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Sobolewski CM, Courchesne-Krak NS, Hyland MT, Bernes GA, Veziris CR, Wozniak JR, Mattson SN. Adaptive, Externalizing, and Internalizing Behavior of Children with Prenatal Alcohol Exposure: A Comparison of Three Parent-Report Questionnaires. Dev Neuropsychol 2024; 49:167-177. [PMID: 38742629 DOI: 10.1080/87565641.2024.2351796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 04/30/2024] [Indexed: 05/16/2024]
Abstract
This study compared the Behavior Assessment System for Children-Third Edition (BASC-3) to the Child Behavior Checklist (CBCL) and the Vineland Adaptive Behavior Scales-Third Edition (VABS-3) in children with and without histories of prenatal alcohol exposure. Data were collected from Collaborative Initiative on Fetal Alcohol Spectrum Disorders Phase 4 sites. Caregivers rated their child's behavior using three questionnaires: BASC-3, CBCL, and VABS-3. BASC-3 Adaptive Skills, Externalizing Problems, and Internalizing Problems scores were correlated with comparable scores from the CBCL (Externalizing and Internalizing Problems) and VABS-3 (Adaptive Skills) both within and across groups. Sensitivity, specificity, and positive and negative predictive values were calculated for the BASC-3. BASC-3 sensitivity rates were 78.1%, 80.5%, and 47.0% and specificity rates were 79.4%, 80.4%, and 81.5% for Adaptive Skills, Externalizing Problems, and Internalizing Problems, respectively. Positive predictive values were 87.1%, 88.0%, and 81.9% and negative predictive values were 67.0%, 69.8%, and 46.3% for Adaptive Skills, Externalizing Problems, and Internalizing Problems, respectively. Results replicated previous reports of behavioral and adaptive difficulties in children with prenatal alcohol exposure. These findings provide support for using the BASC-3 in this population.
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Affiliation(s)
- Chloe M Sobolewski
- Center for Behavioral Teratology, Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Natasia S Courchesne-Krak
- Center for Behavioral Teratology, Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Matthew T Hyland
- Center for Behavioral Teratology, Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Gemma A Bernes
- Center for Behavioral Teratology, Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Christina R Veziris
- Center for Behavioral Teratology, Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Jeffrey R Wozniak
- Department of Psychiatry & Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA
| | - Sarah N Mattson
- Center for Behavioral Teratology, Department of Psychology, San Diego State University, San Diego, CA, USA
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Gimbel BA, Roediger DJ, Ernst AM, Anthony ME, Mueller BA, de Water E, Rockhold MN, Wozniak JR. Normative Magnetic Resonance Imaging Data Increase the Sensitivity to Brain Volume Abnormalities in the Classification of Fetal Alcohol Spectrum Disorder. J Pediatr 2024; 266:113868. [PMID: 38065282 PMCID: PMC10922916 DOI: 10.1016/j.jpeds.2023.113868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 10/27/2023] [Accepted: 12/04/2023] [Indexed: 12/31/2023]
Abstract
OBJECTIVE To evaluate the use of a large magnetic resonance imaging (MRI) normative dataset to quantify structural brain anomalies that may improve diagnostic sensitivity for atypical brain volume in youth with fetal alcohol spectrum disorder (FASD). STUDY DESIGN Participants included 48 children with prenatal alcohol exposure (PAE) and 43 controls, ages 8-17 years, from the longitudinal Collaborative Initiative on FASD s. Recently published lifespan brain charts were used to quantify participants' (per)centile for brain volumes (cortical and subcortical gray matter and cortical white matter), providing an index of (dis)similarity to typically developing individuals of the same age and sex. RESULTS Participants with PAE demonstrated lower mean centile scores compared with controls. Participants with PAE and scores ≤ 10th centile on at least 1 brain volume metric demonstrated significantly lower performance on measures of intellectual function and aspects of executive functioning compared with participants with PAE and "typical" volumes (>10th centile). Brain volume centiles explained a greater amount of variance in IQ and improved sensitivity to brain volume anomalies in FASD compared with the most commonly used diagnostic criterion of occipitofrontal circumference (OFC) ≤ 10th. CONCLUSION Age- and sex-adjusted brain volumes based on a large normative dataset may be useful predictors of functional outcomes and may identify a greater number of individuals with FASD than the currently used criterion of OFC.
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Affiliation(s)
- Blake A Gimbel
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Twin Cities, Minneapolis, MN
| | - Donovan J Roediger
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Twin Cities, Minneapolis, MN
| | - Abigail M Ernst
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Twin Cities, Minneapolis, MN
| | - Mary E Anthony
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Twin Cities, Minneapolis, MN
| | - Bryon A Mueller
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Twin Cities, Minneapolis, MN
| | | | | | - Jeffrey R Wozniak
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Twin Cities, Minneapolis, MN.
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Veziris CR, Hyland MT, Kable JA, Wozniak JR, Coles CD, May PA, Kalberg WO, Sowell ER, Jones KL, Riley EP, Mattson SN. Validation of the ND-PAE Diagnosis in Children with Heavy Prenatal Alcohol Exposure. Res Sq 2024:rs.3.rs-3922436. [PMID: 38410428 PMCID: PMC10896399 DOI: 10.21203/rs.3.rs-3922436/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
This study evaluated criteria for Neurobehavioral Disorder Associated with Prenatal Alcohol Exposure (ND-PAE). Kable et al. (2022) assessed the validity of this diagnosis in a sample with low exposure to alcohol. The current study expanded this assessment to a sample with a wider age range and heavier alcohol exposure. Data were collected from participants (5-17y) with prenatal alcohol exposure (PAE) and typically developing controls at six Collaborative Initiative on Fetal Alcohol Spectrum Disorders sites using neuropsychological assessment and caregiver reports. Impairment was tested at 1SD, 1.5SD, and 2SD below the normative average and a modification of the adaptive functioning requirement was tested. Testing impairment at 1SD resulted in the highest endorsement rates in both groups. Our findings replicated the study by Kable et al. and show that current criteria captured a high rate of those with PAE and that requiring fewer adaptive functioning criteria resulted in higher sensitivity to PAE.
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Smith SM, Weathers TD, Virdee MS, Schwantes-An TH, Voruganti VS, Mattson SN, Coles CD, Kable JA, Sowell E, Wozniak JR, Wetherill L. Polymorphisms in the choline transporter SLC44A1 are associated with reduced cognitive performance in normotypic but not prenatal alcohol-exposed children. Am J Clin Nutr 2024; 119:117-126. [PMID: 38176775 PMCID: PMC10925855 DOI: 10.1016/j.ajcnut.2023.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 09/27/2023] [Accepted: 10/03/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Choline is essential for healthy cognitive development. Single nucleotide polymorphisms (SNPs; rs3199966(G), rs2771040(G)) within the choline transporter SLC44A1 increase risk for choline deficiency. In a choline intervention trial of children who experienced prenatal alcohol exposure (PAE), these alleles are associated with improved cognition. OBJECTIVE This study aimed to determine if SNPs within SLC44A1 are differentially associated with cognition in children with PAE compared with normotypic controls (genotype × exposure). A secondary objective tested for an association of these SNPs and cognition in controls (genotype-only). DESIGN This is a secondary analysis of data from the Collaborative Initiative on Fetal Alcohol Spectrum Disorders. Participants (163 normotypic controls, 162 PAE) underwent psychological assessments and were genotyped within SLC44A1. Choline status was not assessed. Association analysis between genotype × exposure was performed using an additive genetic model and linear regression to identify the allelic effect. The primary outcome was the interaction between SLC44A1 genotype × exposure status with respect to cognition. The secondary outcome was the cognitive-genotype association in normotypic controls. RESULTS Genotype × exposure analysis identified 7 SNPs in SLC44A1, including rs3199966(G) and rs2771040(G), and in strong linkage (D' ≥ 0.87), that were associated (adjusted P ≤ 0.05) with reduced performance in measures of general cognition, nonverbal and quantitative reasoning, memory, and executive function (β, 1.92-3.91). In controls, carriers of rs3199966(GT or GG) had worsened cognitive performance than rs3199966(TT) carriers (β, 0.46-0.83; P < 0.0001), whereas cognitive performance did not differ by rs3199966 genotype in those with PAE. CONCLUSIONS Two functional alleles that increase vulnerability to choline deficiency, rs3199966(G) (Ser644Ala) and rs2771040(G) (3' untranslated region), are associated with worsened cognition in otherwise normotypic children. These alleles were previously associated with greater cognitive improvement in children with PAE who received supplemental choline. The findings endorse that choline benefits cognitive development in normotypic children and those with PAE.
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Affiliation(s)
- Susan M Smith
- UNC Nutrition Research Institute University of North Carolina at Chapel Hill, Kannapolis, NC, United States; Department of Nutrition, University of North Carolina at Chapel Hill, Kannapolis, NC, United States.
| | - Torri D Weathers
- UNC Nutrition Research Institute University of North Carolina at Chapel Hill, Kannapolis, NC, United States
| | - Manjot S Virdee
- UNC Nutrition Research Institute University of North Carolina at Chapel Hill, Kannapolis, NC, United States
| | - Tae-Hwi Schwantes-An
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Venkata Saroja Voruganti
- UNC Nutrition Research Institute University of North Carolina at Chapel Hill, Kannapolis, NC, United States; Department of Nutrition, University of North Carolina at Chapel Hill, Kannapolis, NC, United States
| | - Sarah N Mattson
- Center for Behavioral Teratology, San Diego State University, San Diego, CA, United States
| | - Claire D Coles
- Departments of Psychiatry and Behavioral Science and Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
| | - Julie A Kable
- Departments of Psychiatry and Behavioral Science and Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
| | - Elizabeth Sowell
- Department of Pediatrics, Neurology, and Psychology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Jeffrey R Wozniak
- Department of Psychiatry & Behavioral Science, University of Minnesota, Minneapolis, MN, United States
| | - Leah Wetherill
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, United States
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Hyland MT, Courchesne-Krak NS, Bernes GA, Wozniak JR, Jones KL, Del Campo M, Riley EP, Mattson SN. Results of a screening tool for fetal alcohol spectrum disorders are associated with neuropsychological and behavioral measures. Alcohol Clin Exp Res (Hoboken) 2023; 47:1560-1569. [PMID: 37328959 PMCID: PMC10724376 DOI: 10.1111/acer.15133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 04/25/2023] [Accepted: 06/04/2023] [Indexed: 06/18/2023]
Abstract
PURPOSE This study assessed whether the outcome of a screening tool for fetal alcohol spectrum disorders (FASD), the FASD-Tree, was associated with neuropsychological and behavioral outcomes. METHODS Data for this study were collected as part of the fourth phase of the Collaborative Initiative on Fetal Alcohol Spectrum Disorders (CIFASD-4). Participants (N = 175, 5 to 16 years) with or without histories of prenatal alcohol exposure were recruited from San Diego and Minneapolis. Each participant was screened using the FASD-Tree and administered a neuropsychological test battery; parents or guardians completed behavioral questionnaires. The FASD-Tree incorporates physical and behavioral measures and provides an outcome regarding the presence of FASD (FASD-Positive or FASD-Negative). Logistic regression was used to test whether the FASD-Tree outcome was associated with general cognitive ability, executive function, academic achievement, and behavior. Associations were tested in two groups: the whole sample and only correctly classified participants. RESULTS Results of the FASD-Tree were associated with neuropsychological and behavioral measures. Participants classified as FASD-Positive were more likely than those classified as FASD-Negative to have a lower IQ score and exhibit poorer performance on measures of executive and academic functions. Behaviorally, participants classified as FASD-Positive were rated as having more behavior problems and adaptive difficulties. Similar relationships were found for all measures when including only participants correctly classified by the FASD-Tree screening tool. CONCLUSION Results from the FASD-Tree screening tool were associated with neuropsychological and behavioral measures. Participants classified as FASD-Positive were more likely to have impairment in all domains tested. The results support the effectiveness of the FASD-Tree as a screening tool for use in clinical settings, providing an efficient and accurate way to identify patients in need of additional evaluation.
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Affiliation(s)
- Matthew T. Hyland
- Center for Behavioral Teratology and Department of Psychology, San Diego State University
| | | | - Gemma A. Bernes
- Center for Behavioral Teratology and Department of Psychology, San Diego State University
| | | | - Kenneth L. Jones
- Department of Pediatrics, University of California, San Diego School of Medicine
| | - Miguel Del Campo
- Department of Pediatrics, University of California, San Diego School of Medicine
| | - Edward P. Riley
- Center for Behavioral Teratology and Department of Psychology, San Diego State University
| | - Sarah N. Mattson
- Center for Behavioral Teratology and Department of Psychology, San Diego State University
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Gimbel BA, Roediger DJ, Ernst AM, Anthony ME, de Water E, Mueller BA, Rockhold MN, Schumacher MJ, Mattson SN, Jones KL, Lim KO, Wozniak JR. Delayed cortical thinning in children and adolescents with prenatal alcohol exposure. Alcohol Clin Exp Res (Hoboken) 2023; 47:1312-1326. [PMID: 37132064 PMCID: PMC10851870 DOI: 10.1111/acer.15096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 03/10/2023] [Accepted: 04/26/2023] [Indexed: 05/04/2023]
Abstract
BACKGROUND Prenatal alcohol exposure (PAE) is associated with abnormalities in cortical structure and maturation, including cortical thickness (CT), cortical volume, and surface area. This study provides a longitudinal context for the developmental trajectory and timing of abnormal cortical maturation in PAE. METHODS We studied 35 children with PAE and 30 nonexposed typically developing children (Comparisons), aged 8-17 at enrollment, who were recruited from the University of Minnesota FASD Program. Participants were matched on age and sex. They underwent a formal evaluation of growth and dysmorphic facial features associated with PAE and completed cognitive testing. MRI data were collected on a Siemens Prisma 3T scanner. Two sessions, each including MRI scans and cognitive testing, were spaced approximately 15 months apart on average. Change in CT and performance on tests of executive function (EF) were examined. RESULTS Significant age-by-group (PAE vs. Comparison) linear interaction effects in CT were observed in the parietal, temporal, occipital, and insular cortices suggesting altered developmental trajectories in the PAE vs. Comparison groups. Results suggest a pattern of delayed cortical thinning in PAE, with the Comparison group showing more rapid thinning at younger ages and those with PAE showing accelerated thinning at older ages. Overall, children in the PAE group showed reduced cortical thinning across time relative to the Comparison participants. Symmetrized percent change (SPC) in CT in several regions was significantly correlated with EF performance at 15-month follow-up for the Comparison group but not the group with PAE. CONCLUSIONS Regional differences were seen longitudinally in the trajectory and timing of CT change in children with PAE, suggesting delayed cortical maturation and an atypical pattern of development compared with typically developing individuals. In addition, exploratory correlation analyses of SPC and EF performance suggest the presence of atypical brain-behavior relationships in PAE. The findings highlight the potential role of altered developmental timing of cortical maturation in contributing to long-term functional impairment in PAE.
