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13
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Schworer EK, Esbensen AJ, Fidler DJ, Beebe DW, Carle A, Wiley S. Evaluating working memory outcome measures for children with Down syndrome. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2022; 66:195-211. [PMID: 33763953 PMCID: PMC8463631 DOI: 10.1111/jir.12833] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 01/13/2021] [Accepted: 03/02/2021] [Indexed: 05/13/2023]
Abstract
BACKGROUND There is a critical need for the psychometric evaluation of outcome measures to be used in clinical trials targeting cognition in Down syndrome (DS). This study examines a specific cognitive skill that is of particular importance in DS, working memory, and the psychometric properties of a set of standardised measurements to assess working memory in individuals with DS. METHODS Ninety children and adolescents ages 6 to 18 years old with DS were assessed on a selection of verbal and visuospatial working memory subtests of standardised clinical assessments at two time points to examine feasibility, distributional qualities, test-retest reliability and convergent validity against a priori criteria. Caregivers also completed an adaptive behaviour questionnaire to address working memory subtests' associations with broader developmental functioning. RESULTS The Stanford Binet-5 Verbal Working Memory, Differential Ability Scales-2 Recognition of Pictures, Stanford Binet-5 Nonverbal Working Memory and Wechsler Intelligence Scale for Children-5 Picture Span measures met the most psychometric criteria overall across the full age and IQ range of the study. Although Differential Ability Scales-2 Recall of Sequential Order and Differential Ability Scales-2 Recall of Digits Backward met the fewest a priori criteria, follow-up analyses suggested greater feasibility in specific age and IQ ranges. CONCLUSIONS Several working memory measures appear to be psychometrically sound and appropriate for use in clinical trials for children with DS, especially when focusing on raw scores. However, floor effects on standard scores and feasibility of some measures were problematic. Guidelines for use of the working memory subtests with this population are provided.
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Affiliation(s)
- Emily K. Schworer
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Anna J. Esbensen
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Deborah J. Fidler
- Human Development and Family Studies, Colorado State University, Fort Collins, CO, USA
| | - Dean W. Beebe
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Adam Carle
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- James M Anderson Center for Health Systems Excellence, Cincinnati, OH, USA
- Department of Psychology, University of Cincinnati, Cincinnati, OH, USA
| | - Susan Wiley
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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14
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One-year effects of bifocal and unifocal glasses on executive functions in children with Down syndrome in a randomized controlled trial. Sci Rep 2021; 11:16893. [PMID: 34413362 PMCID: PMC8377071 DOI: 10.1038/s41598-021-96308-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 08/04/2021] [Indexed: 11/08/2022] Open
Abstract
Appropriate glasses can improve visual functioning of children with Down syndrome (DS), but it is unknown if such interventions influence their cognitive impairments. In a randomized controlled trial with 1-year follow-up. Children with DS (2-16 years) were provided either bifocal glasses (add +2.5 Dioptres; n = 50) or unifocal glasses (n = 52). Executive functions were assessed pre- and post-intervention with the task-based Minnesota Executive Function Scale (MEFS) and with questionnaires, BRIEF-P and BRIEF, parents' and teachers' version. Intervention effects and associations between executive functions, (near) vision and ocular alignment were analysed. Intervention improved MEFS-Total-scores in the bifocal group (p = 0.002; Cohen's d = 0.60) but not in the unifocal group (p = 0.191; Cohen's d = 0.24). Post-intervention, there was no intergroup difference (p = 0.120; Cohen's d = 0.34). Post-intervention, higher MEFS-scores were associated with better visual acuities (crowded near p = 0.025; uncrowded near p = 0.019; distant p = 0.045). Pre-post changes in MEFS-scores correlated significantly with improved ocular alignment (p = 0.040). Exploratory analysis of the questionnaires showed improved teacher-rated BRIEF-scores in both groups (bifocals: p = 0.014, Cohen's d = 1.91; unifocals: p = 0.022, Cohen's d = 1.46), with no intergroup difference (p = 0.594; Cohen's d = 0.23). These results demonstrate positive effects of wearing better-correcting glasses on executive functioning in children with DS, suggesting a link between their visual and executive functioning. However, the relative contributions of distant and near vision need further study.
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15
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Nuwer JL, Brady ML, Povysheva NV, Coyne A, Jacob TC. Sustained treatment with an α5 GABA A receptor negative allosteric modulator delays excitatory circuit development while maintaining GABAergic neurotransmission. Neuropharmacology 2021; 197:108724. [PMID: 34284042 DOI: 10.1016/j.neuropharm.2021.108724] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 07/01/2021] [Accepted: 07/14/2021] [Indexed: 01/02/2023]
Abstract
α5 subunit GABA type A receptor (GABAAR) preferring negative allosteric modulators (NAMs) are cognitive enhancers with antidepressant-like effects. α5-NAM success in treating mouse models of neurodevelopmental disorders with excessive inhibition have led to Phase 2 clinical trials for Down syndrome. Despite in vivo efficacy, no study has examined the effects of continued α5-NAM treatment on inhibitory and excitatory synapse plasticity to identify mechanisms of action. Here we used L-655,708, an imidazobenzodiazepine that acts as a highly selective but weak α5-NAM, to investigate the impact of sustained treatment on hippocampal neuron synapse and dendrite development. We show that 2-day pharmacological reduction of α5-GABAAR signaling from DIV12-14, when GABAARs contribute to depolarization, delays dendritic spine maturation and the NMDA receptor (NMDAR) GluN2B/GluN2A developmental shift. In contrast, α5-NAM treatment from DIV19-21, when hyperpolarizing GABAAR signaling predominates, enhances surface synaptic GluN2A while decreasing GluN2B. Despite changes in NMDAR subtype surface levels and localization, total levels of key excitatory synapse proteins were largely unchanged, and mEPSCs were unaltered. Importantly, 2-day α5-NAM treatment does not alter the total surface levels or distribution of α5-GABAARs, reduce the gephyrin inhibitory synaptic scaffold, or impair phasic or tonic inhibition. Furthermore, α5-NAM inhibition of the GABAAR tonic current in mature neurons is maintained after 2-day α5-NAM treatment, suggesting reduced tolerance liability, in contrast to other clinically relevant GABAAR-targeting drugs such as benzodiazepines. Together, these results show that α5-GABAARs contribute to dendritic spine maturation and excitatory synapse development via a NMDAR dependent mechanism without perturbing overall neuronal excitability.
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Affiliation(s)
- Jessica L Nuwer
- Department of Pharmacology and Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Megan L Brady
- Department of Pharmacology and Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Nadya V Povysheva
- Department of Neuroscience and Center for Neuroscience, University of Pittsburgh, Pittsburgh, PA, USA
| | - Amanda Coyne
- Department of Pharmacology and Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Tija C Jacob
- Department of Pharmacology and Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
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16
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Del Hoyo Soriano L, Rosser TC, Hamilton DR, Harvey DJ, Abbeduto L, Sherman SL. Relationship between Apgar scores and long-term cognitive outcomes in individuals with Down syndrome. Sci Rep 2021; 11:12707. [PMID: 34135349 PMCID: PMC8208985 DOI: 10.1038/s41598-021-90651-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 05/12/2021] [Indexed: 11/20/2022] Open
Abstract
This study examined the contribution of the Apgar score at 1 and 5 min after birth to later cognitive functioning in 168 individuals with Down syndrome who were between 6 and 25 years of age at time of cognitive testing. Our results showed that a lower Apgar score at 1 min was related to a worse performance in later cognitive measures of receptive vocabulary, verbal comprehension and production, visual memory and working memory. Results also showed that a lower Apgar score at 5 min was only related to worse later outcomes of verbal comprehension and production and auditory working memory. Our findings suggest a need for future studies investigating how specific perinatal events reflected in the Apgar score are linked to later cognitive functioning in individuals with Down syndrome.
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Affiliation(s)
- Laura Del Hoyo Soriano
- Department of Psychiatry and Behavioral Sciences, MIND Institute University of California Davis, Sacramento, CA, USA.
| | - Tracie C Rosser
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, USA
| | - Debra R Hamilton
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, USA
| | - Danielle J Harvey
- Department of Psychiatry and Behavioral Sciences, MIND Institute University of California Davis, Sacramento, CA, USA
| | - Leonard Abbeduto
- Department of Psychiatry and Behavioral Sciences, MIND Institute University of California Davis, Sacramento, CA, USA
| | - Stephanie L Sherman
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, USA
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17
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Aschenbrenner AJ, Baksh RA, Benejam B, Beresford‐Webb JA, Coppus A, Fortea J, Handen BL, Hartley S, Head E, Jaeger J, Levin J, Loosli SV, Rebillat A, Sacco S, Schmitt FA, Thurlow KE, Zaman S, Hassenstab J, Strydom A. Markers of early changes in cognition across cohorts of adults with Down syndrome at risk of Alzheimer's disease. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2021; 13:e12184. [PMID: 33969175 PMCID: PMC8088591 DOI: 10.1002/dad2.12184] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 03/09/2021] [Accepted: 03/09/2021] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Down syndrome (DS), a genetic variant of early onset Alzheimer's disease (AD), lacks a suitable outcome measure for prevention trials targeting pre-dementia stages. METHODS We used cognitive test data collected in several longitudinal aging studies internationally from 312 participants with DS without dementia to identify composites that were sensitive to change over time. We then conducted additional analyses to provide support for the utility of the composites. The composites were presented to an expert panel to determine the most optimal cognitive battery based on predetermined criteria. RESULTS There were common cognitive domains across site composites, which were sensitive to early decline. The final composite consisted of memory, language/executive functioning, selective attention, orientation, and praxis tests. DISCUSSION We have identified a composite that is sensitive to early decline and thus may have utility as an outcome measure in trials to prevent or delay symptoms of AD in DS.
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Affiliation(s)
| | - R. Asaad Baksh
- Institute of Psychiatry, Psychology, and NeuroscienceDepartment of Forensic and Neurodevelopmental SciencesKing's College LondonLondonUK
- The London Down Syndrome (LonDownS) ConsortiumLondonUK
| | - Bessy Benejam
- Barcelona Down Medical CenterFundació Catalana Síndrome de DownBarcelonaSpain
| | - Jessica A. Beresford‐Webb
- Cambridge Intellectual and Developmental Disabilities Research GroupDepartment of PsychiatryUniversity of CambridgeCambridgeUK
| | - Antonia Coppus
- Department of Primary and Community CareRadboud University Medical CenterNijmegenThe Netherlands
| | - Juan Fortea
- Barcelona Down Medical CenterFundació Catalana Síndrome de DownBarcelonaSpain
- Memory Unit and Biomedical Research Institute Sant Pau (IIB Sant Pau)Neurology DepartmentHospital de la Santa Creu i Sant PauBarcelonaSpain
- Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas (CIBERNED)MadridSpain
| | - Benjamin L. Handen
- Department of PsychiatryUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Sigan Hartley
- Department of Human Development & Family StudiesUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Elizabeth Head
- Department of Pathology & Laboratory MedicineUniversity of CaliforniaIrvineCaliforniaUSA
| | - Judith Jaeger
- CognitionMetricsLLC.WilmingtonDelawareUSA
- Deptment of Psychiatry and Behavioral SciencesAlbert Einstein College of MedicineBronxNew YorkUSA
| | - Johannes Levin
- Department of NeurologyLudwig‐Maximilians‐Universität MünchenMunichGermany
- German Center for Neurodegenerative DiseasesMunichGermany
- Munich Cluster for Systems Neurology (SyNergy)MunichGermany
| | - Sandra V. Loosli
- Department of NeurologyLudwig‐Maximilians‐Universität MünchenMunichGermany
| | | | | | - Frederick A. Schmitt
- Sanders‐Brown Center on AgingUniversity of KentuckyLexingtonKentuckyUSA
- Departments of NeurologyNeurosurgeryBehavioral SciencePsychologyPsychiatryUniversity of KentuckyLexingtonKentuckyUSA
| | - Kate E. Thurlow
- Institute of Psychiatry, Psychology, and NeuroscienceDepartment of Forensic and Neurodevelopmental SciencesKing's College LondonLondonUK
| | - Shahid Zaman
- Cambridge Intellectual and Developmental Disabilities Research GroupDepartment of PsychiatryUniversity of CambridgeCambridgeUK
- Cambridgeshire & Peterborough NHS Foundation TrustCambridgeUK
| | - Jason Hassenstab
- Washington University in St. Louis, Department of NeurologySt. LouisMissouriUSA
| | - Andre Strydom
- Institute of Psychiatry, Psychology, and NeuroscienceDepartment of Forensic and Neurodevelopmental SciencesKing's College LondonLondonUK
- The London Down Syndrome (LonDownS) ConsortiumLondonUK
- South London and the Maudsley NHS Foundation TrustLondonUK
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18
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Hendrix JA, Amon A, Abbeduto L, Agiovlasitis S, Alsaied T, Anderson HA, Bain LJ, Baumer N, Bhattacharyya A, Bogunovic D, Botteron KN, Capone G, Chandan P, Chase I, Chicoine B, Cieuta-Walti C, DeRuisseau LR, Durand S, Esbensen A, Fortea J, Giménez S, Granholm AC, Hahn LJ, Head E, Hillerstrom H, Jacola LM, Janicki MP, Jasien JM, Kamer AR, Kent RD, Khor B, Lawrence JB, Lemonnier C, Lewanda AF, Mobley W, Moore PE, Nelson LP, Oreskovic NM, Osorio RS, Patterson D, Rasmussen SA, Reeves RH, Roizen N, Santoro S, Sherman SL, Talib N, Tapia IE, Walsh KM, Warren SF, White AN, Wong GW, Yi JS. Opportunities, barriers, and recommendations in down syndrome research. TRANSLATIONAL SCIENCE OF RARE DISEASES 2021; 5:99-129. [PMID: 34268067 PMCID: PMC8279178 DOI: 10.3233/trd-200090] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Recent advances in medical care have increased life expectancy and improved the quality of life for people with Down syndrome (DS). These advances are the result of both pre-clinical and clinical research but much about DS is still poorly understood. In 2020, the NIH announced their plan to update their DS research plan and requested input from the scientific and advocacy community. OBJECTIVE The National Down Syndrome Society (NDSS) and the LuMind IDSC Foundation worked together with scientific and medical experts to develop recommendations for the NIH research plan. METHODS NDSS and LuMind IDSC assembled over 50 experts across multiple disciplines and organized them in eleven working groups focused on specific issues for people with DS. RESULTS This review article summarizes the research gaps and recommendations that have the potential to improve the health and quality of life for people with DS within the next decade. CONCLUSIONS This review highlights many of the scientific gaps that exist in DS research. Based on these gaps, a multidisciplinary group of DS experts has made recommendations to advance DS research. This paper may also aid policymakers and the DS community to build a comprehensive national DS research strategy.
