Developmental trajectories of spatial-sequential and spatial-simultaneous working memory in Down syndrome

BACKGROUND

Working memory (WM) is generally considered an area of weakness in the cognitive profile associated with Down syndrome (DS). The great majority of studies explored WM in this population through a comparison with typical development (TD) on the basis of mental age or developmental level. However, it is also relevant to understand how these skills develop and whether such development could be more related to chronological or developmental level. In the present study, we explored cross-sectional developmental trajectories of spatial-sequential and spatial-simultaneous WM in individuals with DS across chronological age and developmental level. Typically developing children (TD) of similar mental age were also included as a comparison group.

METHODS

Eighty-four individuals with DS (aged between 7 and 30 years) and 327 children with TD (aged between 4 and 8 years) were administered with tasks to assess spatial-sequential and spatial-simultaneous WM, together with tasks to assess both general verbal and spatial developmental levels.

RESULTS AND CONCLUSION

Performance in spatial-simultaneous WM task was lower compared with spatial-sequential WM task in both groups. In the case of individuals with DS, the developmental trajectories of chronological age are better described through a segmented model showing increased performance until approximately 13 years of age, followed by a rather flat progress. In the case of TD children, developmental trajectories are better described through a linear model in the spatial-simultaneous WM task when chronological age is considered; in the spatial-sequential WM, the increase in performance with age was however characterised by a discontinuity at age 6. The increase in performance followed a linear pattern in both groups (DS and TD) without substantial differences between the types of measure used (verbal vs. spatial) when the developmental level is considered.

Involvement of complement pathways in patients with bacterial septicemia

The complement system is a major humoral portion of the innate immune system, playing a significant role in host defence against microorganisms. The biological importance of this system is underlined by the fact that at least three different pathways for its activation exist, the classical, the MBL and the alternative pathway. To elucidate the involvement of the classical and/or the MBL pathway during bacterial septicemia, 32 patients with gram-positive and 30 patients with gram-negative bacterial infections were investigated. In patients with gram-positive bacteria, a significant consumption of C1q (p=0.005) but not of mannose-binding lectin (MBL) (p=0.2) was found during the acute phase of infection. In contrast, in patients with gram-negative bacterial infections, a significant reduction of MBL (p=0.002) and only a moderate, less significant reduction of C1q (p=0.03) were observed. As a model for the binding of MBL to gram-negative bacteria, Salmonella strains with defined mutations in their lipopolysaccharide (LPS) structure were used. The comparison of the binding of MBL to these Salmonella strains with that of the corresponding isolated LPS forms bound to microtiter plates revealed a similar binding pattern, supporting the interpretation that LPS on the surface of gram-negative bacteria is the major acceptor molecule for MBL on these bacteria, which according to our results obviously also takes place during gram-negative bacterial septicaemia. Furthermore, we were able to demonstrate that MBL bound to LPS was able to initiate activation of the complement cascade as measured by the occurrence of the cleavage product C4c.