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Kamali T, Day JW, Deutsch GK, Sampson JB, Murad A, Chaufty J, Parker D, Wozniak JR. Learning Spectral Fractional Anisotropy and Mean Diffusivity Features as Neuroimaging Biomarkers for Tracking White Matter Integrity Changes in Myotonic Dystrophy Type 1 Patients using Deep Convolutional Neural Networks. Annu Int Conf IEEE Eng Med Biol Soc 2023; 2023:1-4. [PMID: 38083393 DOI: 10.1109/embc40787.2023.10340468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Myotonic dystrophy type 1 (DM1) is a genetic neuromuscular progressive multisystem disease that results in a broad spectrum of clinical central nervous system (CNS) involvement, including problems with memory, attention, executive functioning, and social cognition. Fractional anisotropy and mean diffusivity along-tract data calculated using diffusion tensor imaging techniques play a vital role in assessing white matter microstructural changes associated with neurodegeneration caused by DM1. In this work, a novel spectrogram-based deep learning method is proposed to characterize white matter network alterations in DM1 with the goal of building a deep learning model as neuroimaging biomarkers of DM1. The proposed method is evaluated on fractional anisotropies and mean diffusivities along-tract data calculated for 25 major white matter tracts of 46 DM1 patients and 96 unaffected controls. The evaluation data consists of a total of 7100 spectrogram images. The model achieved 91% accuracy in identifying DM1, a significant improvement compared to previous methods.Clinical relevance- Clinical care of DM1 is particularly challenging due to DM1 multisystem involvement and the disease variability. Patients with DM1 often experience neurological and psychological symptoms, such as excessive sleepiness and apathy, that greatly impact their quality of life. Some of DM1 CNS symptoms may be responsive to treatment. The goal of this research is to gain a deeper understanding of the impact of DM1 on the CNS and to develop a deep learning model that can serve as a biomarker for the disease, with the potential to be used in future clinical trials as an outcome measure.
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Gimbel BA, Roediger DJ, Ernst AM, Anthony ME, de Water E, Rockhold MN, Mueller BA, Mattson SN, Jones KL, Riley EP, Lim KO, Wozniak JR. Atypical developmental trajectories of white matter microstructure in prenatal alcohol exposure: Preliminary evidence from neurite orientation dispersion and density imaging. Front Neurosci 2023; 17:1172010. [PMID: 37168930 PMCID: PMC10165006 DOI: 10.3389/fnins.2023.1172010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 03/30/2023] [Indexed: 05/13/2023] Open
Abstract
Introduction Fetal alcohol spectrum disorder (FASD), a life-long condition resulting from prenatal alcohol exposure (PAE), is associated with structural brain anomalies and neurobehavioral differences. Evidence from longitudinal neuroimaging suggest trajectories of white matter microstructure maturation are atypical in PAE. We aimed to further characterize longitudinal trajectories of developmental white matter microstructure change in children and adolescents with PAE compared to typically-developing Controls using diffusion-weighted Neurite Orientation Dispersion and Density Imaging (NODDI). Materials and methods Participants: Youth with PAE (n = 34) and typically-developing Controls (n = 31) ages 8-17 years at enrollment. Participants underwent formal evaluation of growth and facial dysmorphology. Participants also completed two study visits (17 months apart on average), both of which involved cognitive testing and an MRI scan (data collected on a Siemens Prisma 3 T scanner). Age-related changes in the orientation dispersion index (ODI) and the neurite density index (NDI) were examined across five corpus callosum (CC) regions defined by tractography. Results While linear trajectories suggested similar overall microstructural integrity in PAE and Controls, analyses of symmetrized percent change (SPC) indicated group differences in the timing and magnitude of age-related increases in ODI (indexing the bending and fanning of axons) in the central region of the CC, with PAE participants demonstrating atypically steep increases in dispersion with age compared to Controls. Participants with PAE also demonstrated greater increases in ODI in the mid posterior CC (trend-level group difference). In addition, SPC in ODI and NDI was differentially correlated with executive function performance for PAE participants and Controls, suggesting an atypical relationship between white matter microstructure maturation and cognitive function in PAE. Discussion Preliminary findings suggest subtle atypicality in the timing and magnitude of age-related white matter microstructure maturation in PAE compared to typically-developing Controls. These findings add to the existing literature on neurodevelopmental trajectories in PAE and suggest that advanced biophysical diffusion modeling (NODDI) may be sensitive to biologically-meaningful microstructural changes in the CC that are disrupted by PAE. Findings of atypical brain maturation-behavior relationships in PAE highlight the need for further study. Further longitudinal research aimed at characterizing white matter neurodevelopmental trajectories in PAE will be important.
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Affiliation(s)
- Blake A. Gimbel
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Twin Cities, Minneapolis, MN, United States
| | - Donovan J. Roediger
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Twin Cities, Minneapolis, MN, United States
| | - Abigail M. Ernst
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Twin Cities, Minneapolis, MN, United States
| | - Mary E. Anthony
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Twin Cities, Minneapolis, MN, United States
| | - Erik de Water
- Great Lakes Neurobehavioral Center, Edina, MN, United States
| | | | - Bryon A. Mueller
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Twin Cities, Minneapolis, MN, United States
| | - Sarah N. Mattson
- Department of Psychology, San Diego State University, San Diego, CA, United States
| | - Kenneth L. Jones
- Department of Pediatrics, University of California, San Diego, San Diego, CA, United States
| | - Edward P. Riley
- Department of Psychology, San Diego State University, San Diego, CA, United States
| | - Kelvin O. Lim
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Twin Cities, Minneapolis, MN, United States
| | | | - Jeffrey R. Wozniak
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Twin Cities, Minneapolis, MN, United States
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Mattson SN, Jones KL, Chockalingam G, Wozniak JR, Hyland MT, Courchesne-Krak NS, Del Campo M, Riley EP. Validation of the FASD-Tree as a screening tool for fetal alcohol spectrum disorders. Alcohol Clin Exp Res (Hoboken) 2023; 47:263-272. [PMID: 36807293 PMCID: PMC9992228 DOI: 10.1111/acer.14987] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 10/25/2022] [Accepted: 11/18/2022] [Indexed: 02/23/2023]
Abstract
BACKGROUND As many as 80% of individuals with fetal alcohol spectrum disorders (FASD) are misdiagnosed or not diagnosed. This study tests the accuracy and validity of a web-based screening tool (the FASD-Tree) for identifying children and adolescents with FASD. METHODS Children with histories of prenatal alcohol exposure (PAE) and controls (N = 302, including 224 with PAE and 78 controls) were examined for physical signs of fetal alcohol syndrome (FAS), and parents completed behavioral questionnaires. Data were entered into the FASD-Tree, a web-based decision tree application. The FASD-Tree provided two outcomes: a dichotomous indicator (yes/no) and a numeric risk score (0 to 5), which have been shown separately to identify children with PAE and neurobehavioral impairment and to correlate with neurobehavioral outcomes. Overall accuracy (ACC), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for the decision tree, risk score, and their combination. Misclassified cases were examined for systematic bias. RESULTS The FASD-Tree was successful in accurately identifying youth with histories of PAE and the subgroup of individuals with FASD, indicating its validity as an FASD screening tool. Overall accuracy rates for FASD-Tree components ranged from 75.0% to 84.1%, and both the decision tree outcome and risk score, and their combination, resulted in fair to good discrimination (area under the curve = 0.722 to 0.862) of youth with histories of PAE or FASD. While most participants were correctly classified, those who were misclassified differed in IQ and attention. Race, ethnicity, and sex did not affect the results. CONCLUSION The FASD-Tree is not a biomarker of PAE and does not provide definitive evidence of prenatal alcohol exposure. Rather it is an accurate and valid screening tool for FASD and can be used by clinicians who suspect that a patient has a history of PAE, even if the exposure is unknown.
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Affiliation(s)
- Sarah N. Mattson
- Center for Behavioral Teratology and Department of Psychology, San Diego State University
| | - Kenneth Lyons Jones
- Department of Pediatrics, University of California, San Diego School of Medicine
| | - Ganz Chockalingam
- Center for Behavioral Teratology and Department of Psychology, San Diego State University
- Blue Resonance, LLC
| | | | - Matthew T. Hyland
- Center for Behavioral Teratology and Department of Psychology, San Diego State University
| | | | - Miguel Del Campo
- Department of Pediatrics, University of California, San Diego School of Medicine
| | - Edward P. Riley
- Center for Behavioral Teratology and Department of Psychology, San Diego State University
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10
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Gimbel BA, Anthony ME, Ernst AM, Roediger DJ, de Water E, Eckerle JK, Boys CJ, Radke JP, Mueller BA, Fuglestad AJ, Zeisel SH, Georgieff MK, Wozniak JR. Long-term follow-up of a randomized controlled trial of choline for neurodevelopment in fetal alcohol spectrum disorder: corpus callosum white matter microstructure and neurocognitive outcomes. J Neurodev Disord 2022; 14:59. [PMID: 36526961 PMCID: PMC9756672 DOI: 10.1186/s11689-022-09470-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Fetal alcohol spectrum disorder (FASD) is a lifelong condition. Early interventions targeting core neurocognitive deficits have the potential to confer long-term neurodevelopmental benefits. Time-targeted choline supplementation is one such intervention that has been shown to provide neurodevelopmental benefits that emerge with age during childhood. We present a long-term follow-up study evaluating the neurodevelopmental effects of early choline supplementation in children with FASD approximately 7 years on average after an initial efficacy trial. METHODS The initial study was a randomized, double-blind, placebo-controlled trial of choline vs. placebo in 2.5 to 5 year olds with FASD. Participants in this long-term follow-up study include 18 children (9 placebo; 9 choline) seen 7 years on average following initial trial completion. The mean age at follow-up was 11.0 years old. Diagnoses were 28% fetal alcohol syndrome (FAS), 28% partial FAS, and 44% alcohol-related neurodevelopmental disorder. The follow-up included measures of executive functioning and an MRI scan. RESULTS Children who received choline had better performance on several tasks of lower-order executive function (e.g., processing speed) and showed higher white matter microstructure organization (i.e., greater axon coherence) in the splenium of the corpus callosum compared to the placebo group. CONCLUSIONS These preliminary findings, although exploratory at this stage, highlight potential long-term benefits of choline as a neurodevelopmental intervention for FASD and suggest that choline may affect white matter development, representing a potential target of choline in this population. TRIAL REGISTRATION Prior to enrollment, this trial was registered with clinicaltrials.gov ( NCT01149538 ) on June 23, 2010.
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Affiliation(s)
- Blake A. Gimbel
- grid.17635.360000000419368657University of Minnesota Twin Cities, 2025 E. River Parkway, Minneapolis, MN 55414 USA
| | - Mary E. Anthony
- grid.17635.360000000419368657University of Minnesota Twin Cities, 2025 E. River Parkway, Minneapolis, MN 55414 USA
| | - Abigail M. Ernst
- grid.17635.360000000419368657University of Minnesota Twin Cities, 2025 E. River Parkway, Minneapolis, MN 55414 USA
| | - Donovan J. Roediger
- grid.17635.360000000419368657University of Minnesota Twin Cities, 2025 E. River Parkway, Minneapolis, MN 55414 USA
| | | | - Judith K. Eckerle
- grid.17635.360000000419368657University of Minnesota Twin Cities, 2025 E. River Parkway, Minneapolis, MN 55414 USA
| | | | | | - Bryon A. Mueller
- grid.17635.360000000419368657University of Minnesota Twin Cities, 2025 E. River Parkway, Minneapolis, MN 55414 USA
| | - Anita J. Fuglestad
- grid.266865.90000 0001 2109 4358University of North Florida, Jacksonville, USA
| | - Steven H. Zeisel
- grid.410711.20000 0001 1034 1720University of North Carolina, Chapel Hill, USA
| | - Michael K. Georgieff
- grid.17635.360000000419368657University of Minnesota Twin Cities, 2025 E. River Parkway, Minneapolis, MN 55414 USA
| | - Jeffrey R. Wozniak
- grid.17635.360000000419368657University of Minnesota Twin Cities, 2025 E. River Parkway, Minneapolis, MN 55414 USA
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11
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Fuglestad AJ, Miller NC, Fink BA, Boys CJ, Eckerle JK, Georgieff MK, Wozniak JR. Neurophysiological correlates of memory change in children with fetal alcohol spectrum disorders treated with choline. Front Psychol 2022; 13:936019. [PMID: 36225707 PMCID: PMC9548619 DOI: 10.3389/fpsyg.2022.936019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 09/02/2022] [Indexed: 01/05/2023] Open
Abstract
Background Prenatal and early postnatal choline supplementation reduces cognitive and behavioral deficits in animal models of Fetal Alcohol Spectrum Disorder (FASD). In a previously published 9-month clinical trial of choline supplementation in children with FASD, we reported that postnatal choline was associated with improved performance on a hippocampal-dependent recognition memory task. The current paper describes the neurophysiological correlates of that memory performance for trial completers. Methods Children with FASD (N = 24) who were enrolled in a clinical trial of choline supplementation were followed for 9 months. Delayed recall on a 9-step elicited imitation task (EI) served as the behavioral measure of recognition memory. Neurophysiological correlates of memory were assessed via event-related potentials (ERP). Results Delayed recall on EI was correlated with two ERP components commonly associated with recognition memory in young children: middle latency negative component (Nc amplitude; range: r = -0.41 to r = -0.44) and positive slow wave (PSW area under the curve; range: r = -0.45 to r = -0.63). No significant ERP differences were observed between the choline and placebo groups at the conclusion of the trial. Conclusion Although the small sample size limits the ability to draw clear conclusions about the treatment effect of choline on ERP, the results suggest a relationship between memory performance and underlying neurophysiological status in FASD. This trial was registered.