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Affiliation(s)
| | - Angelika Amon
- Deceased. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA; Department of Biology, Massachusetts Institute of Technology, Cambridge, MA, USA; Howard Hughes Medical Institute, Chevy Chase, MD, USA
| | - Leonard Abbeduto
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, CA, USA; MIND Institute, University of California, Davis, CA, USA
| | | | - Tarek Alsaied
- Heart Institute Department of Pediatrics Cincinnati Children’s Hospital Medical Center University of Cincinnati, Cincinnati, OH, USA
| | | | | | - Nicole Baumer
- Department of Neurology, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA; Down Syndrome Program, Developmental Medicine Center, Boston Children’s Hospital, Boston, MA, USA
| | - Anita Bhattacharyya
- Waisman Center, University of Wisconsin-Madison, Madison, WI, USA
- Department of Cell and Regenerative Biology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Dusan Bogunovic
- Department of Microbiology, Icahn School of Medicine at Mt. Sinai, New York, NY, USA; Department of Pediatrics, Icahn School of Medicine at Mt. Sinai, New York, NY; Precision Immunology Institute, Icahn School of Medicine at Mt. Sinai, New York, NY, USA; Mindich Child Health and Development Institute, Icahn School of Medicine at Mt. Sinai, New York, NY, USA
| | - Kelly N. Botteron
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | | | - Priya Chandan
- Department of Neurosurgery, Division of Physical Medicine and Rehabilitation, University of Louisville School of Medicine, Louisville, KY, USA
| | - Isabelle Chase
- Department of Pediatric Dentistry, Boston Children’s Hospital, Boston, MA, USA
| | - Brian Chicoine
- Advocate Medical Group Adult Down Syndrome Center, Park Ridge, IL, USA
| | | | | | | | - Anna Esbensen
- Department of Pediatrics, University of Cincinnati College of Medicine & Division of Developmental and Behavioral Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Juan Fortea
- Barcelona Down Medical Center, Fundació Catalana de Síndrome de Down, Barcelona, Spain; Sant Pau Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain; Center of Biomedical Investigation Network for Neurodegenerative Diseases, Madrid, Spain
| | - Sandra Giménez
- Multidisciplinary Sleep Unit, Respiratory Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Ann-Charlotte Granholm
- Knoebel Institute for Healthy Aging, University of Denver, Denver, CO, USA
- Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden
| | - Laura J. Hahn
- Department of Speech and Hearing Science, University of Illinois Urbana Champaign, Champaign, IL, USA
| | - Elizabeth Head
- Department of Pathology and Laboratory Medicine, UC Irvine School of Medicine, Orange, CA, USA
| | | | - Lisa M. Jacola
- Department of Psychology, St Jude Children’s Research Hospital, Memphis, TN, USA
| | | | - Joan M. Jasien
- Division of Pediatric Neurology, Duke University Health System, Durham, NC, USA
| | - Angela R. Kamer
- Department of Periodontology and Implant Dentistry, New York University, College of Dentistry, New York, NY, USA
| | - Raymond D. Kent
- Waisman Center, University of Wisconsin-Madison, Madison, WI, USA
| | - Bernard Khor
- Benaroy Research Institute at Virginia Mason, Seattle, WA, USA
| | - Jeanne B. Lawrence
- Department of Neurology, University of Massachusetts Medical School, Worcester, MA, USA; Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA, USA
| | | | - Amy Feldman Lewanda
- Children s National Rare Disease Institute, Children’s National Health System, Washington, DC., USA
| | - William Mobley
- Department of Neurosciences, University of California, San Diego, CA, USA
| | - Paul E. Moore
- Division of Allergy, Immunology, and Pulmonology, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Nicolas M. Oreskovic
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA; Department of Internal Medicine, Massachusetts General Hospital, Boston, Mass
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Ricardo S. Osorio
- Center for Brain Health, Department of Psychiatry, NYU Langone Medical Center, New York, NY, USA
| | - David Patterson
- Knoebel Institute for Healthy Aging, University of Denver, Denver, CO, USA
- Eleanor Roosevelt Institute, University of Denver, Denver, CO, USA; Department of Biological Sciences, University of Denver, Denver, CO, USA; Molecular and Cellular Biophysics Program, University of Denver, Denver, CO, USA
| | - Sonja A. Rasmussen
- Department of Pediatrics, University of Florida College of Medicine, Gainesville, FL; Department of Epidemiology, University of Florida College of Public Health and Health Professions and College of Medicine, Gainesville, FL
| | - Roger H. Reeves
- Department of Physiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; McKusick-Nathans Department of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nancy Roizen
- Department of Pediatrics, UH/Rainbow Babies and Children’s Hospital and Department of Pediatrics, Case Western Reserve University, Cleveland, OH, USA
| | - Stephanie Santoro
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
- Down Syndrome Program, Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA
| | - Stephanie L. Sherman
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, USA
| | - Nasreen Talib
- Division of General Pediatrics, Children’s Mercy Kansas City, 2401 Gillham Road, Kansas City, MO, USA
| | - Ignacio E. Tapia
- Sleep Center, Division of Pulmonary Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Kyle M. Walsh
- Division of Neuro-epidemiology, Department of Neurosurgery, Duke University, Durham, NC, USA
| | - Steven F. Warren
- Institute for Life Span Studies, University of Kansas, Lawrence, KS, USA
| | - A. Nicole White
- Research Foundation, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Guang William Wong
- Department of Physiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; McKusick-Nathans Department of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Center for Metabolism and Obesity Research, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - John S. Yi
- Division of Surgical Sciences, Department of Surgery, Duke University Medical Center, Durham, NC, USA
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19
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Differences between children with Down syndrome and typically developing children in adaptive behaviour, executive functions and visual acuity. Sci Rep 2021; 11:7602. [PMID: 33828124 PMCID: PMC8027651 DOI: 10.1038/s41598-021-85037-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 02/18/2021] [Indexed: 11/08/2022] Open
Abstract
In children with Down syndrome (DS) development of visual, motor and cognitive functions is atypical. It is unknown whether the visual impairments in children with DS aggravate their lag in cognitive development. Visual impairment and developmental lags in adaptive behaviour and executive functions were assessed in 104 children with DS, 2–16 years, by comparing their adaptive behaviour, executive functions and visual acuity (distant and near) scores against published age-matched norm scores of typically developing children. Associations between these lags were explored. Mean (± SEM) differences to age-matched norms indicated reduced performance in DS: Vineland Screener questionnaire, − 63 ± 3.8 months; task-based Minnesota Executive Function Scale (MEFS), − 46.09 ± 2.07 points; BRIEF-P questionnaire, 25.29 ± 4.66 points; BRIEF parents’ and teachers’ questionnaire, 17.89 ± 3.92 points and 40.10 ± 3.81 points; distant and near visual acuity, 0.51 ± 0.03 LogMAR and 0.63 ± 0.03 LogMAR (near − 0.11 ± 0.04 LogMAR poorer than distant). Adaptive behaviour (Vineland-S) correlated with the severity of visual impairment (r = − 0.396). Children with DS are severely impaired in adaptive behaviour, executive functions and visual acuities (near visual acuity more severely impaired than distant visual acuity). Larger impairment in adaptive behaviour is found in children with larger visual impairment. This supports the idea that visual acuity plays a role in adaptive development.
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20
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Fabjan J, Koniuszewski F, Schaar B, Ernst M. Structure-Guided Computational Methods Predict Multiple Distinct Binding Modes for Pyrazoloquinolinones in GABA A Receptors. Front Neurosci 2021; 14:611953. [PMID: 33519364 PMCID: PMC7844064 DOI: 10.3389/fnins.2020.611953] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 12/23/2020] [Indexed: 12/16/2022] Open
Abstract
Pyrazoloquinolinones (PQs) are a versatile class of GABAA receptor ligands. It has been demonstrated that high functional selectivity for certain receptor subtypes can be obtained by specific substitution patterns, but so far, no clear SAR rules emerge from the studies. As is the case for many GABAA receptor targeting chemotypes, PQs can interact with distinct binding sites on a given receptor pentamer. In pentamers of αβγ composition, such as the most abundant α1β2γ2 subtype, many PQs are high affinity binders of the benzodiazepine binding site at the extracellular α+/γ2- interfaces. There they display a functionally near silent, flumazenil-like allosteric activity. More recently, interactions with extracellular α+/β- interfaces have been investigated, where strong positive modulation can be steered toward interesting subtype preferences. The most prominent examples are functionally α6-selective PQs. Similar to benzodiazepines, PQs also seem to interact with sites in the transmembrane domain, mainly the sites used by etomidate and barbiturates. This promiscuity leads to potential contributions from multiple sites to net modulation. Developing ligands that interact exclusively with the extracellular α+/β- interfaces would be desired. Correlating functional profiles with binding sites usage is hampered by scarce and heterogeneous experimental data, as shown in our meta-analysis of aggregated published data. In the absence of experimental structures, bound states can be predicted with pharmacophore matching methods and with computational docking. We thus performed pharmacophore matching studies for the unwanted sites, and computational docking for the extracellular α1,6+/β3- interfaces. The results suggest that PQs interact with their binding sites with diverse binding modes. As such, rational design of improved ligands needs to take a complex structure-activity landscape with branches between sub-series of derivatives into account. We present a workflow, which is suitable to identify and explore potential branching points on the structure-activity landscape of any small molecule chemotype.
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Affiliation(s)
| | | | | | - Margot Ernst
- Department of Pathobiology of the Nervous System, Center for Brain Research, Medical University of Vienna, Vienna, Austria
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21
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Manrique-Niño J, Díaz-Forero A, Velez-van Meerbeke A, Ramírez-Guerrero S, Florez-Esparza G, Talero-Gutiérrez C. Executive function in down syndrome children in Bogotá, Colombia. Heliyon 2020; 6:e05585. [PMID: 33294710 PMCID: PMC7701347 DOI: 10.1016/j.heliyon.2020.e05585] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 06/01/2020] [Accepted: 11/19/2020] [Indexed: 12/17/2022] Open
Abstract
The study aim was to characterize executive function in 114 children with Down syndrome from a reference institution in Bogotá, Colombia. Children were screened with the Battelle Developmental Inventory to establish their developmental age. Eighty children with an equivalent mental age of 2–5.11 years were allocated to groups of 20 according to their mental age. Parents and teachers then completed the Behavior Rating Inventory of Executive Function-Preschool Version. We found a high variability and a low correlation between parent and teacher ratings. In general, children showed a specific profile characterized by weakness in the domains of working memory, shifting, planning, and organization, and strengths in the emotional control domain. These findings indicate a characteristic pattern of executive function in children with Down syndrome. This profile could form the basis for the planning of clinical assessment programs.
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Affiliation(s)
- Julián Manrique-Niño
- Neuroscience Research Group Neuros, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá D.C., Colombia
| | - Andrés Díaz-Forero
- Neuroscience Research Seedbed SemineURos, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá D.C., Colombia
| | - Alberto Velez-van Meerbeke
- Neuroscience Research Group Neuros, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá D.C., Colombia
| | - Sofía Ramírez-Guerrero
- Neuroscience Research Seedbed SemineURos, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá D.C., Colombia
| | - Gabriela Florez-Esparza
- Neuroscience Research Seedbed SemineURos, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá D.C., Colombia
| | - Claudia Talero-Gutiérrez
- Neuroscience Research Group Neuros, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá D.C., Colombia
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22
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Abstract
Experimental work regarding corrective actions on chromosomes and genes, and control of gene products is yielding promising results. It opens the way to advances in dealing with the etiological aspects of Down syndrome and may lead to important changes in the life of individuals affected with this condition. A small number of molecules are being investigated in pharmacological research that may have positive effects on intellectual functioning. Studies of the pathological consequences of the amyloid cascade and the TAU pathology in the etiology of Alzheimer disease (AD), which is more frequent and occuring earlier in life in persons with Down syndrome (DS), are presented. The search for biological markers of AD and ways for constrasting its early manifestations are also discussed.
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Affiliation(s)
- Jean A. Rondal
- University of Liège, Cognitive Sciences, Building 32, Sart Tilman, Liège 4000, Belgium
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23
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Antonarakis SE, Skotko BG, Rafii MS, Strydom A, Pape SE, Bianchi DW, Sherman SL, Reeves RH. Down syndrome. Nat Rev Dis Primers 2020; 6:9. [PMID: 32029743 PMCID: PMC8428796 DOI: 10.1038/s41572-019-0143-7] [Citation(s) in RCA: 313] [Impact Index Per Article: 78.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/17/2019] [Indexed: 12/11/2022]
Abstract
Trisomy 21, the presence of a supernumerary chromosome 21, results in a collection of clinical features commonly known as Down syndrome (DS). DS is among the most genetically complex of the conditions that are compatible with human survival post-term, and the most frequent survivable autosomal aneuploidy. Mouse models of DS, involving trisomy of all or part of human chromosome 21 or orthologous mouse genomic regions, are providing valuable insights into the contribution of triplicated genes or groups of genes to the many clinical manifestations in DS. This endeavour is challenging, as there are >200 protein-coding genes on chromosome 21 and they can have direct and indirect effects on homeostasis in cells, tissues, organs and systems. Although this complexity poses formidable challenges to understanding the underlying molecular basis for each of the many clinical features of DS, it also provides opportunities for improving understanding of genetic mechanisms underlying the development and function of many cell types, tissues, organs and systems. Since the first description of trisomy 21, we have learned much about intellectual disability and genetic risk factors for congenital heart disease. The lower occurrence of solid tumours in individuals with DS supports the identification of chromosome 21 genes that protect against cancer when overexpressed. The universal occurrence of the histopathology of Alzheimer disease and the high prevalence of dementia in DS are providing insights into the pathology and treatment of Alzheimer disease. Clinical trials to ameliorate intellectual disability in DS signal a new era in which therapeutic interventions based on knowledge of the molecular pathophysiology of DS can now be explored; these efforts provide reasonable hope for the future.
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Affiliation(s)
- Stylianos E Antonarakis
- Department of Genetic Medicine and Development, University of Geneva Medical School, Geneva, Switzerland.
| | - Brian G Skotko
- Down Syndrome Program, Division of Medical Genetics, Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Michael S Rafii
- Keck School of Medicine of University of Southern California, California, CA, USA
| | - Andre Strydom
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Sarah E Pape
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Diana W Bianchi
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Stephanie L Sherman
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, USA
| | - Roger H Reeves
- Department of Physiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- McKusick-Nathans Department of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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24
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Duchon A, Gruart A, Albac C, Delatour B, Zorrilla de San Martin J, Delgado-García JM, Hérault Y, Potier MC. Long-lasting correction of in vivo LTP and cognitive deficits of mice modelling Down syndrome with an α5-selective GABA A inverse agonist. Br J Pharmacol 2020; 177:1106-1118. [PMID: 31652355 PMCID: PMC7042104 DOI: 10.1111/bph.14903] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 09/12/2019] [Accepted: 09/15/2019] [Indexed: 12/19/2022] Open
Abstract
Background and Purpose Excessive GABAergic inhibition contributes to cognitive dysfunctions in Down syndrome (DS). Selective negative allosteric modulators (NAMs) of α5‐containing GABAA receptors such as the α5 inverse agonist (α5IA) restore learning and memory deficits in Ts65Dn mice, a model of DS. In this study we have assessed the long‐lasting effects of α5IA on in vivo LTP and behaviour in Ts65Dn mice. Experimental Approach We made in vivo LTP recordings for six consecutive days in freely moving Ts65Dn mice and their wild‐type littermates, treated with vehicle or α5IA. In parallel, Ts65Dn mice were assessed by various learning and memory tests (Y maze, Morris water maze, or the novel object recognition) for up to 7 days, following one single injection of α5IA or vehicle. Key Results LTP was not evoked in vivo in Ts65Dn mice at hippocampal CA3‐CA1 synapses. However, this deficit was sustainably reversed for at least six consecutive days following a single injection of α5IA. This long‐lasting effect of α5IA was also observed when assessing working and long‐term memory deficits in Ts65Dn mice. Conclusion and Implications We show for the first time in vivo LTP deficits in Ts65Dn mice. These deficits were restored for at least 6 days following acute treatment with α5IA and might be the substrate for the long‐lasting pharmacological effects of α5IA on spatial working and long‐term recognition and spatial memory tasks. Our results demonstrate the relevance of negative allosteric modulators of α5‐containing GABAA receptors to the treatment of cognitive deficits associated with DS.