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Affiliation(s)
- Anita J. Fuglestad
- Department of Psychology, University of North Florida, Jacksonville, FL, United States
| | - Neely C. Miller
- Masonic Institute for the Developing Brain, University of Minnesota Twin Cities, Minneapolis, MN, United States
| | - Birgit A. Fink
- Department of Psychiatry & Behavioral Sciences, University of Minnesota Twin Cities, Minneapolis, MN, United States
| | - Christopher J. Boys
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, United States
| | - Judith K. Eckerle
- Department of Psychiatry & Behavioral Sciences, University of Minnesota Twin Cities, Minneapolis, MN, United States
| | - Michael K. Georgieff
- Masonic Institute for the Developing Brain, University of Minnesota Twin Cities, Minneapolis, MN, United States,Department of Pediatrics, University of Minnesota, Minneapolis, MN, United States
| | - Jeffrey R. Wozniak
- Department of Psychiatry & Behavioral Sciences, University of Minnesota Twin Cities, Minneapolis, MN, United States,*Correspondence: Jeffrey R. Wozniak,
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12
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Kamali T, Deutsch GK, Hagerman KA, Parker D, Day JW, Sampson JB, Wozniak JR. Cognitive Impairment Analysis of Myotonic Dystrophy via Weakly Supervised Classification of Neuropsychological Features. Annu Int Conf IEEE Eng Med Biol Soc 2022; 2022:4377-4382. [PMID: 36086274 DOI: 10.1109/embc48229.2022.9871626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The myotonic dystrophies (DM1 and DM2) are dominantly inherited disorders that cause pathological changes throughout the body. Many individuals with DM experience cognitive, behavioral and other functional central nervous system effects that impact their quality of life. The extent of psychological impairment that will develop in each patient is variable and unpredictable. Hence, it is difficult to get strong supervision information like fully ground truth labels for all cognitive involvement patterns. This study is to assess cognitive involvement among healthy controls and patients with DM. The DM cognitive impairment pattern observation is modeled in a weakly supervised setting and supervision information is used to transform the input feature space to a more discriminative representation suitable for pattern observation. This study incorporated results from 59 adults with DM and 92 control subjects. The developed system categorized the neuropsychological testing data into five cognitive clusters. The quality of the obtained clustering solution was assessed using an internal validity metric. The experimental results show that the proposed algorithm can discover interesting patterns and useful information from neuropsychological data, which will be be crucial in planning clinical trials and monitoring clinical performance. The proposed system resulted in an average classification accuracy of 88%, which is very promising considering the unique challenges present in this population.
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13
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Kovac V, Shapiro EG, Rudser KD, Mueller BA, Eisengart JB, Delaney KA, Ahmed A, King KE, Yund BD, Cowan MJ, Raiman J, Mamak EG, Harmatz PR, Shankar SP, Ali N, Cagle SR, Wozniak JR, Lim KO, Orchard PJ, Whitley CB, Nestrasil I. Quantitative brain MRI morphology in severe and attenuated forms of mucopolysaccharidosis type I. Mol Genet Metab 2022; 135:122-132. [PMID: 35012890 PMCID: PMC8898074 DOI: 10.1016/j.ymgme.2022.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 01/04/2022] [Accepted: 01/04/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To assess our hypothesis that brain macrostructure is different in individuals with mucopolysaccharidosis type I (MPS I) and healthy controls (HC), we conducted a comprehensive multicenter study using a uniform quantitative magnetic resonance imaging (qMRI) protocol, with analyses that account for the effects of disease phenotype, age, and cognition. METHODS Brain MRIs in 23 individuals with attenuated (MPS IA) and 38 with severe MPS I (MPS IH), aged 4-25 years, enrolled under the study protocol NCT01870375, were compared to 98 healthy controls. RESULTS Cortical and subcortical gray matter, white matter, corpus callosum, ventricular and choroid plexus volumes in MPS I significantly differed from HC. Thicker cortex, lower white matter and corpus callosum volumes were already present at the youngest MPS I participants aged 4-5 years. Age-related differences were observed in both MPS I groups, but most markedly in MPS IH, particularly in cortical gray matter metrics. IQ scores were inversely associated with ventricular volume in both MPS I groups and were positively associated with cortical thickness only in MPS IA. CONCLUSIONS Quantitatively-derived MRI measures distinguished MPS I participants from HC as well as severe from attenuated forms. Age-related neurodevelopmental trajectories in both MPS I forms differed from HC. The extent to which brain structure is altered by disease, potentially spared by treatment, and how it relates to neurocognitive dysfunction needs further exploration.
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Affiliation(s)
- Victor Kovac
- Division of Clinical Behavioral Neuroscience, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA.
| | - Elsa G Shapiro
- Division of Clinical Behavioral Neuroscience, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA.
| | - Kyle D Rudser
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA.
| | - Bryon A Mueller
- Department of Psychiatry & Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA.
| | - Julie B Eisengart
- Division of Clinical Behavioral Neuroscience, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA.
| | - Kathleen A Delaney
- Division of Clinical Behavioral Neuroscience, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA.
| | - Alia Ahmed
- Division of Clinical Behavioral Neuroscience, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA.
| | - Kelly E King
- Division of Clinical Behavioral Neuroscience, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA.
| | - Brianna D Yund
- Division of Clinical Behavioral Neuroscience, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA.
| | - Morton J Cowan
- UCSF Benioff Children's Hospital, University of California, San Francisco, CA, USA.
| | - Julian Raiman
- Division of Clinical and Metabolic Genetics, Department of Paediatrics, University of Toronto, The Hospital for Sick Children, Toronto, ON, Canada.
| | - Eva G Mamak
- Department of Psychology, The Hospital for Sick Children, Toronto, ON, Canada.
| | - Paul R Harmatz
- UCSF Benioff Children's Hospital Oakland, Oakland, CA, USA.
| | - Suma P Shankar
- Department of Ophthalmology and Human Genetics, Emory University, Atlanta, GA, USA.
| | - Nadia Ali
- Department of Human Genetics, Emory University, Atlanta, GA, USA.
| | | | - Jeffrey R Wozniak
- Department of Psychiatry & Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA.
| | - Kelvin O Lim
- Department of Psychiatry & Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA.
| | - Paul J Orchard
- Division of Pediatric Blood & Marrow Transplantation, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA.
| | - Chester B Whitley
- Gene Therapy Center, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA.
| | - Igor Nestrasil
- Division of Clinical Behavioral Neuroscience, Department of Pediatrics, University of Minnesota, Center for Magnetic Resonance Research (CMRR), Department of Radiology, Minneapolis, MN, USA.
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14
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Bernes GA, Courchesne NS, Hyland MT, Villodas MT, Coles CD, Kable JA, May PA, Kalberg WO, Sowell ER, Wozniak JR, Jones KL, Riley EP, Mattson SN. Development and validation of a postnatal risk score that identifies children with prenatal alcohol exposure. Alcohol Clin Exp Res 2022; 46:52-65. [PMID: 34806190 PMCID: PMC8799504 DOI: 10.1111/acer.14749] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 10/20/2021] [Accepted: 11/16/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND This study aimed to develop an efficient and easily calculable risk score that can be used to identify an individual's risk of having been exposed to alcohol prenatally. METHODS Data for this study were collected as part of the Collaborative Initiative on Fetal Alcohol Spectrum Disorders, Phases 2 and 3. Two cohorts (ages 5 to 17 years) completed a comprehensive neurobehavioral battery and a standard dysmorphology exam: a development cohort (DC; n = 325) and a comparative cohort (CC; n = 523). Both cohorts included two groups: those with histories of heavy prenatal alcohol exposure (AE-DC, n = 121; AE-CC, n = 177) and a control group that included subjects with minimal or no prenatal alcohol exposure (CON-DC, n = 204; CON-CC, n = 346). Behavioral assessments and physical exam data were combined using regression techniques to derive a risk score indicating the likelihood of prenatal alcohol exposure. Subjects were then divided into two subgroups: (1) low risk and (2) high risk. Chi-square (χ2 ) determined classification accuracy and ROC curves were produced to assess the predictive accuracy. Correlations between risk scores and intelligence quotient and executive function scores were calculated. RESULTS Subjects were accurately classified in the DC (χ2 = 78.61, p < 0.001) and CC (χ2 = 86.63, p < 0.001). The classification model also performed well in the DC (ROC = 0.835 [SE = 0.024, p < 0.001]) and CC (ROC = 0.786 [SE = 0.021, p < 0.001]). In the AE-CC and CON-CC, there were modest but significant associations between the risk score and executive function (AE-CC: r = -0.20, p = 0.034; CON-CC: r = -0.28, p < 0.001) and intelligence quotient (AE-CC: r = -0.20, p = 0.034; CON-CC: r = -0.28, p < 0.001). CONCLUSION(S) The risk score significantly distinguished alcohol-exposed from control subjects and correlated with important cognitive outcomes. It has significant clinical potential and could be easily deployed in clinical settings.
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Affiliation(s)
- Gemma A. Bernes
- Center for Behavioral Teratology, San Diego State University,Department of Psychology, San Diego State University
| | - Natasia S. Courchesne
- Center for Behavioral Teratology, San Diego State University,Department of Psychology, San Diego State University
| | - Matthew T. Hyland
- Center for Behavioral Teratology, San Diego State University,Department of Psychology, San Diego State University
| | | | - Claire D. Coles
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine,Department of Pediatrics, Emory University School of Medicine
| | - Julie A. Kable
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine,Department of Pediatrics, Emory University School of Medicine
| | - Philip A. May
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina Nutrition Research Institute,Center on Alcohol, Substance Abuse, and Addictions, University of New Mexico
| | - Wendy O. Kalberg
- Center on Alcohol, Substance Abuse, and Addictions, University of New Mexico
| | - Elizabeth R. Sowell
- Department of Pediatrics, Keck School of Medicine, University of Southern California
| | | | - Kenneth L. Jones
- Department of Pediatrics, University of California, San Diego School of Medicine
| | - Edward P. Riley
- Center for Behavioral Teratology, San Diego State University,Department of Psychology, San Diego State University
| | - Sarah N. Mattson
- Center for Behavioral Teratology, San Diego State University,Department of Psychology, San Diego State University
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15
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Kamali T, Parker D, Day JW, Sampson J, Deutsch GK, Wozniak JR. Toward Developing Robust Myotonic Dystrophy Brain Biomarkers using White Matter Tract Profiles Sub-Band Energy and A Framework of Ensemble Predictive Learning. Annu Int Conf IEEE Eng Med Biol Soc 2021; 2021:3838-3841. [PMID: 34892071 DOI: 10.1109/embc46164.2021.9630544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The myotonic dystrophies (DM1 and DM2) are dominantly inherited disorders that cause pathological changes throughout the body and the brain. DM patients have difficulties with memory, attention, executive functioning, social cognition, and visuospatial function. Quantifying and understanding diffusion measures along main brain white matter fiber tracts offer a unique opportunity to reveal new insights into DM development and characterization. In this work, a novel supervised system is proposed, which is based on Tract Profiles sub-band energy information. The proposed system utilizes a Bayesian stacked random forest to diagnose, characterize, and predict DM clinical outcomes. The evaluation data consists of fractional anisotropies calculated for twelve major white matter tracts of 96 healthy controls and 62 DM patients. The proposed system discriminates DM vs. control with 86% accuracy, which is significantly higher than previous works. Additionally, it discovered DM brain biomarkers that are accurate and robust and will be helpful in planning clinical trials and monitoring clinical performance.
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16
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Smith SM, Virdee MS, Eckerle JK, Sandness KE, Georgieff MK, Boys CJ, Zeisel SH, Wozniak JR. Polymorphisms in SLC44A1 are associated with cognitive improvement in children diagnosed with fetal alcohol spectrum disorder: an exploratory study of oral choline supplementation. Am J Clin Nutr 2021; 114:617-627. [PMID: 33876196 PMCID: PMC8326038 DOI: 10.1093/ajcn/nqab081] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 03/01/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The essential nutrient choline provides one-carbon units for metabolite synthesis and epigenetic regulation in tissues including brain. Dietary choline intake is often inadequate, and higher intakes are associated with improved cognitive function. OBJECTIVE Choline supplements confer cognitive improvement for those diagnosed with fetal alcohol spectrum disorder (FASD), a common set of neurodevelopmental impairments; however, the effect sizes have been modest. In this retrospective analysis, we report that genetic polymorphisms affecting choline utilization are associated with cognitive improvement following choline intervention. METHODS Fifty-two children from the upper midwestern United States and diagnosed with FASD, ages 2-5 y, were randomly assigned to receive choline (500 mg/d; n = 26) or placebo (n = 26) for 9 mo, and were genotyped for 384 choline-related single nucleotide polymorphisms (SNPs). Memory and cognition were assessed at enrollment, study terminus, and at 4-y follow-up for a subset. RESULTS When stratified by intervention (choline vs. placebo), 14-16 SNPs within the cellular choline transporter gene solute carrier family 44 member 1 (SLC44A1) were significantly associated with performance in an elicited imitation sequential memory task, wherein the effect alleles were associated with the greatest pre-/postintervention improvement. Of these, rs3199966 is a structural variant (S644A) and rs2771040 is a single-nucleotide variant within the 3' untranslated region of the plasma membrane isoform. An additive genetic model best explained the genotype associations. Lesser associations were observed for cognitive outcome and polymorphisms in flavin monooxygenase-3 (FMO3), methylenetetrahydrofolate dehydrogenase-1 (MTHFD1), fatty acid desaturase-2 (FADS2), and adiponectin receptor 1 (ADIPOR1). CONCLUSIONS These SLC44A1 variants were previously associated with greater vulnerability to choline deficiency. Our data potentially support the use of choline supplements to improve cognitive function in individuals diagnosed with FASD who carry these effect alleles. Although these findings require replication in both retrospective and prospective confirmatory trials, they emphasize the need to incorporate similar genetic analyses of choline-related polymorphisms in other FASD-choline trials, and to test for similar associations within the general FASD population. This trial was registered at www.clinicaltrials.gov as NCT01149538.
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Affiliation(s)
| | - Manjot S Virdee
- Nutrition Research Institute, University of North Carolina at Chapel Hill, Kannapolis, NC, USA
| | - Judith K Eckerle
- Department of Pediatrics, University of Minnesota Twin Cities, Minneapolis, MN, USA
| | - Kristin E Sandness
- Department of Pediatrics, University of Minnesota Twin Cities, Minneapolis, MN, USA
| | - Michael K Georgieff
- Department of Pediatrics, University of Minnesota Twin Cities, Minneapolis, MN, USA
| | - Christopher J Boys
- Department of Pediatrics, University of Minnesota Twin Cities, Minneapolis, MN, USA
| | - Steven H Zeisel
- Nutrition Research Institute, University of North Carolina at Chapel Hill, Kannapolis, NC, USA,Department of Nutrition, University of North Carolina at Chapel Hill, Kannapolis, NC, USA
| | - Jeffrey R Wozniak
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Twin Cities, Minneapolis, MN, USA
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17
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de Water E, Rockhold MN, Roediger DJ, Krueger AM, Mueller BA, Boys CJ, Schumacher MJ, Mattson SN, Jones KL, Lim KO, Wozniak JR. Social behaviors and gray matter volumes of brain areas supporting social cognition in children and adolescents with prenatal alcohol exposure. Brain Res 2021; 1761:147388. [PMID: 33621483 PMCID: PMC8377082 DOI: 10.1016/j.brainres.2021.147388] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 02/05/2021] [Accepted: 02/17/2021] [Indexed: 01/22/2023]
Abstract
The goal of this study was to examine: 1) differences in parent-reported prosocial and antisocial behaviors between children and adolescents with and without prenatal alcohol exposure (PAE); 2) differences in gray matter volumes of brain areas supporting social cognition between children and adolescents with and without PAE; 3) correlations between gray matter volumes of brain areas supporting social cognition and parent-reported prosocial and antisocial behaviors. Parents of children and adolescents ages 8-16 years completed measures on their prosocial and antisocial behaviors (i.e., Behavior Assessment Scale for Children, Vineland Adaptive Behaviors Scales, and Child Behavior Checklist) (n = 84; 41 with PAE, 43 without PAE). Seventy-nine participants (40 with PAE, 39 without PAE) also completed a structural Magnetic Resonance Imaging (MRI) scan with quality data. Gray matter volumes of seven brain areas supporting social cognitive processes were computed using automated procedures (FreeSurfer 6.0): bilateral fusiform gyrus, superior temporal gyrus, medial orbitofrontal cortex, lateral orbitofrontal cortex, posterior cingulate cortex, precuneus, and temporal pole. Children and adolescents with PAE showed decreased prosocial behaviors and increased antisocial behaviors as well as smaller volumes of the precuneus and lateral orbitofrontal cortex, even when controlling for total intracranial volume. Social brain volumes were not significantly correlated with prosocial or antisocial behaviors. These findings suggest that children and adolescents with PAE show worse social functioning and smaller volumes of brain areas supporting self-awareness, perspective-taking and emotion-regulation than their same-age peers without PAE.
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Affiliation(s)
- Erik de Water
- University of Minnesota, Twin Cities, Minneapolis, MN, United States
| | | | | | - Alyssa M Krueger
- University of Minnesota, Twin Cities, Minneapolis, MN, United States
| | - Bryon A Mueller
- University of Minnesota, Twin Cities, Minneapolis, MN, United States
| | | | | | | | | | - Kelvin O Lim
- University of Minnesota, Twin Cities, Minneapolis, MN, United States
| | - Jeffrey R Wozniak
- University of Minnesota, Twin Cities, Minneapolis, MN, United States.
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18
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Rockhold MN, Krueger AM, de Water E, Lindgren CW, Sandness KE, Eckerle JK, Schumacher MJ, Fink BA, Boys CJ, Carlson SM, Fuglestad AJ, Mattson SN, Jones KL, Riley EP, Wozniak JR. Executive and Social Functioning Across Development in Children and Adolescents With Prenatal Alcohol Exposure. Alcohol Clin Exp Res 2021; 45:457-469. [PMID: 33349933 DOI: 10.1111/acer.14538] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 12/14/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Prenatal alcohol exposure (PAE) is linked to a variety of neurodevelopmental challenges, including social functioning (SF) and executive functioning (EF) deficits. These deficits present differently across developmental stages from preschool age to adolescence. METHODS The post hoc analyses described here were conducted on data from 83 preschool-age children with PAE (early childhood group; ages 2.5 to 5.0) and 95 adolescents (49 with PAE, 46 controls; ages 8 to 16). Each child completed EF tasks as part of several prior studies. Parents completed social and communication inventories about their child's abilities. Thirty-three participants from the early childhood group returned for a 4-year follow-up and completed both SF and EF measures. RESULTS Both the early childhood and adolescent groups with PAE showed deficits in SF and EF. There was a relationship between SF and EF within the adolescent PAE group that was not present in the adolescent control group or the early childhood PAE group. However, at the 4-year follow-up (Mage = 8.45), participants originally in the early childhood PAE group also demonstrated this relationship. CONCLUSIONS These findings support previous research on EF/SF deficits in adolescents with PAE while also addressing a gap in the literature concerning early childhood research on this topic. Additionally, these findings suggest that the relationship between EF and SF deficits may strengthen throughout development. This line of research highlights potential sensitive periods for SF and EF training in children with PAE and suggests that fetal alcohol spectrum disorders programs consider targeting EF training as a component of social skill interventions.
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19
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de Water E, Krueger AM, Lindgren CW, Fuglestad AJ, Rockhold MN, Sandness KE, Eckerle JK, Fink BA, Boys CJ, Wozniak JR. Early delay of gratification predicts later inhibitory control and academic performance in children with prenatal alcohol exposure. Child Neuropsychol 2020; 27:109-124. [PMID: 32772789 DOI: 10.1080/09297049.2020.1798372] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Fetal alcohol spectrum disorder (FASD) affects 2-5% of the children in the United States. In the preschool age-range, inhibitory deficits frequently manifest as impaired ability to delay gratification, which is associated with deficits in cognitive flexibility in these children. The goal of this longitudinal study was to determine whether the ability to delay gratification in preschool children with FASD is (1) associated with broader manifestations in temperament and behavior; (2) predictive of later inhibitory control, cognitive flexibility and working memory in middle childhood; and (3) predictive of later parent-reported behavioral problems and school functioning in middle childhood. Forty-seven children with FASD, ages 2.5-5 years were administered a delay of gratification task in which they chose between receiving 2 snacks immediately or 10 snacks after waiting for 10 min. Two groups were defined based on a median split of waiting time. Four years later, 29 children completed measures of inhibitory control (Flanker task), cognitive flexibility (Dimensional Change Card Sort Test), and working memory (Stanford-Binet Intelligence Scales), and their parents completed the Child Behavior Checklist as a measure of the child's behavioral problems and school functioning. Children with longer wait times on the delay of gratification task in preschool showed better inhibitory control on the Flanker task in middle childhood and better parent-reported school functioning in English. These findings indicate that early inhibitory capacity persists into middle childhood in those with FASD, and may be a promising target for early intervention to improve later cognitive outcomes in these children.
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Affiliation(s)
- Erik de Water
- Department of Psychiatry & Behavioral Sciences, University of Minnesota , Minneapolis, MN, USA
| | - Alyssa M Krueger
- Department of Psychiatry & Behavioral Sciences, University of Minnesota , Minneapolis, MN, USA
| | - Christopher W Lindgren
- Department of Psychiatry & Behavioral Sciences, University of Minnesota , Minneapolis, MN, USA
| | - Anita J Fuglestad
- Department of Psychology, University of North Florida , Jacksonville, FL, USA
| | - Madeline N Rockhold
- Department of Psychiatry & Behavioral Sciences, University of Minnesota , Minneapolis, MN, USA
| | - Kristin E Sandness
- Department of Psychiatry & Behavioral Sciences, University of Minnesota , Minneapolis, MN, USA
| | - Judith K Eckerle
- Department of Pediatrics, University of Minnesota , Minneapolis, MN, USA
| | - Birgit A Fink
- Department of Psychiatry & Behavioral Sciences, University of Minnesota , Minneapolis, MN, USA
| | - Christopher J Boys
- Department of Pediatrics, University of Minnesota , Minneapolis, MN, USA
| | - Jeffrey R Wozniak
- Department of Psychiatry & Behavioral Sciences, University of Minnesota , Minneapolis, MN, USA
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20
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Krueger AM, Roediger DJ, Mueller BA, Boys CA, Hendrickson TJ, Schumacher MJ, Mattson SN, Jones KL, Riley EP, Lim KO, Wozniak JR. Para-limbic Structural Abnormalities Are Associated With Internalizing Symptoms in Children With Prenatal Alcohol Exposure. Alcohol Clin Exp Res 2020; 44:1598-1608. [PMID: 32524616 PMCID: PMC7484415 DOI: 10.1111/acer.14390] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 05/07/2020] [Accepted: 05/29/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Prenatal alcohol exposure (PAE) is associated with a variety of structural abnormalities in the brain, including several within the para-limbic system. Children with PAE have higher rates of internalizing disorders, including depression and anxiety, which may be related to underlying limbic system anomalies. METHODS Children aged 8 to 16 with PAE (n = 41) or without PAE (n = 36) underwent an magnetic resonance imaging of the brain and parents completed behavioral questionnaires about their children. Semi-automated procedures (FreeSurfer) were used to derive para-limbic volumes from T1-weighted anatomical images. RESULTS There were significant group differences (PAE vs. nonexposed controls) in the caudate, hippocampus, and the putamen; children with PAE had smaller volumes in these regions even after controlling for total intracranial volume. A trend-level association was seen between caudate volume and internalizing symptoms in children with PAE; smaller caudate volumes (presumably reflecting less optimal neurodevelopment) were associated with higher levels of anxiety and depression symptoms in these children. CONCLUSIONS Caudate structure may be disproportionately affected by PAE and may be associated with the later development of internalizing symptoms in those affected by PAE.
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21
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Albott CS, Wozniak JR, McGlinch BP, Wall MH, Gold BS, Vinogradov S. Battle Buddies: Rapid Deployment of a Psychological Resilience Intervention for Health Care Workers During the COVID-19 Pandemic. Anesth Analg 2020; 131:43-54. [PMID: 32345861 PMCID: PMC7199769 DOI: 10.1213/ane.0000000000004912] [Citation(s) in RCA: 233] [Impact Index Per Article: 58.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The outbreak of the coronavirus disease 2019 (COVID-19) and its rapid global spread have created unprecedented challenges to health care systems. Significant and sustained efforts have focused on mobilization of personal protective equipment, intensive care beds, and medical equipment, while substantially less attention has focused on preserving the psychological health of the medical workforce tasked with addressing the challenges of the pandemic. And yet, similar to battlefield conditions, health care workers are being confronted with ongoing uncertainty about resources, capacities, and risks; as well as exposure to suffering, death, and threats to their own safety. These conditions are engendering high levels of fear and anxiety in the shortterm, and place individuals at risk for persistent stressexposure syndromes, subclinical mental health symptoms, and professional burnout in the longterm. Given the potentially wide-ranging mental health impact of COVID-19, protecting health care workers from adverse psychological effects of the pandemic is critical. Therefore, we present an overview of the potential psychological stress responses to the COVID-19 crisis in medical providers and describe preemptive resilience-promoting strategies at the organizational and personal level. We then describe a rapidly deployable Psychological Resilience Intervention founded on a peersupport model (Battle Buddies) developed by the United States Army. This intervention—the product of a multidisciplinary collaboration between the Departments of Anesthesiology and Psychiatry & Behavioral Sciences at the University of Minnesota Medical Center—also incorporates evidence-informed “stress inoculation” methods developed for managing psychological stress exposure in providers deployed to disasters. Our multilevel, resource-efficient, and scalable approach places 2 key tools directly in the hands of providers: (1) apeersupport Battle Buddy; and (2) adesignated mental health consultant who can facilitate training in stress inoculation methods, provide additional support, or coordinate referral for external professional consultation. In parallel, we have instituted a voluntary research data-collection component that will enable us to evaluate the intervention’s effectiveness while also identifying the most salient resilience factors for future iterations. It is our hope that these elements will provide guidance to other organizations seeking to protect the well-being of their medical workforce during the pandemic. Given the remarkable adaptability of human beings, we believe that, by promoting resilience, our diverse health care workforce can emerge from this monumental challenge with new skills, closer relationships, and greater confidence in the power of community.