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Affiliation(s)
- Arnaud Duchon
- Translational Medicine and Neurogenetics, Institut de Génétique et de Biologie Moléculaire et Cellulaire, Illkirch, France.,Centre National de la Recherche Scientifique, UMR7104, Illkirch, France.,Institut National de la Santé et de la Recherche Médicale, U1258, Illkirch, France.,Neuropôle, Université de Strasbourg, Illkirch, France
| | - Agnès Gruart
- División de Neurociencias, Universidad Pablo de Olavide, Seville, Spain
| | - Christelle Albac
- Institut du Cerveau et de la Moelle épinière, Hôpital de la Pitié-Salpêtrière, Paris, France.,Institut National de la Santé et de la Recherche Médicale, U1127, Hôpital de la Pitié-Salpêtrière, Paris, France.,Centre National de la Recherche Scientifique, UMR7225, Hôpital de la Pitié-Salpêtrière, Paris, France.,Sorbonne Université, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Benoît Delatour
- Institut du Cerveau et de la Moelle épinière, Hôpital de la Pitié-Salpêtrière, Paris, France.,Institut National de la Santé et de la Recherche Médicale, U1127, Hôpital de la Pitié-Salpêtrière, Paris, France.,Centre National de la Recherche Scientifique, UMR7225, Hôpital de la Pitié-Salpêtrière, Paris, France.,Sorbonne Université, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Javier Zorrilla de San Martin
- Institut du Cerveau et de la Moelle épinière, Hôpital de la Pitié-Salpêtrière, Paris, France.,Institut National de la Santé et de la Recherche Médicale, U1127, Hôpital de la Pitié-Salpêtrière, Paris, France.,Centre National de la Recherche Scientifique, UMR7225, Hôpital de la Pitié-Salpêtrière, Paris, France.,Sorbonne Université, Hôpital de la Pitié-Salpêtrière, Paris, France
| | | | - Yann Hérault
- Translational Medicine and Neurogenetics, Institut de Génétique et de Biologie Moléculaire et Cellulaire, Illkirch, France.,Centre National de la Recherche Scientifique, UMR7104, Illkirch, France.,Institut National de la Santé et de la Recherche Médicale, U1258, Illkirch, France.,Neuropôle, Université de Strasbourg, Illkirch, France
| | - Marie-Claude Potier
- Institut du Cerveau et de la Moelle épinière, Hôpital de la Pitié-Salpêtrière, Paris, France.,Institut National de la Santé et de la Recherche Médicale, U1127, Hôpital de la Pitié-Salpêtrière, Paris, France.,Centre National de la Recherche Scientifique, UMR7225, Hôpital de la Pitié-Salpêtrière, Paris, France.,Sorbonne Université, Hôpital de la Pitié-Salpêtrière, Paris, France
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25
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Lee SE, Duran-Martinez M, Khantsis S, Bianchi DW, Guedj F. Challenges and Opportunities for Translation of Therapies to Improve Cognition in Down Syndrome. Trends Mol Med 2019; 26:150-169. [PMID: 31706840 DOI: 10.1016/j.molmed.2019.10.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 10/02/2019] [Accepted: 10/03/2019] [Indexed: 02/07/2023]
Abstract
While preclinical studies have reported improvement of behavioral deficits in the Ts65Dn mouse model of Down syndrome (DS), translation to human clinical trials to improve cognition in individuals with DS has had a poor success record. Timing of the intervention, choice of animal models, strategy for drug selection, and lack of translational endpoints between animals and humans contributed to prior failures of human clinical trials. Here, we focus on in vitro cell models from humans with DS to identify the molecular mechanisms underlying the brain phenotype associated with DS. We emphasize the importance of using these cell models to screen for therapeutic molecules, followed by validating them in the most suitable animal models prior to initiating human clinical trials.
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Affiliation(s)
- Sarah E Lee
- Medical Genetics Branch (Prenatal Genomic and Therapy Section), National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA.
| | - Monica Duran-Martinez
- Medical Genetics Branch (Prenatal Genomic and Therapy Section), National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Sabina Khantsis
- Medical Genetics Branch (Prenatal Genomic and Therapy Section), National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Diana W Bianchi
- Medical Genetics Branch (Prenatal Genomic and Therapy Section), National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA; Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda 20892, MD, USA
| | - Faycal Guedj
- Medical Genetics Branch (Prenatal Genomic and Therapy Section), National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA.
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26
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Duff K, Randolph C, Boxer AL. Cognitive decline on the Repeatable Battery for the Assessment of Neuropsychological Status in progressive supranuclear palsy. Clin Neuropsychol 2019; 34:529-540. [PMID: 31559910 DOI: 10.1080/13854046.2019.1670865] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: Progressive supranuclear palsy (PSP) is associated with a variety of cognitive deficits, but few studies have reported on its cognitive trajectory across time, especially on the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS).Methods: Two hundred twenty participants diagnosed with Richardson's syndrome of PSP (PSP-RS) were evaluated with the RBANS at baseline, six months, and one year with alternate forms.Results: When using dependent t-tests, significant declines were observed on all Indexes of the RBANS from baseline to six months (ps < 0.01). Between six months and one year, significant declines were observed on three Indexes of the RBANS (ps < 0.05). Using existing regression-based change formulae from cognitively intact older adults, these participants with PSP showed significant decline on all RBANS Indexes (ps < 0.01) across one year. Finally, new regression-based change formulae were developed on this sample of individuals with PSP-RS to more precisely evaluate cognitive change in this condition.Conclusion: In this large, longitudinal cohort of participants with PSP-RS, many (but not all) showed notable cognitive decline across six months and one year on the RBANS. The different methods of examining change across time yielded different results, with regression-based methods appearing to more accurately capture decline in this sample. These findings are expected to allow clinicians to more accurately evaluate cognitive trajectories in patients with PSP, as well as make better estimates of prognosis and offer more appropriate treatment recommendations. Such findings are also expected to inform clinical trials as to the changes in cognitive outcomes with this neurological condition.
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Affiliation(s)
- Kevin Duff
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
| | | | - Adam L Boxer
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
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27
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Hamburg S, Lowe B, Startin CM, Padilla C, Coppus A, Silverman W, Fortea J, Zaman S, Head E, Handen BL, Lott I, Song W, Strydom A. Assessing general cognitive and adaptive abilities in adults with Down syndrome: a systematic review. J Neurodev Disord 2019; 11:20. [PMID: 31470792 PMCID: PMC6716931 DOI: 10.1186/s11689-019-9279-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 07/22/2019] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Measures of general cognitive and adaptive ability in adults with Down syndrome (DS) used by previous studies vary substantially. This review summarises the different ability measures used previously, focusing on tests of intelligence quotient (IQ) and adaptive behaviour (AB), and where possible examines floor effects and differences between DS subpopulations. We aimed to use information regarding existing measures to provide recommendations for individual researchers and the DS research community. RESULTS Nineteen studies reporting IQ test data met inclusion for this review, with 17 different IQ tests used. Twelve of these IQ tests were used in only one study while five were used in two different studies. Eleven studies reporting AB test data met inclusion for this review, with seven different AB tests used. The only AB scales to be used by more than one study were the Vineland Adaptive Behaviour Scale (VABS; used by three studies) and the Vineland Adaptive Behavior Scale 2nd Edition (VABS-II; used by two studies). A variety of additional factors were identified which make comparison of test scores between studies problematic, including different score types provided between studies (e.g. raw scores compared to age-equivalent scores) and different participant inclusion criteria (e.g. whether individuals with cognitive decline were excluded). Floor effects were common for IQ tests (particularly for standardised test scores). Data exists to suggest that floor effects may be minimised by the use of raw test scores rather than standardised test scores. Raw scores may, therefore, be particularly useful in longitudinal studies to track change in cognitive ability over time. CONCLUSIONS Studies assessing general ability in adults with DS are likely to benefit from the use of both IQ and AB scales. The DS research community may benefit from the development of reporting standards for IQ and AB data, and from the sharing of raw study data enabling further in-depth investigation of issues highlighted by this review.
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Affiliation(s)
- Sarah Hamburg
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, London, SE5 8AF UK
- Division of Psychiatry, University College London, London, W1T 7NF UK
- The London Down Syndrome Consortium (LonDownS), London, UK
| | - Bryony Lowe
- Division of Psychiatry, University College London, London, W1T 7NF UK
- The London Down Syndrome Consortium (LonDownS), London, UK
- Department of Psychology, Loughborough University, Loughborough, Leicestershire LE11 3TU UK
| | - Carla Marie Startin
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, London, SE5 8AF UK
- Division of Psychiatry, University College London, London, W1T 7NF UK
- The London Down Syndrome Consortium (LonDownS), London, UK
| | - Concepcion Padilla
- Department of Psychiatry, Herchel Smith Building for Brain & Mind Sciences, Forvie Site, Robinson Way, Cambridge, CB2 0SZ UK
| | - Antonia Coppus
- Dichterbij, Center for Intellectual Disabilities, Gennep, The Netherlands
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Wayne Silverman
- Department of Pediatrics, University of California, Irvine, USA
| | - Juan Fortea
- Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau–Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Barcelona Down Medical Center, Fundació Catalana de Síndrome de Down, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas, CIBERNED, Madrid, Spain
| | - Shahid Zaman
- Department of Psychiatry, Herchel Smith Building for Brain & Mind Sciences, Forvie Site, Robinson Way, Cambridge, CB2 0SZ UK
| | - Elizabeth Head
- Sanders-Brown Center on Aging, University of Kentucky, 800 South Limestone Street, Lexington, KY 40536-0230 USA
| | - Benjamin L. Handen
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213 USA
| | - Ira Lott
- Departments of Pediatrics and Neurology, University of California, Irvine, USA
| | - Weihong Song
- Townsend Family Laboratories, Department of Psychiatry, The University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC V6T 1Z3 Canada
| | - André Strydom
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, London, SE5 8AF UK
- Division of Psychiatry, University College London, London, W1T 7NF UK
- The London Down Syndrome Consortium (LonDownS), London, UK
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28
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Duff K, McDermott D, Luong D, Randolph C, Boxer AL. Cognitive deficits in progressive supranuclear palsy on the Repeatable Battery for the Assessment of Neuropsychological Status. J Clin Exp Neuropsychol 2019; 41:469-475. [PMID: 30712468 PMCID: PMC6499681 DOI: 10.1080/13803395.2019.1572073] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 01/14/2019] [Indexed: 10/27/2022]
Abstract
Progressive supranuclear palsy (PSP) is associated with a variety of cognitive deficits, as well as motor and psychiatric disturbances. As clinical trials for PSP evolve, briefer screening instruments will be needed to determine cognitive effects of interventions. The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) may fill this gap. Three hundred four participants diagnosed with Richardson's syndrome of PSP were evaluated with the RBANS, as well as other scales typically used in PSP. RBANS performances for these participants fell significantly below expectations for the Total Scale score and all five Indexes. Cognitive scores on the RBANS were also significantly related to other markers of PSP (e.g., motor and functional abilities, depression, global cognition). Compared to other clinical conditions from the literature, patients with PSP show impairment on tests of visuospatial perception and construction and attention. Although additional research is needed, the current study supports the clinical applicability of the RBANS in patients with PSP, as well as its potential for future clinical trials.
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Affiliation(s)
- Kevin Duff
- Department of Neurology, University of Utah, Salt Lake City, UT
| | - Dana McDermott
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA
| | - Dan Luong
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA
| | | | - Adam L. Boxer
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA
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29
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Dekker AD, Sacco S, Carfi A, Benejam B, Vermeiren Y, Beugelsdijk G, Schippers M, Hassefras L, Eleveld J, Grefelman S, Fopma R, Bomer-Veenboer M, Boti M, Oosterling GDE, Scholten E, Tollenaere M, Checkley L, Strydom A, Van Goethem G, Onder G, Blesa R, Zu Eulenburg C, Coppus AMW, Rebillat AS, Fortea J, De Deyn PP. The Behavioral and Psychological Symptoms of Dementia in Down Syndrome (BPSD-DS) Scale: Comprehensive Assessment of Psychopathology in Down Syndrome. J Alzheimers Dis 2019; 63:797-819. [PMID: 29689719 PMCID: PMC5929348 DOI: 10.3233/jad-170920] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
People with Down syndrome (DS) are prone to develop Alzheimer’s disease (AD). Behavioral and psychological symptoms of dementia (BPSD) are core features, but have not been comprehensively evaluated in DS. In a European multidisciplinary study, the novel Behavioral and Psychological Symptoms of Dementia in Down Syndrome (BPSD-DS) scale was developed to identify frequency and severity of behavioral changes taking account of life-long characteristic behavior. 83 behavioral items in 12 clinically defined sections were evaluated. The central aim was to identify items that change in relation to the dementia status, and thus may differentiate between diagnostic groups. Structured interviews were conducted with informants of persons with DS without dementia (DS, n = 149), with questionable dementia (DS+Q, n = 65), and with diagnosed dementia (DS+AD, n = 67). First exploratory data suggest promising interrater, test-retest, and internal consistency reliability measures. Concerning item relevance, group comparisons revealed pronounced increases in frequency and severity in items of anxiety, sleep disturbances, agitation & stereotypical behavior, aggression, apathy, depressive symptoms, and eating/drinking behavior. The proportion of individuals presenting an increase was highest in DS+AD, intermediate in DS+Q, and lowest in DS. Interestingly, among DS+Q individuals, a substantial proportion already presented increased anxiety, sleep disturbances, apathy, and depressive symptoms, suggesting that these changes occur early in the course of AD. Future efforts should optimize the scale based on current results and clinical experiences, and further study applicability, reliability, and validity. Future application of the scale in daily care may aid caregivers to understand changes, and contribute to timely interventions and adaptation of caregiving.