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Affiliation(s)
| | | | - Brian P McGlinch
- Anesthesiology, School of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Michael H Wall
- Anesthesiology, School of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Barbara S Gold
- Anesthesiology, School of Medicine, University of Minnesota, Minneapolis, Minnesota
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22
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Boroda E, Krueger AM, Bansal P, Schumacher MJ, Roy AV, Boys CJ, Lim KO, Wozniak JR. A randomized controlled trial of transcranial direct-current stimulation and cognitive training in children with fetal alcohol spectrum disorder. Brain Stimul 2020; 13:1059-1068. [PMID: 32360392 DOI: 10.1016/j.brs.2020.04.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 04/20/2020] [Accepted: 04/22/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND This study was a randomized double-blind sham-controlled trial examining the effects of transcranial direct current stimulation (tDCS) augmented cognitive training (CT) in children with Fetal Alcohol Spectrum Disorders (FASD). Prenatal alcohol exposure has profound detrimental effects on brain development and individuals with FASD commonly present with deficits in executive functions including attention and working memory. The most commonly studied treatment for executive deficits is CT, which involves repeated drilling of exercises targeting the impaired functions. As currently implemented, CT requires many hours and the observed effect sizes are moderate. Neuromodulation via tDCS can enhance brain plasticity and prior studies demonstrate that combining tDCS with CT improves efficacy and functional outcomes. TDCS-augmented CT has not yet been tested in FASD, a condition in which there are known abnormalities in neuroplasticity and few interventions. METHODS This study examined the feasibility and efficacy of this approach in 44 children with FASD. Participants were randomized to receive five sessions of CT with either active or sham tDCS targeting the dorsolateral prefrontal cortex, a region of the brain that is heavily involved in executive functioning. RESULTS The intervention was feasible and well-tolerated in children with FASD. The tDCS group showed nominally significant improvement in attention on a continuous performance test compared to sham (p = .043). Group differences were observed at the third, fourth and fifth treatment sessions. There was no effect of tDCS on working memory (p = .911). Further, we found no group differences on a trail making task (p = .659) or on the verbal fluency test (p = .826). In the active tDCS group, a significant correlation was observed between improvement in attention scores and decrease in parent-reported attention deficits (p = .010). CONCLUSIONS These results demonstrate that tDCS-augmented CT is well tolerated in children with FASD and potentially offers benefits over and above CT alone.
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23
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Uban KA, Kan E, Wozniak JR, Mattson SN, Coles CD, Sowell ER. The Relationship Between Socioeconomic Status and Brain Volume in Children and Adolescents With Prenatal Alcohol Exposure. Front Hum Neurosci 2020; 14:85. [PMID: 32322193 PMCID: PMC7156853 DOI: 10.3389/fnhum.2020.00085] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 02/27/2020] [Indexed: 01/07/2023] Open
Abstract
The positive relationship between socioeconomic status (SES) and cognitive performance is mediated, in part, by differences in brain structure in typically developing youth. Associations between brain regions that relate to SES overlap with brain regions known to be sensitive to prenatal alcohol exposure (PAE). Animal models demonstrate that PAE attenuates neural and cognitive benefits of early life enrichment. However, whether or not environmental factors related to SES are associated with brain development in youth affected by PAE remains unknown in humans.
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Affiliation(s)
- Kristina A Uban
- Public Health, University of California, Irvine, Irvine, CA, United States.,Department of Pediatrics, Keck School of Medicine, Children's Hospital Los Angeles, University of Southern California, Los Angeles, CA, United States
| | - Eric Kan
- Department of Pediatrics, Keck School of Medicine, Children's Hospital Los Angeles, University of Southern California, Los Angeles, CA, United States
| | - Jeffrey R Wozniak
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, United States
| | - Sarah N Mattson
- Department of Psychology, San Diego State University, San Diego, CA, United States
| | - Claire D Coles
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, United States
| | - Elizabeth R Sowell
- Department of Pediatrics, Keck School of Medicine, Children's Hospital Los Angeles, University of Southern California, Los Angeles, CA, United States
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24
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Wozniak JR, Fink BA, Fuglestad AJ, Eckerle JK, Boys CJ, Sandness KE, Radke JP, Miller NC, Lindgren C, Brearley AM, Zeisel SH, Georgieff MK. Four-year follow-up of a randomized controlled trial of choline for neurodevelopment in fetal alcohol spectrum disorder. J Neurodev Disord 2020; 12:9. [PMID: 32164522 PMCID: PMC7066854 DOI: 10.1186/s11689-020-09312-7] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 02/26/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Despite the high prevalence of fetal alcohol spectrum disorder (FASD), there are few interventions targeting its core neurocognitive and behavioral deficits. FASD is often conceptualized as static and permanent, but interventions that capitalize on brain plasticity and critical developmental windows are emerging. We present a long-term follow-up study evaluating the neurodevelopmental effects of choline supplementation in children with FASD 4 years after an initial efficacy trial. METHODS The initial study was a randomized, double-blind, placebo-controlled trial of choline vs. placebo in 2-5-year-olds with FASD. Participants include 31 children (16 placebo; 15 choline) seen 4 years after trial completion. The mean age at follow-up was 8.6 years. Diagnoses were 12.9% fetal alcohol syndrome (FAS), 41.9% partial FAS, and 45.1% alcohol-related neurodevelopmental disorder. The follow-up included measures of intelligence, memory, executive functioning, and behavior. RESULTS Children who received choline had higher non-verbal intelligence, higher visual-spatial skill, higher working memory ability, better verbal memory, and fewer behavioral symptoms of attention deficit hyperactivity disorder than the placebo group. No differences were seen for verbal intelligence, visual memory, or other executive functions. CONCLUSIONS These data support choline as a potential neurodevelopmental intervention for FASD and highlight the need for long-term follow-up to capture treatment effects on neurodevelopmental trajectories. TRIAL REGISTRATION ClinicalTrials.Gov #NCT01149538; Registered: June 23, 2010; first enrollment July 2, 2010.
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Affiliation(s)
- Jeffrey R Wozniak
- University of Minnesota Twin Cities, Minneapolis, MN, USA.
- Department of Psychiatry, University of Minnesota, F282 / 2A West, 2450 Riverside Ave, Minneapolis, MN, 55454, USA.
| | - Birgit A Fink
- University of Minnesota Twin Cities, Minneapolis, MN, USA
| | | | | | | | | | | | - Neely C Miller
- University of Minnesota Twin Cities, Minneapolis, MN, USA
| | | | - Ann M Brearley
- University of Minnesota Twin Cities, Minneapolis, MN, USA
| | - Steven H Zeisel
- University of North Carolina, Nutrition Research Institute, Kannapolis, NC, USA
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25
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Sarkar DK, Gangisetty O, Wozniak JR, Eckerle JK, Georgieff MK, Foroud TM, Wetherill L, Wertelecki W, Chambers CD, Riley E, Zymak-Zakutnya N, Yevtushok L. Persistent Changes in Stress-Regulatory Genes in Pregnant Women or Children Exposed Prenatally to Alcohol. Alcohol Clin Exp Res 2019; 43:1887-1897. [PMID: 31329297 PMCID: PMC6722014 DOI: 10.1111/acer.14148] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 07/10/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND We have recently shown that binge or heavy levels of alcohol drinking increase deoxyribonucleic acid (DNA) methylation and reduce gene expression of proopiomelanocortin (POMC) and period 2 (PER2) in adult human subjects (Gangisetty et al., Alcohol Clin Exp Res, 43, 2019, 212). One hypothesis would be that methylation of these 2 genes is consistently associated with alcohol exposure and could be used as biomarkers to predict risk of prenatal alcohol exposure (PAE). Results of the present study provided some support for this hypothesis. METHODS We conducted a series of studies to determine DNA methylation changes in stress regulatory genes proopiomelanocortin (POMC) and period 2 (PER2) using biological samples from 3 separate cohorts of patients: (i) pregnant women who consumed moderate-to-high levels of alcohol or low/unexposed controls, (ii) children with PAE and non-alcohol-exposed controls, and (iii) children with PAE treated with or without choline. RESULTS We found pregnant women who consumed moderate-to-high levels of alcohol and gave birth to PAE children had higher DNA methylation of POMC and PER2. PAE children also had increased methylation of POMC and PER2. The differences in the gene methylation of PER2 and POMC between PAE and controls did not differ by maternal smoking status. PAE children had increased levels of stress hormone cortisol and adrenocorticotropic hormone. Choline supplementation reduced DNA hypermethylation and increased expression of POMC and PER2 in children with PAE. CONCLUSIONS These data suggest that PAE significantly elevates DNA methylation of POMC and PER2 and increases levels of stress hormones. Furthermore, these results suggest the possibility that measuring DNA methylation levels of PER2 and POMC in biological samples from pregnant women or from children may be useful for identification of a woman or a child with PAE.
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Affiliation(s)
- Dipak K. Sarkar
- Rutgers Endocrine Research Program. Department of Animal Sciences, Rutgers University, 67 Poultry Farm Lane, New Brunswick, NJ 08901, USA
| | - Omkaram Gangisetty
- Rutgers Endocrine Research Program. Department of Animal Sciences, Rutgers University, 67 Poultry Farm Lane, New Brunswick, NJ 08901, USA
| | - Jeffrey R. Wozniak
- Department of Psychiatry, University of Minnesota Twin Cities, F282/2A West, 2450 Riverside Ave, Minneapolis, MN 55454, USA
| | - Judith K. Eckerle
- Department Pediatrics, University of Minnesota, Minneapolis, MN 55414, USA
| | - Michael K. Georgieff
- Division of Pediatric Neonatology, University of Minnesota, Minneapolis, MN 55414, USA
| | - Tatiana M Foroud
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, 46202, USA
| | - Leah Wetherill
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, 46202, USA
| | - Wladimir Wertelecki
- Department of Pediatrics, University of California San Diego, La Jolla, CA, 92054, USA
| | - Christina D. Chambers
- Department of Pediatrics, University of California San Diego, La Jolla, CA, 92054, USA
| | - Edward Riley
- Department of Psychology, Center for Behavioral Teratology, San Diego State University, San Diego, California, 92120, USA
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26
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Doyle LR, Glass L, Wozniak JR, Kable JA, Riley EP, Coles CD, Sowell ER, Jones KL, Mattson SN. Relation Between Oppositional/Conduct Behaviors and Executive Function Among Youth with Histories of Heavy Prenatal Alcohol Exposure. Alcohol Clin Exp Res 2019; 43:1135-1144. [PMID: 30908651 DOI: 10.1111/acer.14036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 03/16/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Youth with heavy prenatal alcohol exposure have high rates of behavioral concerns and psychopathology, including increased oppositional and conduct behaviors. The relation between those concerns and executive function (EF) deficits is unknown. We investigated the association of oppositional and conduct behavior and EF in adolescents to inform targeted intervention. METHODS Subjects (N = 267) ages 10 to 17 years comprised 3 groups: alcohol-exposed with oppositional/conduct behaviors (AE+), alcohol-exposed without oppositional/conduct behaviors (AE-), and controls (CON). Group differences on direct neuropsychological (Delis-Kaplan Executive Function System [D-KEFS]) and indirect parent-report (Behavior Rating Inventory of Executive Function [BRIEF]) EF measures were tested with multivariate analysis of covariances, followed by univariate analysis of variances and pairwise comparisons. The contribution of attention-deficit/hyperactivity disorder (ADHD) within the AE groups was assessed in secondary analyses. RESULTS On the D-KEFS, there was an omnibus main effect of group, with significant main effects on 3 of 6 variables (CON>AE+, AE-). Within the AE groups, ADHD did not alter the results. On the BRIEF, there was an omnibus significant main effect of group, with significant main effects on all scales (CON<AE-<AE+). Within the AE groups, the AE+ group had higher BRIEF scores (i.e., more difficulty) than the AE- group on 4 of 8 subscales when accounting for presence of ADHD. CONCLUSIONS EF deficits in youth with histories of prenatal alcohol exposure were confirmed using direct and indirect measures. Oppositional/conduct behaviors related to EF deficits on indirect but not direct EF measures. Greater understanding of the contribution of concurrent psychopathology to long-term outcomes for alcohol-exposed youth requires further investigation.
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Affiliation(s)
- Lauren R Doyle
- Center for Behavioral Teratology and Department of Psychology , San Diego State University, San Diego, California
| | - Leila Glass
- Semel Institute for Neuroscience and Human Behavior , University of California, Los Angeles, California
| | - Jeffrey R Wozniak
- Department of Psychiatry , University of Minnesota, Minneapolis, Minnesota
| | - Julie A Kable
- Department of Pediatrics , Emory University School of Medicine, Atlanta, Georgia
| | - Edward P Riley
- Center for Behavioral Teratology and Department of Psychology , San Diego State University, San Diego, California
| | - Claire D Coles
- Department of Pediatrics , Emory University School of Medicine, Atlanta, Georgia.,Department of Psychiatry and Behavioral Sciences , Emory University School of Medicine, Atlanta, Georgia
| | - Elizabeth R Sowell
- Department of Pediatrics , Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Kenneth Lyons Jones
- Department of Pediatrics , San Diego School of Medicine, University of California, San Diego, California
| | - Sarah N Mattson
- Center for Behavioral Teratology and Department of Psychology , San Diego State University, San Diego, California
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27
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King KE, Rudser KD, Nestrasil I, Kovac V, Delaney KA, Wozniak JR, Mueller BA, Lim KO, Eisengart JB, Mamak EG, Raiman J, Ali N, Cagle S, Harmatz P, Whitley CB, Shapiro EG. Attention and corpus callosum volumes in individuals with mucopolysaccharidosis type I. Neurology 2019; 92:e2321-e2328. [PMID: 30979856 DOI: 10.1212/wnl.0000000000007496] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 01/16/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Previous research suggests attention and white matter (WM) abnormalities in individuals with mucopolysaccharidosis type I (MPS I); this cross-sectional comparison is one of the first to examine the relationship of WM structural abnormalities as measured by corpus callosum (CC) volumes with attention scores to evaluate this relationship in a larger sample of patients with MPS I. METHODS Volumetric MRI data and performance on a computerized measure of sustained attention were compared for 18 participants with the severe form of MPS I (MPS IH), 18 participants with the attenuated form of MPS I (MPS IATT), and 60 typically developing age-matched controls. RESULTS The MPS I groups showed below-average mean attention scores (p < 0.001) and smaller CC volumes (p < 0.001) than controls. No significant associations were found between attention performance and CC volume for controls. Attention was associated with posterior CC volumes in the participants with MPS IH (p = 0.053) and total (p = 0.007) and anterior (p < 0.001) CC volumes in participants with MPS IATT. CONCLUSIONS We found that attention and CC volumes were reduced in participants with MPS I compared to typically developing controls. Smaller CC volumes in participants with MPS I were associated with decreased attention; such an association was not seen in controls. While hematopoietic cell transplantation used to treat MPS IH may compound these effects, attention difficulties were also seen in the MPS IATT group, suggesting that disease effects contribute substantially to the clinical attentional difficulties seen in this population.
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Affiliation(s)
- Kelly E King
- From the Departments of Pediatrics (K.K., I.N., V.K., K.A.D., J.B.E., E.G.S.), Psychiatry (J.R.W., B.A.M., K.O.L.), and Genetics and Metabolism (C.B.W.), University of Minnesota Medical Center; Division of Biostatistics (K.D.R.), University of Minnesota School of Public Health, Minneapolis; Department of Psychology (E.G.M., J.R.), Hospital for Sick Children-Toronto, Ontario, Canada; Department of Human Genetics (N.A., S.C.), Emory University, Atlanta, GA; and Division of Gastroenterology and Nutrition (P.H.), UCSF Benioff Children's Hospital Oakland, San Francisco, CA. Dr. Kovac is now at the School of Medicine, Washington University in St. Louis, MO. Dr. Raiman is now at the Department of Inherited Metabolic Diseases, Birmingham Children's Hospital, UK. K.A. Delaney is now at Biomarin Pharmaceuticals, San Rafael, CA.
| | - Kyle D Rudser
- From the Departments of Pediatrics (K.K., I.N., V.K., K.A.D., J.B.E., E.G.S.), Psychiatry (J.R.W., B.A.M., K.O.L.), and Genetics and Metabolism (C.B.W.), University of Minnesota Medical Center; Division of Biostatistics (K.D.R.), University of Minnesota School of Public Health, Minneapolis; Department of Psychology (E.G.M., J.R.), Hospital for Sick Children-Toronto, Ontario, Canada; Department of Human Genetics (N.A., S.C.), Emory University, Atlanta, GA; and Division of Gastroenterology and Nutrition (P.H.), UCSF Benioff Children's Hospital Oakland, San Francisco, CA. Dr. Kovac is now at the School of Medicine, Washington University in St. Louis, MO. Dr. Raiman is now at the Department of Inherited Metabolic Diseases, Birmingham Children's Hospital, UK. K.A. Delaney is now at Biomarin Pharmaceuticals, San Rafael, CA
| | - Igor Nestrasil
- From the Departments of Pediatrics (K.K., I.N., V.K., K.A.D., J.B.E., E.G.S.), Psychiatry (J.R.W., B.A.M., K.O.L.), and Genetics and Metabolism (C.B.W.), University of Minnesota Medical Center; Division of Biostatistics (K.D.R.), University of Minnesota School of Public Health, Minneapolis; Department of Psychology (E.G.M., J.R.), Hospital for Sick Children-Toronto, Ontario, Canada; Department of Human Genetics (N.A., S.C.), Emory University, Atlanta, GA; and Division of Gastroenterology and Nutrition (P.H.), UCSF Benioff Children's Hospital Oakland, San Francisco, CA. Dr. Kovac is now at the School of Medicine, Washington University in St. Louis, MO. Dr. Raiman is now at the Department of Inherited Metabolic Diseases, Birmingham Children's Hospital, UK. K.A. Delaney is now at Biomarin Pharmaceuticals, San Rafael, CA
| | - Victor Kovac
- From the Departments of Pediatrics (K.K., I.N., V.K., K.A.D., J.B.E., E.G.S.), Psychiatry (J.R.W., B.A.M., K.O.L.), and Genetics and Metabolism (C.B.W.), University of Minnesota Medical Center; Division of Biostatistics (K.D.R.), University of Minnesota School of Public Health, Minneapolis; Department of Psychology (E.G.M., J.R.), Hospital for Sick Children-Toronto, Ontario, Canada; Department of Human Genetics (N.A., S.C.), Emory University, Atlanta, GA; and Division of Gastroenterology and Nutrition (P.H.), UCSF Benioff Children's Hospital Oakland, San Francisco, CA. Dr. Kovac is now at the School of Medicine, Washington University in St. Louis, MO. Dr. Raiman is now at the Department of Inherited Metabolic Diseases, Birmingham Children's Hospital, UK. K.A. Delaney is now at Biomarin Pharmaceuticals, San Rafael, CA
| | - Kathleen A Delaney
- From the Departments of Pediatrics (K.K., I.N., V.K., K.A.D., J.B.E., E.G.S.), Psychiatry (J.R.W., B.A.M., K.O.L.), and Genetics and Metabolism (C.B.W.), University of Minnesota Medical Center; Division of Biostatistics (K.D.R.), University of Minnesota School of Public Health, Minneapolis; Department of Psychology (E.G.M., J.R.), Hospital for Sick Children-Toronto, Ontario, Canada; Department of Human Genetics (N.A., S.C.), Emory University, Atlanta, GA; and Division of Gastroenterology and Nutrition (P.H.), UCSF Benioff Children's Hospital Oakland, San Francisco, CA. Dr. Kovac is now at the School of Medicine, Washington University in St. Louis, MO. Dr. Raiman is now at the Department of Inherited Metabolic Diseases, Birmingham Children's Hospital, UK. K.A. Delaney is now at Biomarin Pharmaceuticals, San Rafael, CA
| | - Jeffrey R Wozniak
- From the Departments of Pediatrics (K.K., I.N., V.K., K.A.D., J.B.E., E.G.S.), Psychiatry (J.R.W., B.A.M., K.O.L.), and Genetics and Metabolism (C.B.W.), University of Minnesota Medical Center; Division of Biostatistics (K.D.R.), University of Minnesota School of Public Health, Minneapolis; Department of Psychology (E.G.M., J.R.), Hospital for Sick Children-Toronto, Ontario, Canada; Department of Human Genetics (N.A., S.C.), Emory University, Atlanta, GA; and Division of Gastroenterology and Nutrition (P.H.), UCSF Benioff Children's Hospital Oakland, San Francisco, CA. Dr. Kovac is now at the School of Medicine, Washington University in St. Louis, MO. Dr. Raiman is now at the Department of Inherited Metabolic Diseases, Birmingham Children's Hospital, UK. K.A. Delaney is now at Biomarin Pharmaceuticals, San Rafael, CA
| | - Bryon A Mueller
- From the Departments of Pediatrics (K.K., I.N., V.K., K.A.D., J.B.E., E.G.S.), Psychiatry (J.R.W., B.A.M., K.O.L.), and Genetics and Metabolism (C.B.W.), University of Minnesota Medical Center; Division of Biostatistics (K.D.R.), University of Minnesota School of Public Health, Minneapolis; Department of Psychology (E.G.M., J.R.), Hospital for Sick Children-Toronto, Ontario, Canada; Department of Human Genetics (N.A., S.C.), Emory University, Atlanta, GA; and Division of Gastroenterology and Nutrition (P.H.), UCSF Benioff Children's Hospital Oakland, San Francisco, CA. Dr. Kovac is now at the School of Medicine, Washington University in St. Louis, MO. Dr. Raiman is now at the Department of Inherited Metabolic Diseases, Birmingham Children's Hospital, UK. K.A. Delaney is now at Biomarin Pharmaceuticals, San Rafael, CA
| | - Kelvin O Lim
- From the Departments of Pediatrics (K.K., I.N., V.K., K.A.D., J.B.E., E.G.S.), Psychiatry (J.R.W., B.A.M., K.O.L.), and Genetics and Metabolism (C.B.W.), University of Minnesota Medical Center; Division of Biostatistics (K.D.R.), University of Minnesota School of Public Health, Minneapolis; Department of Psychology (E.G.M., J.R.), Hospital for Sick Children-Toronto, Ontario, Canada; Department of Human Genetics (N.A., S.C.), Emory University, Atlanta, GA; and Division of Gastroenterology and Nutrition (P.H.), UCSF Benioff Children's Hospital Oakland, San Francisco, CA. Dr. Kovac is now at the School of Medicine, Washington University in St. Louis, MO. Dr. Raiman is now at the Department of Inherited Metabolic Diseases, Birmingham Children's Hospital, UK. K.A. Delaney is now at Biomarin Pharmaceuticals, San Rafael, CA
| | - Julie B Eisengart
- From the Departments of Pediatrics (K.K., I.N., V.K., K.A.D., J.B.E., E.G.S.), Psychiatry (J.R.W., B.A.M., K.O.L.), and Genetics and Metabolism (C.B.W.), University of Minnesota Medical Center; Division of Biostatistics (K.D.R.), University of Minnesota School of Public Health, Minneapolis; Department of Psychology (E.G.M., J.R.), Hospital for Sick Children-Toronto, Ontario, Canada; Department of Human Genetics (N.A., S.C.), Emory University, Atlanta, GA; and Division of Gastroenterology and Nutrition (P.H.), UCSF Benioff Children's Hospital Oakland, San Francisco, CA. Dr. Kovac is now at the School of Medicine, Washington University in St. Louis, MO. Dr. Raiman is now at the Department of Inherited Metabolic Diseases, Birmingham Children's Hospital, UK. K.A. Delaney is now at Biomarin Pharmaceuticals, San Rafael, CA
| | - Eva G Mamak
- From the Departments of Pediatrics (K.K., I.N., V.K., K.A.D., J.B.E., E.G.S.), Psychiatry (J.R.W., B.A.M., K.O.L.), and Genetics and Metabolism (C.B.W.), University of Minnesota Medical Center; Division of Biostatistics (K.D.R.), University of Minnesota School of Public Health, Minneapolis; Department of Psychology (E.G.M., J.R.), Hospital for Sick Children-Toronto, Ontario, Canada; Department of Human Genetics (N.A., S.C.), Emory University, Atlanta, GA; and Division of Gastroenterology and Nutrition (P.H.), UCSF Benioff Children's Hospital Oakland, San Francisco, CA. Dr. Kovac is now at the School of Medicine, Washington University in St. Louis, MO. Dr. Raiman is now at the Department of Inherited Metabolic Diseases, Birmingham Children's Hospital, UK. K.A. Delaney is now at Biomarin Pharmaceuticals, San Rafael, CA
| | - Julian Raiman
- From the Departments of Pediatrics (K.K., I.N., V.K., K.A.D., J.B.E., E.G.S.), Psychiatry (J.R.W., B.A.M., K.O.L.), and Genetics and Metabolism (C.B.W.), University of Minnesota Medical Center; Division of Biostatistics (K.D.R.), University of Minnesota School of Public Health, Minneapolis; Department of Psychology (E.G.M., J.R.), Hospital for Sick Children-Toronto, Ontario, Canada; Department of Human Genetics (N.A., S.C.), Emory University, Atlanta, GA; and Division of Gastroenterology and Nutrition (P.H.), UCSF Benioff Children's Hospital Oakland, San Francisco, CA. Dr. Kovac is now at the School of Medicine, Washington University in St. Louis, MO. Dr. Raiman is now at the Department of Inherited Metabolic Diseases, Birmingham Children's Hospital, UK. K.A. Delaney is now at Biomarin Pharmaceuticals, San Rafael, CA
| | - Nadia Ali
- From the Departments of Pediatrics (K.K., I.N., V.K., K.A.D., J.B.E., E.G.S.), Psychiatry (J.R.W., B.A.M., K.O.L.), and Genetics and Metabolism (C.B.W.), University of Minnesota Medical Center; Division of Biostatistics (K.D.R.), University of Minnesota School of Public Health, Minneapolis; Department of Psychology (E.G.M., J.R.), Hospital for Sick Children-Toronto, Ontario, Canada; Department of Human Genetics (N.A., S.C.), Emory University, Atlanta, GA; and Division of Gastroenterology and Nutrition (P.H.), UCSF Benioff Children's Hospital Oakland, San Francisco, CA. Dr. Kovac is now at the School of Medicine, Washington University in St. Louis, MO. Dr. Raiman is now at the Department of Inherited Metabolic Diseases, Birmingham Children's Hospital, UK. K.A. Delaney is now at Biomarin Pharmaceuticals, San Rafael, CA