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Affiliation(s)
- Alain D Dekker
- Department of Neurology and Alzheimer Research Center, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Laboratory of Neurochemistry and Behaviour, Institute Born-Bunge, University of Antwerp, Wilrijk, Belgium
| | | | - Angelo Carfi
- Department of Geriatrics, Policlinico Gemelli, Universitá Cattolica del Sacro Cuore, Rome, Italy
| | - Bessy Benejam
- Down Medical Center, Catalan Down Syndrome Foundation, Barcelona, Spain
| | - Yannick Vermeiren
- Department of Neurology and Alzheimer Research Center, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Laboratory of Neurochemistry and Behaviour, Institute Born-Bunge, University of Antwerp, Wilrijk, Belgium
| | - Gonny Beugelsdijk
- Ipse de Bruggen, Center for Intellectual Disabilities, Nieuwveen/Zwammerdam, The Netherlands
| | - Mieke Schippers
- Ipse de Bruggen, Center for Intellectual Disabilities, Nieuwveen/Zwammerdam, The Netherlands
| | - Lyanne Hassefras
- Ipse de Bruggen, Center for Intellectual Disabilities, Nieuwveen/Zwammerdam, The Netherlands
| | - José Eleveld
- Cosis, Center for Intellectual Disabilities, Groningen, The Netherlands
| | - Sharina Grefelman
- Cosis, Center for Intellectual Disabilities, Groningen, The Netherlands
| | - Roelie Fopma
- Talant, Center for Intellectual Disabilities, Heerenveen, The Netherlands
| | | | - Mariángeles Boti
- Down Medical Center, Catalan Down Syndrome Foundation, Barcelona, Spain
| | | | - Esther Scholten
- Elver, Center for Intellectual Disabilities, Nieuw-Wehl, The Netherlands
| | - Marleen Tollenaere
- Laboratory of Neurochemistry and Behaviour, Institute Born-Bunge, University of Antwerp, Wilrijk, Belgium.,Department of Neurology and Memory Clinic, Hospital Network Antwerp (ZNA) Middelheim and Hoge Beuken, Antwerp, Belgium
| | - Laura Checkley
- Division of Psychiatry, University College London, London, UK
| | - André Strydom
- Division of Psychiatry, University College London, London, UK
| | - Gert Van Goethem
- Het GielsBos, Center for Intellectual Disabilities, Gierle, Belgium.,Department of Neurology, University Hospital Antwerp, Antwerp, Belgium
| | - Graziano Onder
- Department of Geriatrics, Policlinico Gemelli, Universitá Cattolica del Sacro Cuore, Rome, Italy
| | - Rafael Blesa
- Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Christine Zu Eulenburg
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Antonia M W Coppus
- Dichterbij, Center for Intellectual Disabilities, Gennep, The Netherlands.,Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Juan Fortea
- Down Medical Center, Catalan Down Syndrome Foundation, Barcelona, Spain.,Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Peter P De Deyn
- Department of Neurology and Alzheimer Research Center, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Laboratory of Neurochemistry and Behaviour, Institute Born-Bunge, University of Antwerp, Wilrijk, Belgium.,Department of Neurology and Memory Clinic, Hospital Network Antwerp (ZNA) Middelheim and Hoge Beuken, Antwerp, Belgium
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30
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Brose RD, Savonenko A, Devenney B, Smith KD, Reeves RH. Hydroxyurea Improves Spatial Memory and Cognitive Plasticity in Mice and Has a Mild Effect on These Parameters in a Down Syndrome Mouse Model. Front Aging Neurosci 2019; 11:96. [PMID: 31139073 PMCID: PMC6527804 DOI: 10.3389/fnagi.2019.00096] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 04/09/2019] [Indexed: 01/08/2023] Open
Abstract
Down syndrome (DS), a genetic disorder caused by partial or complete triplication of chromosome 21, is the most common genetic cause of intellectual disability. DS mouse models and cell lines display defects in cellular adaptive stress responses including autophagy, unfolded protein response, and mitochondrial bioenergetics. We tested the ability of hydroxyurea (HU), an FDA-approved pharmacological agent that activates adaptive cellular stress response pathways, to improve the cognitive function of Ts65Dn mice. The chronic HU treatment started at a stage when early mild cognitive deficits are present in this model (∼3 months of age) and continued until a stage of advanced cognitive deficits in untreated mice (∼5–6 months of age). The HU effects on cognitive performance were analyzed using a battery of water maze tasks designed to detect changes in different types of memory with sensitivity wide enough to detect deficits as well as improvements in spatial memory. The most common characteristic of cognitive deficits observed in trisomic mice at 5–6 months of age was their inability to rapidly acquire new information for long-term storage, a feature akin to episodic-like memory. On the background of severe cognitive impairments in untreated trisomic mice, HU-treatment produced mild but significant benefits in Ts65Dn by improving memory acquisition and short-term retention of spatial information. In control mice, HU treatment facilitated memory retention in constant (reference memory) as well as time-variant conditions (episodic-like memory) implicating a robust nootropic effect. This was the first proof-of-concept study of HU treatment in a DS model, and indicates that further studies are warranted to assess a window to optimize timing and dosage of the treatment in this pre-clinical phase. Findings of this study indicate that HU has potential for improving memory retention and cognitive flexibility that can be harnessed for the amelioration of cognitive deficits in normal aging and in cognitive decline (dementia) related to DS and other neurodegenerative diseases.
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Affiliation(s)
- Rebecca Deering Brose
- Department of Physiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Alena Savonenko
- Departments of Pathology and Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Benjamin Devenney
- Department of Physiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Kirby D Smith
- McKusick-Nathans Institute of Genetic Medicine, Baltimore, MD, United States
| | - Roger H Reeves
- Department of Physiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States.,McKusick-Nathans Institute of Genetic Medicine, Baltimore, MD, United States
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Esbensen AJ, Hoffman EK, Shaffer R, Chen E, Patel L, Jacola L. Reliability of Informant-Report Measures of Executive Functioning in Children With Down Syndrome. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2019; 124:220-233. [PMID: 31026204 PMCID: PMC6487878 DOI: 10.1352/1944-7558-124.3.220] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The current study evaluates the psychometric properties of the Behavior Rating Inventory of Executive Function (BRIEF) with children with Down syndrome. Caregivers of 84 children with Down syndrome rated their child's behavior with the BRIEF. Teacher ratings were obtained for 57 children. About 40% of children with Down syndrome were reported by parents, and 70% by teachers, to exhibit clinically significant challenges with executive functioning. Distribution of scores was normal, internal consistency for subscales was questionable to primarily excellent, and inter-rater reliability was poor to good. Normative data conversions controlled for age, IQ, and gender differences, with some exceptions. The study findings suggest that the BRIEF and its subscales generally performed in a psychometrically sound manner among children with Down syndrome.
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Affiliation(s)
- Anna J. Esbensen
- Department of Pediatrics, University of Cincinnati College of Medicine
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children’s Hospital Medical Center
| | - Emily K. Hoffman
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children’s Hospital Medical Center
| | - Rebecca Shaffer
- Department of Pediatrics, University of Cincinnati College of Medicine
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children’s Hospital Medical Center
| | - Elizabeth Chen
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children’s Hospital Medical Center
| | - Lina Patel
- Sie Center for Down Syndrome, Children’s Hospital Colorado
| | - Lisa Jacola
- Department of Psychology, St Jude Children’s Research Hospital
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32
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Hithersay R, Startin CM, Hamburg S, Mok KY, Hardy J, Fisher EMC, Tybulewicz VLJ, Nizetic D, Strydom A. Association of Dementia With Mortality Among Adults With Down Syndrome Older Than 35 Years. JAMA Neurol 2019; 76:152-160. [PMID: 30452522 PMCID: PMC6439956 DOI: 10.1001/jamaneurol.2018.3616] [Citation(s) in RCA: 89] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 09/20/2018] [Indexed: 01/30/2023]
Abstract
Importance This work quantifies the fatal burden of dementia associated with Alzheimer disease in individuals with Down syndrome (DS). Objective To explore the association of dementia associated with Alzheimer disease with mortality and examine factors associated with dementia in adults with DS. Design, Settings and Participants Prospective longitudinal study in a community setting in England. Data collection began March 29, 2012. Cases were censored on December 13, 2017. The potential sample consisted of all adults 36 years and older from the London Down Syndrome Consortium cohort with 2 data times and dementia status recorded (N = 300); 6 withdrew from study, 28 were lost to follow-up, and 55 had a single data collection point at time of analysis. The final sample consisted of 211 participants, with 503.92 person-years' follow-up. Exposures Dementia status, age, sex, APOE genotype, level of intellectual disability, health variables, and living situation. Main Outcomes and Measures Crude mortality rates, time to death, and time to dementia diagnosis with proportional hazards of predictors. Results Of the 211 participants, 96 were women (45.5%) and 66 (31.3%) had a clinical dementia diagnosis. Twenty-seven participants (11 female; mean age at death, 56.74 years) died during the study period. Seventy percent had dementia. Crude mortality rates for individuals with dementia (1191.85 deaths per 10 000 person-years; 95% CI, 1168.49-1215.21) were 5 times higher than for those without (232.22 deaths per 10 000 person-years; 95% CI, 227.67-236.77). For those with dementia, APOE ε4 carriers had a 7-fold increased risk of death (hazard ratio [HR], 6.91; 95% CI, 1.756-27.195). For those without dementia, epilepsy with onset after age 36 years was associated with mortality (HR, 9.66; 95% CI, 1.59-58.56). APOE ε4 carriers (HR, 4.91; 95% CI, 2.53-9.56), adults with early-onset epilepsy (HR, 3.61; 95% CI, 1.12-11.60), multiple health comorbidities (HR, 1.956; 95% CI, 1.087-3.519), and those living with family (HR, 2.14; 95% CI, 1.08-4.20) received significantly earlier dementia diagnoses. Conclusions and Relevance Dementia was associated with mortality in 70% of older adults with DS. APOE ε4 carriers and/or people with multiple comorbid health conditions were at increased risk of dementia and death, highlighting the need for good health care. For those who died without a dementia diagnosis, late-onset epilepsy was the only significant factor associated with death, raising questions about potentially undiagnosed dementia cases in this group.
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Affiliation(s)
- Rosalyn Hithersay
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, England
- Division of Psychiatry, University College London, London, England
- London Down Syndrome Consortium, London, England
| | - Carla M. Startin
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, England
- Division of Psychiatry, University College London, London, England
- London Down Syndrome Consortium, London, England
| | - Sarah Hamburg
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, England
- Division of Psychiatry, University College London, London, England
- London Down Syndrome Consortium, London, England
| | - Kin Y. Mok
- London Down Syndrome Consortium, London, England
- Department of Neurodegenerative Disease, Institute of Neurology, University College London, London, England
- Division of Life Science, Hong Kong University of Science and Technology, Hong Kong, Special Administrative Region of China
| | - John Hardy
- London Down Syndrome Consortium, London, England
- Department of Neurodegenerative Disease, Institute of Neurology, University College London, London, England
- Reta Lila Weston Institute, Institute of Neurology, University College London, London, England
| | - Elizabeth M. C. Fisher
- London Down Syndrome Consortium, London, England
- Department of Neuromuscular Diseases, Institute of Neurology, University College London, London, England
| | - Victor L. J. Tybulewicz
- London Down Syndrome Consortium, London, England
- The Francis Crick Institute, London, England
- Imperial College, London, England
| | - Dean Nizetic
- London Down Syndrome Consortium, London, England
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Blizard Institute, Barts and the London School of Medicine, Queen Mary University of London, London, England
| | - André Strydom
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, England
- Division of Psychiatry, University College London, London, England
- London Down Syndrome Consortium, London, England
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Startin CM, Hamburg S, Strydom A. Comparison of Receptive Verbal Abilities Assessed Using the KBIT-2 and BPVS3 in Adults With Down Syndrome. Front Psychol 2019; 9:2730. [PMID: 30705655 PMCID: PMC6344413 DOI: 10.3389/fpsyg.2018.02730] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 12/18/2018] [Indexed: 11/15/2022] Open
Abstract
Down syndrome (DS) is the most common genetic cause of intellectual disability. There is, however, considerable variation in cognitive abilities between those with DS, with some individuals scoring at floor on some tests, particularly for age-standardised outcomes. This variation and these floor effects can pose a problem for comparing and combining study populations when different standardised measures have been used to assess individuals' cognitive abilities, for example combining results across studies to investigate genetic or other factors associated with cognitive abilities. To facilitate this comparison and combination of study populations assessed using different tests of verbal abilities, we administered two commonly used standardised tests of receptive language, the Kaufmann Brief Intelligence Test 2 (KBIT-2) verbal scale and the British Picture Vocabulary Scale 3 (BPVS3) to 34 adults with DS (age range 19-59) to investigate relationships between outcomes for these two tests. We found a very strong correlation between raw scores for the KBIT-2 verbal scale and the BPVS3, and determined equations to convert between scores for the two tests. Intraclass correlations between the two scales for age-equivalents and calculated z scores relative to population norms were also strong, though scores for both outcomes were significantly higher for the KBIT-2 verbal scale compared to the BPVS3. This deviation in scores between the two tests was greater as z scores decreased for both tests (i.e., for lower scoring individuals), with no such relationship observed for age-equivalents. These results indicate the conversion of raw scores between the KBIT-2 verbal scale and the BPVS3 may be a more valid method for the comparison or combination of study samples with DS compared to the use of standardised scores. Such comparisons or combinations will aid our understanding of cognitive variations and factors associated with these variations within the population with DS.
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Affiliation(s)
- Carla M. Startin
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- Division of Psychiatry, University College London, London, United Kingdom
- LonDownS Consortium, London, United Kingdom
| | - Sarah Hamburg
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- Division of Psychiatry, University College London, London, United Kingdom
- LonDownS Consortium, London, United Kingdom
| | - Andre Strydom
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- Division of Psychiatry, University College London, London, United Kingdom
- LonDownS Consortium, London, United Kingdom
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34
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Spiridigliozzi GA, Goeldner C, Edgin J, Hart SJ, Noeldeke J, Squassante L, Visootsak J, Heller JH, Khwaja O, Kishnani PS, Liogier d'Ardhuy X. Adaptive behavior in adolescents and adults with Down syndrome: Results from a 6-month longitudinal study. Am J Med Genet A 2018; 179:85-93. [PMID: 30569586 DOI: 10.1002/ajmg.a.60685] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 09/09/2018] [Accepted: 10/10/2018] [Indexed: 11/10/2022]
Abstract
Measures of adaptive behavior are important in the assessment and treatment of individuals with intellectual disabilities (ID). The purpose of the current study was to evaluate the stability of an established and a novel measure of adaptive behavior over time, and their suitability as outcome measures in clinical trials targeting individuals with Down syndrome (DS). This 6-month, longitudinal, noninterventional, multinational study included adolescents (12-17 years) and adults (18-30 years) with DS. Participants were from seven countries (11 different sites) with English, Spanish and French as their native language. The Vineland Adaptive Behavior Scales-II (VABS-II) and a newly developed Clinician Global Impression (CGI) scale were administered at baseline, 1 and 6 months. Adults had lower composite standard scores on all domains of the VABS-II compared with adolescents. The communication domain was a weakness relative to the socialization and daily living skills domains on the VABS-II and the CGI-Severity scale. These findings were stable over 6 months, as exhibited by high intraclass correlations (>0.75). These results provide valuable baseline data for use in trial design and endpoint selection for studies including individuals with DS. ClinicalTrials.gov identifier: NCT01580384.
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Affiliation(s)
- Gail A Spiridigliozzi
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
| | - Celia Goeldner
- F. Hoffmann-La Roche, Roche Pharma Research and Early Development, Neuroscience, Roche Innovation Center Basel, Basel, Switzerland
| | - Jamie Edgin
- Department of Psychology, University of Arizona, Tucson, Arizona
| | - Sarah J Hart
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
| | - Jana Noeldeke
- F. Hoffmann-La Roche, Roche Pharma Research and Early Development, Neuroscience, Roche Innovation Center Basel, Basel, Switzerland
| | - Lisa Squassante
- F. Hoffmann-La Roche, Roche Pharma Research and Early Development, Neuroscience, Roche Innovation Center Basel, Basel, Switzerland
| | - Jeannie Visootsak
- F. Hoffmann-La Roche, Roche Pharma Research and Early Development, Neuroscience, Roche Innovation Center, New York, New York
| | | | - Omar Khwaja
- F. Hoffmann-La Roche, Roche Pharma Research and Early Development, Neuroscience, Roche Innovation Center Basel, Basel, Switzerland
| | - Priya S Kishnani
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
| | - Xavier Liogier d'Ardhuy
- F. Hoffmann-La Roche, Roche Pharma Research and Early Development, Neuroscience, Roche Innovation Center Basel, Basel, Switzerland
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35
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On the Design of Broad-Based Neuropsychological Test Batteries to Assess the Cognitive Abilities of Individuals with Down Syndrome in the Context of Clinical Trials. Brain Sci 2018; 8:brainsci8120205. [PMID: 30486228 PMCID: PMC6315396 DOI: 10.3390/brainsci8120205] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 11/14/2018] [Accepted: 11/21/2018] [Indexed: 12/29/2022] Open
Abstract
Down syndrome (DS) is the most common genetically-defined cause of intellectual disability. Neurodevelopmental deficits displayed by individuals with DS are generally global, however, disproportionate deficits in cognitive processes that depend heavily on the hippocampus and prefrontal cortex are also well documented. Additionally, DS is associated with relative strengths in visual processing and visuospatial short-term memory, and weaknesses in the verbal domain. Although reports of pharmacological rescuing of learning and memory deficits in mouse models of DS abound in the literature, proving the principle that cognitive ability of persons with DS can be boosted through pharmacological means is still an elusive goal. The design of customized batteries of neuropsychological efficacy outcome measures is essential for the successful implementation of clinical trials of potential cognitive enhancing strategies. Here, we review the neurocognitive phenotype of individuals with DS and major broad-based test batteries designed to quantify specific cognitive domains in these individuals, including the one used in a pilot trial of the drug memantine. The main goal is to illustrate the essential considerations in planning trials to enhance cognitive functions in individuals with DS, which should also have implications for the design of similar studies in individuals with other forms of intellectual disability.
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36
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REM sleep in naps differentially relates to memory consolidation in typical preschoolers and children with Down syndrome. Proc Natl Acad Sci U S A 2018; 115:11844-11849. [PMID: 30373840 DOI: 10.1073/pnas.1811488115] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Sleep is recognized as a physiological state associated with learning, with studies showing that knowledge acquisition improves with naps. Little work has examined sleep-dependent learning in people with developmental disorders, for whom sleep quality is often impaired. We examined the effect of natural, in-home naps on word learning in typical young children and children with Down syndrome (DS). Despite similar immediate memory retention, naps benefitted memory performance in typical children but hindered performance in children with DS, who retained less when tested after a nap, but were more accurate after a wake interval. These effects of napping persisted 24 h later in both groups, even after an intervening overnight period of sleep. During naps in typical children, memory retention for object-label associations correlated positively with percent of time in rapid eye movement (REM) sleep. However, in children with DS, a population with reduced REM, learning was impaired, but only after the nap. This finding shows that a nap can increase memory loss in a subpopulation, highlighting that naps are not universally beneficial. Further, in healthy preschooler's naps, processes in REM sleep may benefit learning.
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37
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Faundez V, De Toma I, Bardoni B, Bartesaghi R, Nizetic D, de la Torre R, Cohen Kadosh R, Herault Y, Dierssen M, Potier MC. Translating molecular advances in Down syndrome and Fragile X syndrome into therapies. Eur Neuropsychopharmacol 2018; 28:675-690. [PMID: 29887288 DOI: 10.1016/j.euroneuro.2018.03.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 02/19/2018] [Accepted: 03/12/2018] [Indexed: 12/27/2022]
Abstract
Ongoing treatments for genetic developmental disorders of the central nervous system are mostly symptomatic and do not correct the genetic cause. Recent identification of common mechanisms between diseases has suggested that new therapeutic targets could be applied across intellectual disabilities with potential disease-modifying properties. The European Down syndrome and other genetic developmental disorders (DSG2D) network joined basic and clinical scientists to foster this research and carry out clinical trials. Here we discuss common mechanisms between several intellectual disabilities from genetic origin including Down's and Fragile X syndromes: i) how to model these complex diseases using neuronal cells and brain organoids derived from induced pluripotent stem cells; ii) how to integrate genomic, proteomic and interactome data to help defining common mechanisms and boundaries between diseases; iii) how to target common pathways for designing clinical trials and assessing their efficacy; iv) how to bring new neuro-therapies, such as noninvasive brain stimulations and cognitive training to clinical research. The basic and translational research efforts of the last years have utterly transformed our understanding of the molecular pathology of these diseases but much is left to be done to bring them to newborn babies and children to improve their quality of life.
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Affiliation(s)
- Victor Faundez
- Department of Cell Biology, Emory University, Atlanta, GA, USA
| | - Ilario De Toma
- Cellular and Systems Neurobiology, Center for Genomic Regulation, The Barcelona Institute of Science and Technology, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; Centro de Investigación Biomédica en Red CIBERER, Spain
| | - Barbara Bardoni
- Université Côte d'Azur, INSERM, CNRS, Institute of Molecular and Cellular Pharmacology, Valbonne, France
| | - Renata Bartesaghi
- University of Bologna, Department of Biomedical and Neuromotor Sciences, Bologna, Italy
| | - Dean Nizetic
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Barts and The London School of Medicine, Queen Mary University of London, United Kingdom
| | - Rafael de la Torre
- Integrated Pharmacology and Neurosciences Systems Research Group, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain; CIBEROBN, Madrid, Spain
| | - Roi Cohen Kadosh
- Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom
| | - Yann Herault
- Institut de Génétique et de Biologie Moléculaire et Cellulaire, Université de Strasbourg, Illkirch, France; Centre National de la Recherche Scientifique, UMR7104, Illkirch, France; Institut National de la Santé et de la Recherche Médicale, U964, Illkirch, France
| | - Mara Dierssen
- Cellular and Systems Neurobiology, Center for Genomic Regulation, The Barcelona Institute of Science and Technology, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; Centro de Investigación Biomédica en Red CIBERER, Spain.
| | - Marie-Claude Potier
- Institut du Cerveau et de la Moelle épinière, CNRS UMR7225, INSERM U1127, UPMC, Hôpital de la Pitié-Salpêtrière, 47 Bd de l'Hôpital, Paris, France.
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38
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Hart SJ, Visootsak J, Tamburri P, Phuong P, Baumer N, Hernandez MC, Skotko BG, Ochoa-Lubinoff C, Liogier D'Ardhuy X, Kishnani PS, Spiridigliozzi GA. Pharmacological interventions to improve cognition and adaptive functioning in Down syndrome: Strides to date. Am J Med Genet A 2017; 173:3029-3041. [PMID: 28884975 DOI: 10.1002/ajmg.a.38465] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 06/02/2017] [Accepted: 08/10/2017] [Indexed: 12/21/2022]
Abstract
Although an increasing number of clinical trials have been developed for cognition in Down syndrome, there has been limited success to date in identifying effective interventions. This review describes the progression from pre-clinical studies with mouse models to human clinical trials research using pharmacological interventions to improve cognition and adaptive functioning in Down syndrome. We also provide considerations for investigators when conducting human clinical trials and describe strategies for the pharmaceutical industry to advance the field in drug discovery for Down syndrome. Future research focusing on earlier pharmaceutical interventions, development of appropriate outcome measures, and greater collaboration between industry, academia, advocacy, and regulatory groups will be important for addressing limitations from prior studies and developing potential effective interventions for cognition in Down syndrome.
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Affiliation(s)
- Sarah J Hart
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
| | - Jeannie Visootsak
- F. Hoffmann-La Roche, Roche Pharma Research and Early Development, Neuroscience, Roche Innovation Center New York, New York, New York
| | - Paul Tamburri
- F. Hoffmann-La Roche, Roche Pharma Research and Early Development, Neuroscience, Roche Innovation Center New York, New York, New York
| | - Patrick Phuong
- F. Hoffmann-La Roche, Roche Pharma Research and Early Development, Neuroscience, Roche Innovation Center New York, New York, New York
| | - Nicole Baumer
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts.,Down Syndrome Program, Developmental Medicine Center, Boston Children's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Maria-Clemencia Hernandez
- F. Hoffmann-La Roche, Roche Pharma Research and Early Development, Neuroscience, Roche Innovation Center Basel, Basel, Switzerland
| | - Brian G Skotko
- Harvard Medical School, Boston, Massachusetts.,Down Syndrome Program, Division of Medical Genetics, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts
| | - Cesar Ochoa-Lubinoff
- Section of Developmental-Behavioral Pediatrics, Department of Pediatrics, Rush University Medical Center, Chicago, Illinois
| | - Xavier Liogier D'Ardhuy
- F. Hoffmann-La Roche, Roche Pharma Research and Early Development, Neuroscience, Roche Innovation Center Basel, Basel, Switzerland
| | - Priya S Kishnani
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
| | - Gail A Spiridigliozzi
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
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39
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Keeling LA, Spiridigliozzi GA, Hart SJ, Baker JA, Jones HN, Kishnani PS. Challenges in measuring the effects of pharmacological interventions on cognitive and adaptive functioning in individuals with Down syndrome: A systematic review. Am J Med Genet A 2017; 173:3058-3066. [PMID: 28857390 DOI: 10.1002/ajmg.a.38416] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 07/24/2017] [Accepted: 07/29/2017] [Indexed: 12/16/2022]
Abstract
We systematically reviewed the measures used in pharmaceutical trials in children/adults with Down syndrome without dementia. Our purpose was to identify developmentally appropriate outcome measures capable of detecting changes in cognitive and adaptive functioning in this population. Eleven studies were included and used diverse outcome measures across the domains of language, memory, attention, behavior, and executive/adaptive functioning. Our results highlight the challenges in selecting measures capable of capturing improvements in pharmaceutical trials in individuals with DS. We offer suggestions to enhance future research, including: conducting studies with larger samples of participants with a range of developmental abilities; modifying existing/developing novel outcome measures; incorporating advances from related areas and DS observational studies; and considering alternative analytic techniques to characterize treatment effects.
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Affiliation(s)
- Lori A Keeling
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
| | - Gail A Spiridigliozzi
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
| | - Sarah J Hart
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
| | - Jane A Baker
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
| | - Harrison N Jones
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Priya S Kishnani
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
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40
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Reid D, Moss J, Nelson L, Groves L, Oliver C. Executive functioning in Cornelia de Lange syndrome: domain asynchrony and age-related performance. J Neurodev Disord 2017; 9:29. [PMID: 28806899 PMCID: PMC5556702 DOI: 10.1186/s11689-017-9208-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 06/13/2017] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The aim of this study was to examine executive functioning in adolescents and adults with Cornelia de Lange syndrome (CdLS) to identify a syndrome and age-related profile of cognitive impairment. METHODS Participants were 24 individuals with CdLS aged 13-42 years (M = 22; SD = 8.98), and a comparable contrast group of 21 individuals with Down syndrome (DS) aged 15-33 years (M = 24; SD = 5.82). Measures were selected to test verbal and visual fluency, inhibition, perseverance/flexibility, and working memory and comprised both questionnaire and performance tests. RESULTS Individuals with CdLS showed significantly greater impairment on tasks requiring flexibility and inhibition (rule switch) and on forwards span capacity. These impairments were also reported in the parent/carer-rated questionnaire measures. Backwards Digit Span was significantly negatively correlated with chronological age in CdLS, indicating increased deficits with age. This was not identified in individuals with DS. CONCLUSIONS The relative deficits in executive functioning task performance are important in understanding the behavioural phenotype of CdLS. Prospective longitudinal follow-up is required to examine further the changes in executive functioning with age and if these map onto observed changes in behaviour in CdLS. Links with recent research indicating heightened responses to oxidative stress in CdLS may also be important.
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Affiliation(s)
- Donna Reid
- Cerebra Centre of Neurodevelopmental Disorders, University of Birmingham, Birmingham, UK
| | - Jo Moss
- Cerebra Centre of Neurodevelopmental Disorders, University of Birmingham, Birmingham, UK.
- Institute of Cognitive Neuroscience, University College London, London, UK.
| | - Lisa Nelson
- Cerebra Centre of Neurodevelopmental Disorders, University of Birmingham, Birmingham, UK
| | - Laura Groves
- Cerebra Centre of Neurodevelopmental Disorders, University of Birmingham, Birmingham, UK
| | - Chris Oliver
- Cerebra Centre of Neurodevelopmental Disorders, University of Birmingham, Birmingham, UK
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41
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Lee M, Bush L, Martin GE, Barstein J, Maltman N, Klusek J, Losh M. A Multi-Method Investigation of Pragmatic Development in Individuals With Down Syndrome. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2017; 122:289-309. [PMID: 28654411 PMCID: PMC5800500 DOI: 10.1352/1944-7558-122.4.289] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
This longitudinal study examined pragmatic language in boys and girls with Down syndrome (DS) at up to three time points, using parent report, standardized and direct assessments. We also explored relationships among theory of mind, executive function, nonverbal mental age, receptive and expressive vocabulary, grammatical complexity, and pragmatic competence. Controlling for cognitive and language abilities, children with DS demonstrated greater difficulty than younger typically developing controls on parent report and standardized assessments, but only girls with DS differed on direct assessments. Further, pragmatic skills of individuals with DS developed at a delayed rate relative to controls. Some sex-specific patterns of pragmatic impairments emerged. Theory of mind and executive function both correlated with pragmatic competence. Clinical and theoretical implications are discussed.