| | - Stephanie Cagle
- From the Departments of Pediatrics (K.K., I.N., V.K., K.A.D., J.B.E., E.G.S.), Psychiatry (J.R.W., B.A.M., K.O.L.), and Genetics and Metabolism (C.B.W.), University of Minnesota Medical Center; Division of Biostatistics (K.D.R.), University of Minnesota School of Public Health, Minneapolis; Department of Psychology (E.G.M., J.R.), Hospital for Sick Children-Toronto, Ontario, Canada; Department of Human Genetics (N.A., S.C.), Emory University, Atlanta, GA; and Division of Gastroenterology and Nutrition (P.H.), UCSF Benioff Children's Hospital Oakland, San Francisco, CA. Dr. Kovac is now at the School of Medicine, Washington University in St. Louis, MO. Dr. Raiman is now at the Department of Inherited Metabolic Diseases, Birmingham Children's Hospital, UK. K.A. Delaney is now at Biomarin Pharmaceuticals, San Rafael, CA
| | - Paul Harmatz
- From the Departments of Pediatrics (K.K., I.N., V.K., K.A.D., J.B.E., E.G.S.), Psychiatry (J.R.W., B.A.M., K.O.L.), and Genetics and Metabolism (C.B.W.), University of Minnesota Medical Center; Division of Biostatistics (K.D.R.), University of Minnesota School of Public Health, Minneapolis; Department of Psychology (E.G.M., J.R.), Hospital for Sick Children-Toronto, Ontario, Canada; Department of Human Genetics (N.A., S.C.), Emory University, Atlanta, GA; and Division of Gastroenterology and Nutrition (P.H.), UCSF Benioff Children's Hospital Oakland, San Francisco, CA. Dr. Kovac is now at the School of Medicine, Washington University in St. Louis, MO. Dr. Raiman is now at the Department of Inherited Metabolic Diseases, Birmingham Children's Hospital, UK. K.A. Delaney is now at Biomarin Pharmaceuticals, San Rafael, CA
| | - Chester B Whitley
- From the Departments of Pediatrics (K.K., I.N., V.K., K.A.D., J.B.E., E.G.S.), Psychiatry (J.R.W., B.A.M., K.O.L.), and Genetics and Metabolism (C.B.W.), University of Minnesota Medical Center; Division of Biostatistics (K.D.R.), University of Minnesota School of Public Health, Minneapolis; Department of Psychology (E.G.M., J.R.), Hospital for Sick Children-Toronto, Ontario, Canada; Department of Human Genetics (N.A., S.C.), Emory University, Atlanta, GA; and Division of Gastroenterology and Nutrition (P.H.), UCSF Benioff Children's Hospital Oakland, San Francisco, CA. Dr. Kovac is now at the School of Medicine, Washington University in St. Louis, MO. Dr. Raiman is now at the Department of Inherited Metabolic Diseases, Birmingham Children's Hospital, UK. K.A. Delaney is now at Biomarin Pharmaceuticals, San Rafael, CA
| | - Elsa G Shapiro
- From the Departments of Pediatrics (K.K., I.N., V.K., K.A.D., J.B.E., E.G.S.), Psychiatry (J.R.W., B.A.M., K.O.L.), and Genetics and Metabolism (C.B.W.), University of Minnesota Medical Center; Division of Biostatistics (K.D.R.), University of Minnesota School of Public Health, Minneapolis; Department of Psychology (E.G.M., J.R.), Hospital for Sick Children-Toronto, Ontario, Canada; Department of Human Genetics (N.A., S.C.), Emory University, Atlanta, GA; and Division of Gastroenterology and Nutrition (P.H.), UCSF Benioff Children's Hospital Oakland, San Francisco, CA. Dr. Kovac is now at the School of Medicine, Washington University in St. Louis, MO. Dr. Raiman is now at the Department of Inherited Metabolic Diseases, Birmingham Children's Hospital, UK. K.A. Delaney is now at Biomarin Pharmaceuticals, San Rafael, CA
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Gross LA, Moore EM, Wozniak JR, Coles CD, Kable JA, Sowell ER, Jones KL, Riley EP, Mattson SN. Neural correlates of verbal memory in youth with heavy prenatal alcohol exposure. Brain Imaging Behav 2019; 12:806-822. [PMID: 28656347 DOI: 10.1007/s11682-017-9739-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Prenatal alcohol exposure can impact both brain development and neurobehavioral function, including verbal learning and recall, although the relation between verbal recall and brain structure in this population has not been examined fully. We aimed to determine the structural neural correlates of verbal learning and recall in youth with histories of heavy prenatal alcohol exposure using a region of interest (ROI) approach. As part of an ongoing multisite project, subjects (age 10-16 years) with prenatal alcohol exposure (AE, n = 81) and controls (CON, n = 81) were tested using the CVLT-C and measures of cortical volume, surface area, and thickness as well as hippocampal volume were derived from MRI. Group differences in brain and memory indices were tested with ANOVA. Multiple regression analyses tested whether brain ROIs significantly predicted memory performance. The AE group had lower scores than the CON group on all CVLT-C variables (ps ≤ .001) and volume and surface area (ps < .025), although results varied by ROI. No group differences in cortical thickness were found. The relations between cortical structure and memory performance differed between group among some ROIs, particularly those in the frontal cortex, generally with smaller surface area and/or thinner cortex predicting better performance in CON but worse performance in AE. Cortical surface area appears to be the most sensitive index to the effects of prenatal alcohol exposure, while cortical thickness appears to be the least sensitive. These findings also indicate that the neural correlates of verbal memory are altered in youth with heavy prenatal alcohol exposure compared to controls.
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Affiliation(s)
- Lauren A Gross
- Center for Behavioral Teratology, Department of Psychology, San Diego State University, 6330 Alvarado Court, Suite 100, San Diego, CA, 92120, USA
| | - Eileen M Moore
- Center for Behavioral Teratology, Department of Psychology, San Diego State University, 6330 Alvarado Court, Suite 100, San Diego, CA, 92120, USA
| | - Jeffrey R Wozniak
- Department of Psychiatry, University of Minnesota, F282/2A West, 2450 Riverside Ave, Minneapolis, MN, 55454, USA
| | - Claire D Coles
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 12 Executive Park Drive, Atlanta, GA, 30329, USA.,Department of Pediatrics, Emory University School of Medicine, 12 Executive Park Drive, Atlanta, GA, 30329, USA
| | - Julie A Kable
- Department of Pediatrics, Emory University School of Medicine, 12 Executive Park Drive, Atlanta, GA, 30329, USA
| | - Elizabeth R Sowell
- Department of Pediatrics, Keck School of Medicine, Children's Hospital Los Angeles, University of Southern California, 4650 Sunset Blvd., Mailstop #130, Los Angeles, CA, 90027, USA
| | - Kenneth L Jones
- Department of Pediatrics, School of Medicine, University of California, San Diego, 9500 Gilman Dr, La Jolla, CA, 92093-0828, USA
| | - Edward P Riley
- Center for Behavioral Teratology, Department of Psychology, San Diego State University, 6330 Alvarado Court, Suite 100, San Diego, CA, 92120, USA
| | - Sarah N Mattson
- Center for Behavioral Teratology, Department of Psychology, San Diego State University, 6330 Alvarado Court, Suite 100, San Diego, CA, 92120, USA.
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29
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Suttie M, Wozniak JR, Parnell SE, Wetherill L, Mattson SN, Sowell ER, Kan E, Riley EP, Jones KL, Coles C, Foroud T, Hammond P. Combined Face-Brain Morphology and Associated Neurocognitive Correlates in Fetal Alcohol Spectrum Disorders. Alcohol Clin Exp Res 2018; 42:1769-1782. [PMID: 29935097 PMCID: PMC6120799 DOI: 10.1111/acer.13820] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 06/20/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Since the 1970s, a range of facial, neurostructural, and neurocognitive adverse effects have been shown to be associated with prenatal alcohol exposure. Typically, these effects are studied individually and not in combination. Our objective is to improve the understanding of the teratogenic effects of prenatal alcohol exposure by simultaneously considering face-brain morphology and neurocognitive measures. METHODS Participants were categorized as control (n = 47), fetal alcohol syndrome (FAS, n = 22), or heavily exposed (HE) prenatally, but not eligible for a FAS diagnosis (HE, n = 50). Structural brain MRI images and high-resolution 3D facial images were analyzed using dense surface models of features of the face and surface shape of the corpus callosum (CC) and caudate nucleus (CN). Asymmetry of the CN was evaluated for correlations with neurocognitive measures. RESULTS (i) Facial growth delineations for FAS, HE, and controls are replicated for the CN and the CC. (ii) Concordance of clinical diagnosis and face-based control-FAS discrimination improves when the latter is combined with specific brain regions. In particular, midline facial regions discriminate better when combined with a midsagittal profile of the CC. (iii) A subset of HE individuals was identified with FAS-like CN dysmorphism. The average of this HE subset was FAS-like in its facial dysmorphism. (iv) Right-left asymmetry found in the CNs of controls is not apparent for FAS, is diminished for HE, and correlates with neurocognitive measures in the combined FAS and HE population. CONCLUSIONS Shape analysis which combines facial regions with the CN, and with the CC, better identify those with FAS. CN asymmetry was reduced for FAS compared to controls and is strongly associated with general cognitive ability, verbal learning, and recall in those with prenatal alcohol exposure. This study further extends the brain-behavior relationships known to be vulnerable to alcohol teratogenesis.
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Affiliation(s)
- Michael Suttie
- Nuffield Department of Women’s and Reproductive Health, University of Oxford, UK
- Big Data Institute, University of Oxford, UK
| | | | - Scott E. Parnell
- Department of Cell Biology and Physiology, University of North Carolina, Chapel Hill, USA
| | - Leah Wetherill
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, USA
| | - Sarah N. Mattson
- Department of Psychology, San Diego State University, San Diego, California, USA
| | - Elizabeth R. Sowell
- Department of Pediatrics, University of Southern California and Children’s Hospital Los Angeles, USA
| | - Eric Kan
- Department of Pediatrics, University of Southern California and Children’s Hospital Los Angeles, USA
| | - Edward P. Riley
- Department of Psychology, San Diego State University, San Diego, California, USA
| | - Kenneth L. Jones
- Department of Pediatrics, School of Medicine, UCSD, San Diego, USA
| | - Claire Coles
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, USA
| | - Tatiana Foroud
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, USA
| | - Peter Hammond
- Nuffield Department of Women’s and Reproductive Health, University of Oxford, UK
- Big Data Institute, University of Oxford, UK
| | - CIFASD
- Nuffield Department of Women’s and Reproductive Health, University of Oxford, UK
- Big Data Institute, University of Oxford, UK
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Wozniak JR, Mueller BA, Mattson SN, Coles CD, Kable JA, Jones KL, Boys CJ, Lim KO, Riley EP, Sowell ER. Functional connectivity abnormalities and associated cognitive deficits in fetal alcohol Spectrum disorders (FASD). Brain Imaging Behav 2018; 11:1432-1445. [PMID: 27734306 DOI: 10.1007/s11682-016-9624-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Consistent with well-documented structural and microstructural abnormalities in prenatal alcohol exposure (PAE), recent studies suggest that functional connectivity (FC) may also be disrupted. We evaluated whole-brain FC in a large multi-site sample, examined its cognitive correlates, and explored its potential to objectively identify neurodevelopmental abnormality in individuals without definitive dysmorphic features. Included were 75 children with PAE and 68 controls from four sites. All participants had documented heavy prenatal alcohol exposure. All underwent a formal evaluation of physical anomalies and dysmorphic facial features. MRI data were collected using modified matched protocols on three platforms (Siemens, GE, and Philips). Resting-state FC was examined using whole-brain graph theory metrics to characterize each individual's connectivity. Although whole-brain FC metrics did not discriminate prenatally-exposed from unexposed overall, atypical FC (> 1 standard deviation from the grand mean) was significantly more common (2.7 times) in the PAE group vs. CONTROLS In a subset of 55 individuals (PAE and controls) whose dysmorphology examination could not definitively characterize them as either Fetal Alcohol Syndrome (FAS) or non-FAS, atypical FC was seen in 27 % of the PAE group, but 0 % of controls. Across participants, a 1 % difference in local network efficiency was associated with a 36 point difference in global cognitive functioning. Whole-brain FC metrics have potential to identify individuals with objective neurodevelopmental abnormalities from prenatal alcohol exposure. When applied to individuals unable to be classified as FAS or non-FAS from dysmorphology alone, these measures separate prenatally-exposed from non-exposed with high specificity.