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Affiliation(s)
- Michelle Lee
- Michelle Lee and Lauren Bush, Northwestern University; Gary E. Martin, St. John's University; Jamie Barstein and Nell Maltman, Northwestern University; Jessica Klusek, University of South Carolina; and Molly Losh, Northwestern University
| | - Lauren Bush
- Michelle Lee and Lauren Bush, Northwestern University; Gary E. Martin, St. John's University; Jamie Barstein and Nell Maltman, Northwestern University; Jessica Klusek, University of South Carolina; and Molly Losh, Northwestern University
| | - Gary E Martin
- Michelle Lee and Lauren Bush, Northwestern University; Gary E. Martin, St. John's University; Jamie Barstein and Nell Maltman, Northwestern University; Jessica Klusek, University of South Carolina; and Molly Losh, Northwestern University
| | - Jamie Barstein
- Michelle Lee and Lauren Bush, Northwestern University; Gary E. Martin, St. John's University; Jamie Barstein and Nell Maltman, Northwestern University; Jessica Klusek, University of South Carolina; and Molly Losh, Northwestern University
| | - Nell Maltman
- Michelle Lee and Lauren Bush, Northwestern University; Gary E. Martin, St. John's University; Jamie Barstein and Nell Maltman, Northwestern University; Jessica Klusek, University of South Carolina; and Molly Losh, Northwestern University
| | - Jessica Klusek
- Michelle Lee and Lauren Bush, Northwestern University; Gary E. Martin, St. John's University; Jamie Barstein and Nell Maltman, Northwestern University; Jessica Klusek, University of South Carolina; and Molly Losh, Northwestern University
| | - Molly Losh
- Michelle Lee and Lauren Bush, Northwestern University; Gary E. Martin, St. John's University; Jamie Barstein and Nell Maltman, Northwestern University; Jessica Klusek, University of South Carolina; and Molly Losh, Northwestern University
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42
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Esbensen AJ, Hooper SR, Fidler D, Hartley SL, Edgin J, d'Ardhuy XL, Capone G, Conners FA, Mervis CB, Abbeduto L, Rafii M, Krinsky-McHale SJ, Urv T. Outcome Measures for Clinical Trials in Down Syndrome. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2017. [PMID: 28452584 DOI: 10.1352/1944-7558-122.2.247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Increasingly individuals with intellectual and developmental disabilities, including Down syndrome, are being targeted for clinical trials. However, a challenge exists in effectively evaluating the outcomes of these new pharmacological interventions. Few empirically evaluated, psychometrically sound outcome measures appropriate for use in clinical trials with individuals with Down syndrome have been identified. To address this challenge, the National Institutes of Health (NIH) assembled leading clinicians and scientists to review existing measures and identify those that currently are appropriate for trials; those that may be appropriate after expansion of age range addition of easier items, and/or downward extension of psychometric norms; and areas where new measures need to be developed. This article focuses on measures in the areas of cognition and behavior.
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Affiliation(s)
- Anna J Esbensen
- Anna J. Esbensen, Cincinnati Children's Hospital Medical Center; Stephen R. Hooper, University of North Carolina - Chapel Hill; Deborah Fidler, Colorado State University; Sigan L. Hartley, University of Wisconsin - Madison; Jamie Edgin, University of Arizona; Xavier Liogier d'Ardhuy, Roche Innovation Center Basel; George Capone, Kennedy Krieger Institute; Frances A. Conners, University of Alabama; Carolyn B. Mervis, University of Louisville; Leonard Abbeduto, MIND Institute, University of California, Davis School of Medicine; Michael Rafii, University of Southern California and University of California, San Diego; Sharon J. Krinsky-McHale, New York State Institute for Basic Research in Developmental Disabilities and Columbia University Medical Center; Tiina Urv, Eunice Kennedy Shriver National Institute of Child Health and Human Development; and Outcome Measures Working Group. Note: Outcome Measures Working Group Participants: Cognition Working Group-Leonard Abbeduto, Frances Conners, Jamie Edgin, Michael Harpold, Stephen Hooper, Sharon J. Krinsky-McHale, Nancy Raitano Lee, Xavier Liogier d'Ardhuy, Carolyn Mervis, Roger Reeves, Michael Ropacki, Paul Wang; Behavior Working Group-George Capone, Elisabeth Dykens, Anna Esbensen, Deborah Fidler, Sigan Hartley, Seth Keller, Michael Rafii, Sara Weir
| | - Stephen R Hooper
- Anna J. Esbensen, Cincinnati Children's Hospital Medical Center; Stephen R. Hooper, University of North Carolina - Chapel Hill; Deborah Fidler, Colorado State University; Sigan L. Hartley, University of Wisconsin - Madison; Jamie Edgin, University of Arizona; Xavier Liogier d'Ardhuy, Roche Innovation Center Basel; George Capone, Kennedy Krieger Institute; Frances A. Conners, University of Alabama; Carolyn B. Mervis, University of Louisville; Leonard Abbeduto, MIND Institute, University of California, Davis School of Medicine; Michael Rafii, University of Southern California and University of California, San Diego; Sharon J. Krinsky-McHale, New York State Institute for Basic Research in Developmental Disabilities and Columbia University Medical Center; Tiina Urv, Eunice Kennedy Shriver National Institute of Child Health and Human Development; and Outcome Measures Working Group. Note: Outcome Measures Working Group Participants: Cognition Working Group-Leonard Abbeduto, Frances Conners, Jamie Edgin, Michael Harpold, Stephen Hooper, Sharon J. Krinsky-McHale, Nancy Raitano Lee, Xavier Liogier d'Ardhuy, Carolyn Mervis, Roger Reeves, Michael Ropacki, Paul Wang; Behavior Working Group-George Capone, Elisabeth Dykens, Anna Esbensen, Deborah Fidler, Sigan Hartley, Seth Keller, Michael Rafii, Sara Weir
| | - Deborah Fidler
- Anna J. Esbensen, Cincinnati Children's Hospital Medical Center; Stephen R. Hooper, University of North Carolina - Chapel Hill; Deborah Fidler, Colorado State University; Sigan L. Hartley, University of Wisconsin - Madison; Jamie Edgin, University of Arizona; Xavier Liogier d'Ardhuy, Roche Innovation Center Basel; George Capone, Kennedy Krieger Institute; Frances A. Conners, University of Alabama; Carolyn B. Mervis, University of Louisville; Leonard Abbeduto, MIND Institute, University of California, Davis School of Medicine; Michael Rafii, University of Southern California and University of California, San Diego; Sharon J. Krinsky-McHale, New York State Institute for Basic Research in Developmental Disabilities and Columbia University Medical Center; Tiina Urv, Eunice Kennedy Shriver National Institute of Child Health and Human Development; and Outcome Measures Working Group. Note: Outcome Measures Working Group Participants: Cognition Working Group-Leonard Abbeduto, Frances Conners, Jamie Edgin, Michael Harpold, Stephen Hooper, Sharon J. Krinsky-McHale, Nancy Raitano Lee, Xavier Liogier d'Ardhuy, Carolyn Mervis, Roger Reeves, Michael Ropacki, Paul Wang; Behavior Working Group-George Capone, Elisabeth Dykens, Anna Esbensen, Deborah Fidler, Sigan Hartley, Seth Keller, Michael Rafii, Sara Weir
| | - Sigan L Hartley
- Anna J. Esbensen, Cincinnati Children's Hospital Medical Center; Stephen R. Hooper, University of North Carolina - Chapel Hill; Deborah Fidler, Colorado State University; Sigan L. Hartley, University of Wisconsin - Madison; Jamie Edgin, University of Arizona; Xavier Liogier d'Ardhuy, Roche Innovation Center Basel; George Capone, Kennedy Krieger Institute; Frances A. Conners, University of Alabama; Carolyn B. Mervis, University of Louisville; Leonard Abbeduto, MIND Institute, University of California, Davis School of Medicine; Michael Rafii, University of Southern California and University of California, San Diego; Sharon J. Krinsky-McHale, New York State Institute for Basic Research in Developmental Disabilities and Columbia University Medical Center; Tiina Urv, Eunice Kennedy Shriver National Institute of Child Health and Human Development; and Outcome Measures Working Group. Note: Outcome Measures Working Group Participants: Cognition Working Group-Leonard Abbeduto, Frances Conners, Jamie Edgin, Michael Harpold, Stephen Hooper, Sharon J. Krinsky-McHale, Nancy Raitano Lee, Xavier Liogier d'Ardhuy, Carolyn Mervis, Roger Reeves, Michael Ropacki, Paul Wang; Behavior Working Group-George Capone, Elisabeth Dykens, Anna Esbensen, Deborah Fidler, Sigan Hartley, Seth Keller, Michael Rafii, Sara Weir
| | - Jamie Edgin
- Anna J. Esbensen, Cincinnati Children's Hospital Medical Center; Stephen R. Hooper, University of North Carolina - Chapel Hill; Deborah Fidler, Colorado State University; Sigan L. Hartley, University of Wisconsin - Madison; Jamie Edgin, University of Arizona; Xavier Liogier d'Ardhuy, Roche Innovation Center Basel; George Capone, Kennedy Krieger Institute; Frances A. Conners, University of Alabama; Carolyn B. Mervis, University of Louisville; Leonard Abbeduto, MIND Institute, University of California, Davis School of Medicine; Michael Rafii, University of Southern California and University of California, San Diego; Sharon J. Krinsky-McHale, New York State Institute for Basic Research in Developmental Disabilities and Columbia University Medical Center; Tiina Urv, Eunice Kennedy Shriver National Institute of Child Health and Human Development; and Outcome Measures Working Group. Note: Outcome Measures Working Group Participants: Cognition Working Group-Leonard Abbeduto, Frances Conners, Jamie Edgin, Michael Harpold, Stephen Hooper, Sharon J. Krinsky-McHale, Nancy Raitano Lee, Xavier Liogier d'Ardhuy, Carolyn Mervis, Roger Reeves, Michael Ropacki, Paul Wang; Behavior Working Group-George Capone, Elisabeth Dykens, Anna Esbensen, Deborah Fidler, Sigan Hartley, Seth Keller, Michael Rafii, Sara Weir
| | - Xavier Liogier d'Ardhuy
- Anna J. Esbensen, Cincinnati Children's Hospital Medical Center; Stephen R. Hooper, University of North Carolina - Chapel Hill; Deborah Fidler, Colorado State University; Sigan L. Hartley, University of Wisconsin - Madison; Jamie Edgin, University of Arizona; Xavier Liogier d'Ardhuy, Roche Innovation Center Basel; George Capone, Kennedy Krieger Institute; Frances A. Conners, University of Alabama; Carolyn B. Mervis, University of Louisville; Leonard Abbeduto, MIND Institute, University of California, Davis School of Medicine; Michael Rafii, University of Southern California and University of California, San Diego; Sharon J. Krinsky-McHale, New York State Institute for Basic Research in Developmental Disabilities and Columbia University Medical Center; Tiina Urv, Eunice Kennedy Shriver National Institute of Child Health and Human Development; and Outcome Measures Working Group. Note: Outcome Measures Working Group Participants: Cognition Working Group-Leonard Abbeduto, Frances Conners, Jamie Edgin, Michael Harpold, Stephen Hooper, Sharon J. Krinsky-McHale, Nancy Raitano Lee, Xavier Liogier d'Ardhuy, Carolyn Mervis, Roger Reeves, Michael Ropacki, Paul Wang; Behavior Working Group-George Capone, Elisabeth Dykens, Anna Esbensen, Deborah Fidler, Sigan Hartley, Seth Keller, Michael Rafii, Sara Weir
| | - George Capone
- Anna J. Esbensen, Cincinnati Children's Hospital Medical Center; Stephen R. Hooper, University of North Carolina - Chapel Hill; Deborah Fidler, Colorado State University; Sigan L. Hartley, University of Wisconsin - Madison; Jamie Edgin, University of Arizona; Xavier Liogier d'Ardhuy, Roche Innovation Center Basel; George Capone, Kennedy Krieger Institute; Frances A. Conners, University of Alabama; Carolyn B. Mervis, University of Louisville; Leonard Abbeduto, MIND Institute, University of California, Davis School of Medicine; Michael Rafii, University of Southern California and University of California, San Diego; Sharon J. Krinsky-McHale, New York State Institute for Basic Research in Developmental Disabilities and Columbia University Medical Center; Tiina Urv, Eunice Kennedy Shriver National Institute of Child Health and Human Development; and Outcome Measures Working Group. Note: Outcome Measures Working Group Participants: Cognition Working Group-Leonard Abbeduto, Frances Conners, Jamie Edgin, Michael Harpold, Stephen Hooper, Sharon J. Krinsky-McHale, Nancy Raitano Lee, Xavier Liogier d'Ardhuy, Carolyn Mervis, Roger Reeves, Michael Ropacki, Paul Wang; Behavior Working Group-George Capone, Elisabeth Dykens, Anna Esbensen, Deborah Fidler, Sigan Hartley, Seth Keller, Michael Rafii, Sara Weir
| | - Frances A Conners
- Anna J. Esbensen, Cincinnati Children's Hospital Medical Center; Stephen R. Hooper, University of North Carolina - Chapel Hill; Deborah Fidler, Colorado State University; Sigan L. Hartley, University of Wisconsin - Madison; Jamie Edgin, University of Arizona; Xavier Liogier d'Ardhuy, Roche Innovation Center Basel; George Capone, Kennedy Krieger Institute; Frances A. Conners, University of Alabama; Carolyn B. Mervis, University of Louisville; Leonard Abbeduto, MIND Institute, University of California, Davis School of Medicine; Michael Rafii, University of Southern California and University of California, San Diego; Sharon J. Krinsky-McHale, New York State Institute for Basic Research in Developmental Disabilities and Columbia University Medical Center; Tiina Urv, Eunice Kennedy Shriver National Institute of Child Health and Human Development; and Outcome Measures Working Group. Note: Outcome Measures Working Group Participants: Cognition Working Group-Leonard Abbeduto, Frances Conners, Jamie Edgin, Michael Harpold, Stephen Hooper, Sharon J. Krinsky-McHale, Nancy Raitano Lee, Xavier Liogier d'Ardhuy, Carolyn Mervis, Roger Reeves, Michael Ropacki, Paul Wang; Behavior Working Group-George Capone, Elisabeth Dykens, Anna Esbensen, Deborah Fidler, Sigan Hartley, Seth Keller, Michael Rafii, Sara Weir
| | - Carolyn B Mervis
- Anna J. Esbensen, Cincinnati Children's Hospital Medical Center; Stephen R. Hooper, University of North Carolina - Chapel Hill; Deborah Fidler, Colorado State University; Sigan L. Hartley, University of Wisconsin - Madison; Jamie Edgin, University of Arizona; Xavier Liogier d'Ardhuy, Roche Innovation Center Basel; George Capone, Kennedy Krieger Institute; Frances A. Conners, University of Alabama; Carolyn B. Mervis, University of Louisville; Leonard Abbeduto, MIND Institute, University of California, Davis School of Medicine; Michael Rafii, University of Southern California and University of California, San Diego; Sharon J. Krinsky-McHale, New York State Institute for Basic Research in Developmental Disabilities and Columbia University Medical Center; Tiina Urv, Eunice Kennedy Shriver National Institute of Child Health and Human Development; and Outcome Measures Working Group. Note: Outcome Measures Working Group Participants: Cognition Working Group-Leonard Abbeduto, Frances Conners, Jamie Edgin, Michael Harpold, Stephen Hooper, Sharon J. Krinsky-McHale, Nancy Raitano Lee, Xavier Liogier d'Ardhuy, Carolyn Mervis, Roger Reeves, Michael Ropacki, Paul Wang; Behavior Working Group-George Capone, Elisabeth Dykens, Anna Esbensen, Deborah Fidler, Sigan Hartley, Seth Keller, Michael Rafii, Sara Weir
| | - Leonard Abbeduto
- Anna J. Esbensen, Cincinnati Children's Hospital Medical Center; Stephen R. Hooper, University of North Carolina - Chapel Hill; Deborah Fidler, Colorado State University; Sigan L. Hartley, University of Wisconsin - Madison; Jamie Edgin, University of Arizona; Xavier Liogier d'Ardhuy, Roche Innovation Center Basel; George Capone, Kennedy Krieger Institute; Frances A. Conners, University of Alabama; Carolyn B. Mervis, University of Louisville; Leonard Abbeduto, MIND Institute, University of California, Davis School of Medicine; Michael Rafii, University of Southern California and University of California, San Diego; Sharon J. Krinsky-McHale, New York State Institute for Basic Research in Developmental Disabilities and Columbia University Medical Center; Tiina Urv, Eunice Kennedy Shriver National Institute of Child Health and Human Development; and Outcome Measures Working Group. Note: Outcome Measures Working Group Participants: Cognition Working Group-Leonard Abbeduto, Frances Conners, Jamie Edgin, Michael Harpold, Stephen Hooper, Sharon J. Krinsky-McHale, Nancy Raitano Lee, Xavier Liogier d'Ardhuy, Carolyn Mervis, Roger Reeves, Michael Ropacki, Paul Wang; Behavior Working Group-George Capone, Elisabeth Dykens, Anna Esbensen, Deborah Fidler, Sigan Hartley, Seth Keller, Michael Rafii, Sara Weir
| | - Michael Rafii
- Anna J. Esbensen, Cincinnati Children's Hospital Medical Center; Stephen R. Hooper, University of North Carolina - Chapel Hill; Deborah Fidler, Colorado State University; Sigan L. Hartley, University of Wisconsin - Madison; Jamie Edgin, University of Arizona; Xavier Liogier d'Ardhuy, Roche Innovation Center Basel; George Capone, Kennedy Krieger Institute; Frances A. Conners, University of Alabama; Carolyn B. Mervis, University of Louisville; Leonard Abbeduto, MIND Institute, University of California, Davis School of Medicine; Michael Rafii, University of Southern California and University of California, San Diego; Sharon J. Krinsky-McHale, New York State Institute for Basic Research in Developmental Disabilities and Columbia University Medical Center; Tiina Urv, Eunice Kennedy Shriver National Institute of Child Health and Human Development; and Outcome Measures Working Group. Note: Outcome Measures Working Group Participants: Cognition Working Group-Leonard Abbeduto, Frances Conners, Jamie Edgin, Michael Harpold, Stephen Hooper, Sharon J. Krinsky-McHale, Nancy Raitano Lee, Xavier Liogier d'Ardhuy, Carolyn Mervis, Roger Reeves, Michael Ropacki, Paul Wang; Behavior Working Group-George Capone, Elisabeth Dykens, Anna Esbensen, Deborah Fidler, Sigan Hartley, Seth Keller, Michael Rafii, Sara Weir
| | - Sharon J Krinsky-McHale
- Anna J. Esbensen, Cincinnati Children's Hospital Medical Center; Stephen R. Hooper, University of North Carolina - Chapel Hill; Deborah Fidler, Colorado State University; Sigan L. Hartley, University of Wisconsin - Madison; Jamie Edgin, University of Arizona; Xavier Liogier d'Ardhuy, Roche Innovation Center Basel; George Capone, Kennedy Krieger Institute; Frances A. Conners, University of Alabama; Carolyn B. Mervis, University of Louisville; Leonard Abbeduto, MIND Institute, University of California, Davis School of Medicine; Michael Rafii, University of Southern California and University of California, San Diego; Sharon J. Krinsky-McHale, New York State Institute for Basic Research in Developmental Disabilities and Columbia University Medical Center; Tiina Urv, Eunice Kennedy Shriver National Institute of Child Health and Human Development; and Outcome Measures Working Group. Note: Outcome Measures Working Group Participants: Cognition Working Group-Leonard Abbeduto, Frances Conners, Jamie Edgin, Michael Harpold, Stephen Hooper, Sharon J. Krinsky-McHale, Nancy Raitano Lee, Xavier Liogier d'Ardhuy, Carolyn Mervis, Roger Reeves, Michael Ropacki, Paul Wang; Behavior Working Group-George Capone, Elisabeth Dykens, Anna Esbensen, Deborah Fidler, Sigan Hartley, Seth Keller, Michael Rafii, Sara Weir
| | - Tiina Urv
- Anna J. Esbensen, Cincinnati Children's Hospital Medical Center; Stephen R. Hooper, University of North Carolina - Chapel Hill; Deborah Fidler, Colorado State University; Sigan L. Hartley, University of Wisconsin - Madison; Jamie Edgin, University of Arizona; Xavier Liogier d'Ardhuy, Roche Innovation Center Basel; George Capone, Kennedy Krieger Institute; Frances A. Conners, University of Alabama; Carolyn B. Mervis, University of Louisville; Leonard Abbeduto, MIND Institute, University of California, Davis School of Medicine; Michael Rafii, University of Southern California and University of California, San Diego; Sharon J. Krinsky-McHale, New York State Institute for Basic Research in Developmental Disabilities and Columbia University Medical Center; Tiina Urv, Eunice Kennedy Shriver National Institute of Child Health and Human Development; and Outcome Measures Working Group. Note: Outcome Measures Working Group Participants: Cognition Working Group-Leonard Abbeduto, Frances Conners, Jamie Edgin, Michael Harpold, Stephen Hooper, Sharon J. Krinsky-McHale, Nancy Raitano Lee, Xavier Liogier d'Ardhuy, Carolyn Mervis, Roger Reeves, Michael Ropacki, Paul Wang; Behavior Working Group-George Capone, Elisabeth Dykens, Anna Esbensen, Deborah Fidler, Sigan Hartley, Seth Keller, Michael Rafii, Sara Weir
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Edgin JO, Anand P, Rosser T, Pierpont EI, Figueroa C, Hamilton D, Huddleston L, Mason G, Spanò G, Toole L, Nguyen-Driver M, Capone G, Abbeduto L, Maslen C, Reeves RH, Sherman S. The Arizona Cognitive Test Battery for Down Syndrome: Test-Retest Reliability and Practice Effects. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2017; 122:215-234. [PMID: 28452581 PMCID: PMC6215707 DOI: 10.1352/1944-7558-122.3.215] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
A multisite study investigated the test-retest reliability and practice effects of a battery of assessments to measure neurocognitive function in individuals with Down syndrome (DS). The study aimed to establish the appropriateness of these measures as potential endpoints for clinical trials. Neurocognitive tasks and parent report measures comprising the Arizona Cognitive Test Battery (ACTB) were administered to 54 young participants with DS (7-20 years of age) with mild to moderate levels of intellectual disability in an initial baseline evaluation and a follow-up assessment 3 months later. Although revisions to ACTB measures are indicated, results demonstrate adequate levels of reliability and resistance to practice effects for some measures. The ACTB offers viable options for repeated testing of memory, motor planning, behavioral regulation, and attention. Alternative measures of executive functioning are required.
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Affiliation(s)
- Jamie O Edgin
- Jamie O. Edgin and Payal Anand, University of Arizona; Tracie Rosser, Emory University; Elizabeth I. Pierpont, University of Wisconsin-Madison and University of Minnesota; Carlos Figueroa, University of Arizona; Debra Hamilton and Lillie Huddleston, Georgia State University; Gina Mason, Cornell University; Goffredina Spanò, University of Arizona; Lisa Toole, Johns Hopkins University; Mina Nguyen-Driver, Oregon Health Sciences University; George Capone, Johns Hopkins University; Leonard Abbeduto, University of Wisconsin-Madison and University of California, Davis; Cheryl Maslen, Oregon Health Sciences University; Roger H. Reeves, Johns Hopkins University; and Stephanie Sherman, Emory University
| | - Payal Anand
- Jamie O. Edgin and Payal Anand, University of Arizona; Tracie Rosser, Emory University; Elizabeth I. Pierpont, University of Wisconsin-Madison and University of Minnesota; Carlos Figueroa, University of Arizona; Debra Hamilton and Lillie Huddleston, Georgia State University; Gina Mason, Cornell University; Goffredina Spanò, University of Arizona; Lisa Toole, Johns Hopkins University; Mina Nguyen-Driver, Oregon Health Sciences University; George Capone, Johns Hopkins University; Leonard Abbeduto, University of Wisconsin-Madison and University of California, Davis; Cheryl Maslen, Oregon Health Sciences University; Roger H. Reeves, Johns Hopkins University; and Stephanie Sherman, Emory University
| | - Tracie Rosser
- Jamie O. Edgin and Payal Anand, University of Arizona; Tracie Rosser, Emory University; Elizabeth I. Pierpont, University of Wisconsin-Madison and University of Minnesota; Carlos Figueroa, University of Arizona; Debra Hamilton and Lillie Huddleston, Georgia State University; Gina Mason, Cornell University; Goffredina Spanò, University of Arizona; Lisa Toole, Johns Hopkins University; Mina Nguyen-Driver, Oregon Health Sciences University; George Capone, Johns Hopkins University; Leonard Abbeduto, University of Wisconsin-Madison and University of California, Davis; Cheryl Maslen, Oregon Health Sciences University; Roger H. Reeves, Johns Hopkins University; and Stephanie Sherman, Emory University
| | - Elizabeth I Pierpont
- Jamie O. Edgin and Payal Anand, University of Arizona; Tracie Rosser, Emory University; Elizabeth I. Pierpont, University of Wisconsin-Madison and University of Minnesota; Carlos Figueroa, University of Arizona; Debra Hamilton and Lillie Huddleston, Georgia State University; Gina Mason, Cornell University; Goffredina Spanò, University of Arizona; Lisa Toole, Johns Hopkins University; Mina Nguyen-Driver, Oregon Health Sciences University; George Capone, Johns Hopkins University; Leonard Abbeduto, University of Wisconsin-Madison and University of California, Davis; Cheryl Maslen, Oregon Health Sciences University; Roger H. Reeves, Johns Hopkins University; and Stephanie Sherman, Emory University
| | - Carlos Figueroa
- Jamie O. Edgin and Payal Anand, University of Arizona; Tracie Rosser, Emory University; Elizabeth I. Pierpont, University of Wisconsin-Madison and University of Minnesota; Carlos Figueroa, University of Arizona; Debra Hamilton and Lillie Huddleston, Georgia State University; Gina Mason, Cornell University; Goffredina Spanò, University of Arizona; Lisa Toole, Johns Hopkins University; Mina Nguyen-Driver, Oregon Health Sciences University; George Capone, Johns Hopkins University; Leonard Abbeduto, University of Wisconsin-Madison and University of California, Davis; Cheryl Maslen, Oregon Health Sciences University; Roger H. Reeves, Johns Hopkins University; and Stephanie Sherman, Emory University
| | - Debra Hamilton
- Jamie O. Edgin and Payal Anand, University of Arizona; Tracie Rosser, Emory University; Elizabeth I. Pierpont, University of Wisconsin-Madison and University of Minnesota; Carlos Figueroa, University of Arizona; Debra Hamilton and Lillie Huddleston, Georgia State University; Gina Mason, Cornell University; Goffredina Spanò, University of Arizona; Lisa Toole, Johns Hopkins University; Mina Nguyen-Driver, Oregon Health Sciences University; George Capone, Johns Hopkins University; Leonard Abbeduto, University of Wisconsin-Madison and University of California, Davis; Cheryl Maslen, Oregon Health Sciences University; Roger H. Reeves, Johns Hopkins University; and Stephanie Sherman, Emory University
| | - Lillie Huddleston
- Jamie O. Edgin and Payal Anand, University of Arizona; Tracie Rosser, Emory University; Elizabeth I. Pierpont, University of Wisconsin-Madison and University of Minnesota; Carlos Figueroa, University of Arizona; Debra Hamilton and Lillie Huddleston, Georgia State University; Gina Mason, Cornell University; Goffredina Spanò, University of Arizona; Lisa Toole, Johns Hopkins University; Mina Nguyen-Driver, Oregon Health Sciences University; George Capone, Johns Hopkins University; Leonard Abbeduto, University of Wisconsin-Madison and University of California, Davis; Cheryl Maslen, Oregon Health Sciences University; Roger H. Reeves, Johns Hopkins University; and Stephanie Sherman, Emory University
| | - Gina Mason
- Jamie O. Edgin and Payal Anand, University of Arizona; Tracie Rosser, Emory University; Elizabeth I. Pierpont, University of Wisconsin-Madison and University of Minnesota; Carlos Figueroa, University of Arizona; Debra Hamilton and Lillie Huddleston, Georgia State University; Gina Mason, Cornell University; Goffredina Spanò, University of Arizona; Lisa Toole, Johns Hopkins University; Mina Nguyen-Driver, Oregon Health Sciences University; George Capone, Johns Hopkins University; Leonard Abbeduto, University of Wisconsin-Madison and University of California, Davis; Cheryl Maslen, Oregon Health Sciences University; Roger H. Reeves, Johns Hopkins University; and Stephanie Sherman, Emory University
| | - Goffredina Spanò
- Jamie O. Edgin and Payal Anand, University of Arizona; Tracie Rosser, Emory University; Elizabeth I. Pierpont, University of Wisconsin-Madison and University of Minnesota; Carlos Figueroa, University of Arizona; Debra Hamilton and Lillie Huddleston, Georgia State University; Gina Mason, Cornell University; Goffredina Spanò, University of Arizona; Lisa Toole, Johns Hopkins University; Mina Nguyen-Driver, Oregon Health Sciences University; George Capone, Johns Hopkins University; Leonard Abbeduto, University of Wisconsin-Madison and University of California, Davis; Cheryl Maslen, Oregon Health Sciences University; Roger H. Reeves, Johns Hopkins University; and Stephanie Sherman, Emory University
| | - Lisa Toole
- Jamie O. Edgin and Payal Anand, University of Arizona; Tracie Rosser, Emory University; Elizabeth I. Pierpont, University of Wisconsin-Madison and University of Minnesota; Carlos Figueroa, University of Arizona; Debra Hamilton and Lillie Huddleston, Georgia State University; Gina Mason, Cornell University; Goffredina Spanò, University of Arizona; Lisa Toole, Johns Hopkins University; Mina Nguyen-Driver, Oregon Health Sciences University; George Capone, Johns Hopkins University; Leonard Abbeduto, University of Wisconsin-Madison and University of California, Davis; Cheryl Maslen, Oregon Health Sciences University; Roger H. Reeves, Johns Hopkins University; and Stephanie Sherman, Emory University
| | - Mina Nguyen-Driver
- Jamie O. Edgin and Payal Anand, University of Arizona; Tracie Rosser, Emory University; Elizabeth I. Pierpont, University of Wisconsin-Madison and University of Minnesota; Carlos Figueroa, University of Arizona; Debra Hamilton and Lillie Huddleston, Georgia State University; Gina Mason, Cornell University; Goffredina Spanò, University of Arizona; Lisa Toole, Johns Hopkins University; Mina Nguyen-Driver, Oregon Health Sciences University; George Capone, Johns Hopkins University; Leonard Abbeduto, University of Wisconsin-Madison and University of California, Davis; Cheryl Maslen, Oregon Health Sciences University; Roger H. Reeves, Johns Hopkins University; and Stephanie Sherman, Emory University
| | - George Capone
- Jamie O. Edgin and Payal Anand, University of Arizona; Tracie Rosser, Emory University; Elizabeth I. Pierpont, University of Wisconsin-Madison and University of Minnesota; Carlos Figueroa, University of Arizona; Debra Hamilton and Lillie Huddleston, Georgia State University; Gina Mason, Cornell University; Goffredina Spanò, University of Arizona; Lisa Toole, Johns Hopkins University; Mina Nguyen-Driver, Oregon Health Sciences University; George Capone, Johns Hopkins University; Leonard Abbeduto, University of Wisconsin-Madison and University of California, Davis; Cheryl Maslen, Oregon Health Sciences University; Roger H. Reeves, Johns Hopkins University; and Stephanie Sherman, Emory University
| | - Leonard Abbeduto
- Jamie O. Edgin and Payal Anand, University of Arizona; Tracie Rosser, Emory University; Elizabeth I. Pierpont, University of Wisconsin-Madison and University of Minnesota; Carlos Figueroa, University of Arizona; Debra Hamilton and Lillie Huddleston, Georgia State University; Gina Mason, Cornell University; Goffredina Spanò, University of Arizona; Lisa Toole, Johns Hopkins University; Mina Nguyen-Driver, Oregon Health Sciences University; George Capone, Johns Hopkins University; Leonard Abbeduto, University of Wisconsin-Madison and University of California, Davis; Cheryl Maslen, Oregon Health Sciences University; Roger H. Reeves, Johns Hopkins University; and Stephanie Sherman, Emory University
| | - Cheryl Maslen
- Jamie O. Edgin and Payal Anand, University of Arizona; Tracie Rosser, Emory University; Elizabeth I. Pierpont, University of Wisconsin-Madison and University of Minnesota; Carlos Figueroa, University of Arizona; Debra Hamilton and Lillie Huddleston, Georgia State University; Gina Mason, Cornell University; Goffredina Spanò, University of Arizona; Lisa Toole, Johns Hopkins University; Mina Nguyen-Driver, Oregon Health Sciences University; George Capone, Johns Hopkins University; Leonard Abbeduto, University of Wisconsin-Madison and University of California, Davis; Cheryl Maslen, Oregon Health Sciences University; Roger H. Reeves, Johns Hopkins University; and Stephanie Sherman, Emory University
| | - Roger H Reeves
- Jamie O. Edgin and Payal Anand, University of Arizona; Tracie Rosser, Emory University; Elizabeth I. Pierpont, University of Wisconsin-Madison and University of Minnesota; Carlos Figueroa, University of Arizona; Debra Hamilton and Lillie Huddleston, Georgia State University; Gina Mason, Cornell University; Goffredina Spanò, University of Arizona; Lisa Toole, Johns Hopkins University; Mina Nguyen-Driver, Oregon Health Sciences University; George Capone, Johns Hopkins University; Leonard Abbeduto, University of Wisconsin-Madison and University of California, Davis; Cheryl Maslen, Oregon Health Sciences University; Roger H. Reeves, Johns Hopkins University; and Stephanie Sherman, Emory University
| | - Stephanie Sherman
- Jamie O. Edgin and Payal Anand, University of Arizona; Tracie Rosser, Emory University; Elizabeth I. Pierpont, University of Wisconsin-Madison and University of Minnesota; Carlos Figueroa, University of Arizona; Debra Hamilton and Lillie Huddleston, Georgia State University; Gina Mason, Cornell University; Goffredina Spanò, University of Arizona; Lisa Toole, Johns Hopkins University; Mina Nguyen-Driver, Oregon Health Sciences University; George Capone, Johns Hopkins University; Leonard Abbeduto, University of Wisconsin-Madison and University of California, Davis; Cheryl Maslen, Oregon Health Sciences University; Roger H. Reeves, Johns Hopkins University; and Stephanie Sherman, Emory University
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Esbensen AJ, Hooper SR, Fidler D, Hartley S, Edgin J, d’Ardhuy XL, Capone G, Conners F, Mervis CB, Abbeduto L, Rafii M, Krinsky-McHale SJ, Urv T. Outcome Measures for Clinical Trials in Down Syndrome. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2017; 122:247-281. [PMID: 28452584 PMCID: PMC5424621 DOI: 10.1352/1944-7558-122.3.247] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Increasingly individuals with intellectual and developmental disabilities, including Down syndrome, are being targeted for clinical trials. However, a challenge exists in effectively evaluating the outcomes of these new pharmacological interventions. Few empirically evaluated, psychometrically sound outcome measures appropriate for use in clinical trials with individuals with Down syndrome have been identified. To address this challenge, the National Institutes of Health (NIH) assembled leading clinicians and scientists to review existing measures and identify those that currently are appropriate for trials; those that may be appropriate after expansion of age range addition of easier items, and/or downward extension of psychometric norms; and areas where new measures need to be developed. This article focuses on measures in the areas of cognition and behavior.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Leonard Abbeduto
- MIND Institute, University of California, Davis School of Medicine
| | | | | | - Tiina Urv
- Eunice Kennedy Shriver National Institute of Child Health and Human Development
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Startin CM, Hamburg S, Hithersay R, Davies A, Rodger E, Aggarwal N, Al-Janabi T, Strydom A. The LonDownS adult cognitive assessment to study cognitive abilities and decline in Down syndrome. Wellcome Open Res 2016; 1:11. [PMID: 28018980 PMCID: PMC5176078 DOI: 10.12688/wellcomeopenres.9961.1] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Background: Down syndrome (DS), the most common genetic cause of intellectual disability, is associated with an ultra-high risk of developing Alzheimer’s disease. However, there is individual variability in the onset of clinical dementia and in baseline cognitive abilities prior to decline, particularly in memory, executive functioning, and motor coordination. The LonDownS Consortium aims to determine risk and protective factors for the development of dementia and factors relating to cognitive abilities in people with DS. Here we describe our cognitive test battery and related informant measures along with reporting data from our baseline cognitive and informant assessments. Methods: We developed a cognitive test battery to assess general abilities, memory, executive function, and motor coordination abilities in adults with DS, with informant ratings of similar domains also collected, designed to allow for data on a broad range of participants. Participants (n=305) had a range of ages and abilities, and included adults with and without a clinical diagnosis of dementia. Results: Results suggest the battery is suitable for the majority of adults with DS, although approximately half the adults with dementia were unable to undertake any cognitive task. Many test outcomes showed a range of scores with low floor and ceiling effects. Non-verbal age-adjusted IQ scores had lower floor effects than verbal IQ scores. Before the onset of any cognitive decline, females aged 16-35 showed better verbal abilities compared to males. We also identified clusters of cognitive test scores within our battery related to visuospatial memory, motor coordination, language abilities, and processing speed / sustained attention. Conclusions: Our further studies will use baseline and longitudinal assessments to explore factors influencing cognitive abilities and cognitive decline related to ageing and onset of dementia in adults with DS.
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Affiliation(s)
- Carla M Startin
- UCL Division of Psychiatry, University College London, London, UK.,The LonDownS Consortium, University College London, London, UK
| | - Sarah Hamburg
- UCL Division of Psychiatry, University College London, London, UK.,The LonDownS Consortium, University College London, London, UK
| | - Rosalyn Hithersay
- UCL Division of Psychiatry, University College London, London, UK.,The LonDownS Consortium, University College London, London, UK
| | - Amy Davies
- UCL Division of Psychiatry, University College London, London, UK.,Faculty of Health and Medical Sciences, University of Surrey, Guilford, UK
| | - Erin Rodger
- UCL Division of Psychiatry, University College London, London, UK
| | - Nidhi Aggarwal
- UCL Division of Psychiatry, University College London, London, UK
| | - Tamara Al-Janabi
- UCL Division of Psychiatry, University College London, London, UK.,The LonDownS Consortium, University College London, London, UK
| | - André Strydom
- UCL Division of Psychiatry, University College London, London, UK.,The LonDownS Consortium, University College London, London, UK
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46
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The Emerging Roles of the Calcineurin-Nuclear Factor of Activated T-Lymphocytes Pathway in Nervous System Functions and Diseases. J Aging Res 2016; 2016:5081021. [PMID: 27597899 PMCID: PMC5002468 DOI: 10.1155/2016/5081021] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 07/21/2016] [Indexed: 12/27/2022] Open
Abstract
The ongoing epidemics of metabolic diseases and increase in the older population have increased the incidences of neurodegenerative diseases. Evidence from murine and cell line models has implicated calcineurin-nuclear factor of activated T-lymphocytes (NFAT) signaling pathway, a Ca2+/calmodulin-dependent major proinflammatory pathway, in the pathogenesis of these diseases. Neurotoxins such as amyloid-β, tau protein, and α-synuclein trigger abnormal calcineurin/NFAT signaling activities. Additionally increased activities of endogenous regulators of calcineurin like plasma membrane Ca2+-ATPase (PMCA) and regulator of calcineurin 1 (RCAN1) also cause neuronal and glial loss and related functional alterations, in neurodegenerative diseases, psychotic disorders, epilepsy, and traumatic brain and spinal cord injuries. Treatment with calcineurin/NFAT inhibitors induces some degree of neuroprotection and decreased reactive gliosis in the central and peripheral nervous system. In this paper, we summarize and discuss the current understanding of the roles of calcineurin/NFAT signaling in physiology and pathologies of the adult and developing nervous system, with an emphasis on recent reports and cutting-edge findings. Calcineurin/NFAT signaling is known for its critical roles in the developing and adult nervous system. Its role in physiological and pathological processes is still controversial. However, available data suggest that its beneficial and detrimental effects are context-dependent. In view of recent reports calcineurin/NFAT signaling is likely to serve as a potential therapeutic target for neurodegenerative diseases and conditions. This review further highlights the need to characterize better all factors determining the outcome of calcineurin/NFAT signaling in diseases and the downstream targets mediating the beneficial and detrimental effects.
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Abstract
Down syndrome (DS), often due to trisomy 21, is the most common genetic cause of intellectual disability (ID). In addition, virtually all individuals with DS develop the neuropathology of Alzheimer's disease (AD) by the age of 40 years and almost 60 % will manifest symptoms of AD dementia by the age of 65 years. Currently, there are no pharmacological treatments available for ID in individuals with DS and only limited symptomatic treatments for AD dementia. Advances in our understanding in both the molecular basis of ID and the pathogenesis of AD have created opportunities to study potential therapeutic targets. Recent studies in animal models of DS continue to provide a rational basis for translating specific compounds into human clinical trials. However, target and compound selection are only initial steps in the drug development pathway. Other necessary considerations include appropriate study designs to assess efficacy in the DS population, as well as operational aspects specifically tailored to assess cognition in this population. We discuss recent progress in the development of compounds for both ID and AD in individuals with DS, as well as concepts for the design and conduct of clinical trials with such compounds.
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Affiliation(s)
- Michael S Rafii
- Department of Neurosciences, University of California, San Diego, 9500 Gilman Drive #0949, La Jolla, CA, 92093-0949, USA. .,Department of Neurology, Alzheimer's Therapeutic Research Institute, University of Southern California, San Diego, CA, USA.
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48
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Assessing Specific Cognitive Deficits Associated with Dementia in Older Adults with Down Syndrome: Use and Validity of the Arizona Cognitive Test Battery (ACTB). PLoS One 2016; 11:e0153917. [PMID: 27171413 PMCID: PMC4865091 DOI: 10.1371/journal.pone.0153917] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 04/06/2016] [Indexed: 01/24/2023] Open
Abstract
Background Down syndrome is associated with specific cognitive deficits. Alongside this, older adults with Down syndrome are a high risk group for dementia. The Arizona Cognitive Test Battery (ACTB), a cognitive assessment battery specifically developed for use with individuals with Down syndrome, has been proposed for use as outcome measures for clinical trials in this population. It has not been validated in older adults with Down syndrome. This study aims to assess the use and validity of the ACTB in older adults with Down syndrome. Methods Participants with Down syndrome aged 45 and over were assessed using the ACTB, standard tabletop tests and informant ratings. Results Assessment outcomes of 49 participants were analysed. Of these, 19 (39%) had a diagnosis of dementia or possible dementia. Most participants were able to attempt most of the tasks, although some tasks had high floor effects (including CANTAB Intra-Extra Dimensional shift stages completed and Modified Dots Task). Of the ACTB tasks, statistically significant differences were observed between the dementia and no dementia groups on CANTAB Simple Reaction Time median latency, NEPSY Visuomotor Precision—Car and Motorbike and CANTAB Paired Associates Learning stages completed. No significant differences were observed for CANTAB Intra-Extra Dimensional Shift, Modified Dots Task, Finger Sequencing, NEPSY Visuomotor precision—Train and Car and CANTAB Paired Associates Learning first trial memory score. Several of the tasks in the ACTB can be used in older adults with Down syndrome and have mild to moderate concurrent validity when compared to tabletop tests and informant ratings, although this varies on a test by test basis. Conclusions Overall, scores for a number of tests in the ACTB were similar when comparing dementia and no dementia groups of older adults with Down syndrome, suggesting that it would not be an appropriate outcome measure of cognitive function for clinical trials of dementia treatments without further modification and validation.
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Startin CM, Rodger E, Fodor-Wynne L, Hamburg S, Strydom A. Developing an Informant Questionnaire for Cognitive Abilities in Down Syndrome: The Cognitive Scale for Down Syndrome (CS-DS). PLoS One 2016; 11:e0154596. [PMID: 27153191 PMCID: PMC4859552 DOI: 10.1371/journal.pone.0154596] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 04/17/2016] [Indexed: 11/18/2022] Open
Abstract
Down syndrome (DS) is the most common genetic cause of intellectual disability (ID). Abilities relating to executive function, memory and language are particularly affected in DS, although there is a large variability across individuals. People with DS also show an increased risk of developing dementia. While assessment batteries have been developed for adults with DS to assess cognitive abilities, these batteries may not be suitable for those with more severe IDs, dementia, or visual / hearing difficulties. Here we report the development of an informant rated questionnaire, the Cognitive Scale for Down Syndrome (CS-DS), which focuses on everyday abilities relating to executive function, memory and language, and is suitable for assessing these abilities in all adults with DS regardless of cognitive ability. Complete questionnaires were collected about 128 individuals with DS. After final question selection we found high internal consistency scores across the total questionnaire and within the executive function, memory and language domains. CS-DS scores showed a wide range, with minimal floor and ceiling effects. We found high interrater (n = 55) and test retest (n = 36) intraclass correlations. CS-DS scores were significantly lower in those aged 41+ with significant cognitive decline compared to those without decline. Across all adults without cognitive decline, CS-DS scores correlated significantly to measures of general abilities. Exploratory factor analysis suggested five factors within the scale, relating to memory, self-regulation / inhibition, self-direction / initiation, communication, and focussing attention. The CS-DS therefore shows good interrater and test retest reliability, and appears to be a valid and suitable informant rating tool for assessing everyday cognitive abilities in a wide range of individuals with DS. Such a questionnaire may be a useful outcome measure for intervention studies to assess improvements to cognition, in addition to detecting dementia-related cognitive decline. The CS-DS may also be a useful tool for other populations with ID.
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Affiliation(s)
- Carla M. Startin
- UCL Division of Psychiatry, University College London, London, United Kingdom
- The LonDownS Consortium
- * E-mail:
| | - Erin Rodger
- UCL Division of Psychiatry, University College London, London, United Kingdom
- The LonDownS Consortium
| | - Lucy Fodor-Wynne
- UCL Division of Psychiatry, University College London, London, United Kingdom
- The LonDownS Consortium
| | - Sarah Hamburg
- UCL Division of Psychiatry, University College London, London, United Kingdom
- The LonDownS Consortium
| | - André Strydom
- UCL Division of Psychiatry, University College London, London, United Kingdom
- The LonDownS Consortium
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