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Affiliation(s)
- Jeffrey R Wozniak
- Department of Psychiatry, University of Minnesota Twin Cities, F282/2A West, 2450 Riverside Ave, Minneapolis, MN, 55454, USA.
| | - Bryon A Mueller
- Department of Psychiatry, University of Minnesota Twin Cities, F282/2A West, 2450 Riverside Ave, Minneapolis, MN, 55454, USA
| | | | | | | | - Kenneth L Jones
- University of California, San Diego, La Jolla, CA, 92093, USA
| | - Christopher J Boys
- Department of Psychiatry, University of Minnesota Twin Cities, F282/2A West, 2450 Riverside Ave, Minneapolis, MN, 55454, USA
| | - Kelvin O Lim
- Department of Psychiatry, University of Minnesota Twin Cities, F282/2A West, 2450 Riverside Ave, Minneapolis, MN, 55454, USA
| | | | - Elizabeth R Sowell
- Children's Hospital of Los Angeles, University of Southern California, Los Angeles, CA, USA
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Hendrickson TJ, Mueller BA, Sowell ER, Mattson SN, Coles CD, Kable JA, Jones KL, Boys CJ, Lee S, Lim KO, Riley EP, Wozniak JR. Two-year cortical trajectories are abnormal in children and adolescents with prenatal alcohol exposure. Dev Cogn Neurosci 2018; 30:123-133. [PMID: 29486453 PMCID: PMC5949095 DOI: 10.1016/j.dcn.2018.02.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 10/30/2017] [Accepted: 02/16/2018] [Indexed: 10/29/2022] Open
Abstract
OBJECTIVES Cortical abnormalities in prenatal alcohol exposure (PAE) are known, including in gyrification (LGI), thickness (CT), volume (CV), and surface area (CS). This study provides longitudinal and developmental context to the PAE cortical development literature. EXPERIMENTAL DESIGN Included: 58 children with PAE and 52 controls, ages 6-17 at enrollment, from four Collaborative Initiative on FASD (CIFASD) sites. Participants underwent a formal evaluation of physical anomalies and dysmorphic facial features associated with PAE. MRI data were collected on three platforms (Siemens, GE, and Philips) at four sites. Scans were spaced two years apart. Change in LGI, CT, CS, and CV were examined. PRINCIPAL OBSERVATIONS Several significant regional age-by-diagnosis linear and quadratic interaction effects in LGI, CT, and CV were found, indicating atypical developmental trajectories in PAE. No significant correlations were observed between cortical measures and IQ. CONCLUSIONS Regional differences were seen longitudinally in CT, CV, and LGI in those with PAE. The findings represent important insights into developmental trajectories and may have implications for the timing of assessments and interventions in this population. It is noteworthy that cortical metrics did not correlate with IQ, suggesting that more specific aspects of cognitive development may need to be explored to provide further context.
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Affiliation(s)
| | | | - Elizabeth R Sowell
- Children's Hospital of Los Angeles, USA; University of Southern California, USA
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32
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Medina AE, Wozniak JR, Klintsova AY, Hamilton DA. Proceedings of the 2016 annual meeting of the Fetal Alcohol Spectrum Disorders Study Group. Alcohol 2017; 65:19-24. [PMID: 29084625 DOI: 10.1016/j.alcohol.2017.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 07/08/2017] [Indexed: 11/24/2022]
Abstract
The 2016 Fetal Alcohol Spectrum Disorders Study Group (FASDSG) meeting was titled "Rehabilitation in FASD: Potential Interventions and Challenges". During the previous decades, studies with human subjects and animal models have improved much of our understanding of the mechanisms underlying FASD, putting the scientific community in a good position to test hypotheses that can lead to potential therapeutic interventions. During the conference, two keynote speakers addressed potential interventions used in different fields and their applicability to FASD research. The conference also included updates from several government agencies, short presentations by junior and senior investigators that showcased the latest in FASD research, and award presentations. The conference was closed by a talk by Dr. Charles Goodlett, the recipient of the 2016 Henry Rosett award.
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33
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Suttie M, Wetherill L, Jacobson SW, Jacobson JL, Hoyme HE, Sowell ER, Coles C, Wozniak JR, Riley EP, Jones KL, Foroud T, Hammond P. Facial Curvature Detects and Explicates Ethnic Differences in Effects of Prenatal Alcohol Exposure. Alcohol Clin Exp Res 2017; 41:1471-1483. [PMID: 28608920 DOI: 10.1111/acer.13429] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Accepted: 06/02/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Our objective is to help clinicians detect the facial effects of prenatal alcohol exposure by developing computer-based tools for screening facial form. METHODS All 415 individuals considered were evaluated by expert dysmorphologists and categorized as (i) healthy control (HC), (ii) fetal alcohol syndrome (FAS), or (iii) heavily prenatally alcohol exposed (HE) but not clinically diagnosable as FAS; 3D facial photographs were used to build models of facial form to support discrimination studies. Surface curvature-based delineations of facial form were introduced. RESULTS (i) Facial growth in FAS, HE, and control subgroups is similar in both cohorts. (ii) Cohort consistency of agreement between clinical diagnosis and HC-FAS facial form classification is lower for midline facial regions and higher for nonmidline regions. (iii) Specific HC-FAS differences within and between the cohorts include: for HC, a smoother philtrum in Cape Coloured individuals; for FAS, a smoother philtrum in Caucasians; for control-FAS philtrum difference, greater homogeneity in Caucasians; for control-FAS face difference, greater homogeneity in Cape Coloured individuals. (iv) Curvature changes in facial profile induced by prenatal alcohol exposure are more homogeneous and greater in Cape Coloureds than in Caucasians. (v) The Caucasian HE subset divides into clusters with control-like and FAS-like facial dysmorphism. The Cape Coloured HE subset is similarly divided for nonmidline facial regions but not clearly for midline structures. (vi) The Cape Coloured HE subset with control-like facial dysmorphism shows orbital hypertelorism. CONCLUSIONS Facial curvature assists the recognition of the effects of prenatal alcohol exposure and helps explain why different facial regions result in inconsistent control-FAS discrimination rates in disparate ethnic groups. Heavy prenatal alcohol exposure can give rise to orbital hypertelorism, supporting a long-standing suggestion that prenatal alcohol exposure at a particular time causes increased separation of the brain hemispheres with a concomitant increase in orbital separation.
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Affiliation(s)
- Michael Suttie
- Nuffield Department of Obstetrics and Gynaecology , University of Oxford, Oxford, United Kingdom.,Big Data Institute , University of Oxford, Oxford, UK
| | - Leah Wetherill
- Department of Medical and Molecular Genetics , Indiana University School of Medicine, Indianapolis, Indiana
| | - Sandra W Jacobson
- Department of Psychiatry and Behavioral Neurosciences , Wayne State University School of Medicine, Detroit, Michigan.,Departments of Human Biology and of Psychiatry and Mental Health , University of Cape Town Faculty of Health Sciences, Cape Town, South Africa
| | - Joseph L Jacobson
- Department of Psychiatry and Behavioral Neurosciences , Wayne State University School of Medicine, Detroit, Michigan.,Departments of Human Biology and of Psychiatry and Mental Health , University of Cape Town Faculty of Health Sciences, Cape Town, South Africa
| | - H Eugene Hoyme
- Sanford Research and Department of Pediatrics , Sanford School of Medicine, University of South Dakota, Sioux Falls, South Dakota
| | - Elizabeth R Sowell
- Developmental Cognitive Neuroimaging Laboratory , Children's Hospital Los Angeles, Los Angeles, California
| | - Claire Coles
- Department of Psychiatry and Behavioral Sciences , Emory University School of Medicine, Atlanta, Georgia
| | - Jeffrey R Wozniak
- Department of Psychiatry , University of Minnesota, Minneapolis, Minnesota
| | - Edward P Riley
- Department of Psychology , San Diego State University, San Diego, California
| | - Kenneth L Jones
- Department of Pediatrics , School of Medicine, UCSD, San Diego, California
| | - Tatiana Foroud
- Department of Medical and Molecular Genetics , Indiana University School of Medicine, Indianapolis, Indiana
| | - Peter Hammond
- Nuffield Department of Obstetrics and Gynaecology , University of Oxford, Oxford, United Kingdom.,Big Data Institute , University of Oxford, Oxford, UK
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Hendrickson TJ, Mueller BA, Sowell ER, Mattson SN, Coles CD, Kable JA, Jones KL, Boys CJ, Lim KO, Riley EP, Wozniak JR. Cortical gyrification is abnormal in children with prenatal alcohol exposure. Neuroimage Clin 2017; 15:391-400. [PMID: 28580296 PMCID: PMC5447653 DOI: 10.1016/j.nicl.2017.05.015] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 04/18/2017] [Accepted: 05/21/2017] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Prenatal alcohol exposure (PAE) adversely affects early brain development. Previous studies have shown a wide range of structural and functional abnormalities in children and adolescents with PAE. The current study adds to the existing literature specifically on cortical development by examining cortical gyrification in a large sample of children with PAE compared to controls. Relationships between cortical development and intellectual functioning are also examined. EXPERIMENTAL DESIGN Included were 92 children with PAE and 83 controls ages 9-16 from four sites in the Collaborative Initiative on FASD (CIFASD). All PAE participants had documented heavy PAE. All underwent a formal evaluation of physical anomalies and dysmorphic facial features. MRI data were collected using modified matched protocols on three platforms (Siemens, GE, and Philips). Cortical gyrification was examined using a semi-automated procedure. PRINCIPAL OBSERVATIONS Whole brain group comparisons using Monte Carlo z-simulation for multiple comparisons showed significantly lower cortical gyrification across a large proportion of the cerebral cortex amongst PAE compared to controls. Whole brain comparisons and ROI based analyses showed strong positive correlations between cortical gyrification and IQ (i.e. less developed cortex was associated with lower IQ). CONCLUSIONS Abnormalities in cortical development were seen across the brain in children with PAE compared to controls. Cortical gyrification and IQ were strongly correlated, suggesting that examining mechanisms by which alcohol disrupts cortical formation may yield clinically relevant insights and potential directions for early intervention.
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Affiliation(s)
| | | | - Elizabeth R Sowell
- Children's Hospital of Los Angeles, University of Southern California, United States
| | | | | | | | | | | | - Kelvin O Lim
- University of Minnesota, Twin Cities, United States
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Evanoff NG, Marlatt KL, Mueller BA, Hecht SS, Wozniak JR, Lim KO, Dengel DR. Effects of Multiple Sports Related Concussions On Neurocognition and Cerebral Vascular Function. Med Sci Sports Exerc 2017. [DOI: 10.1249/01.mss.0000517445.11620.b5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Goh PK, Doyle LR, Glass L, Jones KL, Riley EP, Coles CD, Hoyme HE, Kable JA, May PA, Kalberg WO, Elizabeth RS, Wozniak JR, Mattson SN. A Decision Tree to Identify Children Affected by Prenatal Alcohol Exposure. J Pediatr 2016; 177:121-127.e1. [PMID: 27476634 PMCID: PMC5291174 DOI: 10.1016/j.jpeds.2016.06.047] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 05/06/2016] [Accepted: 06/13/2016] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To develop and validate a hierarchical decision tree model that combines neurobehavioral and physical measures to identify children affected by prenatal alcohol exposure even when facial dysmorphology is not present. STUDY DESIGN Data were collected as part of a multisite study across the US. The model was developed after we evaluated more than 1000 neurobehavioral and dysmorphology variables collected from 434 children (8-16 years of age) with prenatal alcohol exposure, with and without fetal alcohol syndrome, and nonexposed control subjects, with and without other clinically-relevant behavioral or cognitive concerns. The model subsequently was validated in an independent sample of 454 children in 2 age ranges (5-7 years or 10-16 years). In all analyses, the discriminatory ability of each model step was tested with logistic regression. Classification accuracies and positive and negative predictive values were calculated. RESULTS The model consisted of variables from 4 measures (2 parent questionnaires, an IQ score, and a physical examination). Overall accuracy rates for both the development and validation samples met or exceeded our goal of 80% overall accuracy. CONCLUSIONS The decision tree model distinguished children affected by prenatal alcohol exposure from nonexposed control subjects, including those with other behavioral concerns or conditions. Improving identification of this population will streamline access to clinical services, including multidisciplinary evaluation and treatment.
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Affiliation(s)
- Patrick K. Goh
- Center for Behavioral Teratology, Department of Psychology, San Diego State University, San Diego, California
| | - Lauren R. Doyle
- Center for Behavioral Teratology, Department of Psychology, San Diego State University, San Diego, California
| | - Leila Glass
- Center for Behavioral Teratology, Department of Psychology, San Diego State University, San Diego, California
| | - Kenneth L. Jones
- Department of Pediatrics, University of California, San Diego, School of Medicine, San Diego, California
| | - Edward P. Riley
- Center for Behavioral Teratology, Department of Psychology, San Diego State University, San Diego, California
| | - Claire D. Coles
- Department of Psychiatry and Behavior Sciences, Emory University School of Medicine, Atlanta, Georgia,Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia,Collaborative Initiative on Fetal Alcohol Spectrum Disorders
| | - H. Eugene Hoyme
- Sanford Research and Sanford School of Medicine of the University of South Dakota, Sioux Falls, South Dakota
| | - Julie A. Kable
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia,Collaborative Initiative on Fetal Alcohol Spectrum Disorders
| | - Philip A. May
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina Nutrition Research Institute, Kannapolis,Center on Alcoholism, Substance Abuse and Addictions, The University of New Mexico, Albuquerque, New Mexico,Collaborative Initiative on Fetal Alcohol Spectrum Disorders
| | - Wendy O. Kalberg
- Center on Alcoholism, Substance Abuse and Addictions, The University of New Mexico, Albuquerque, New Mexico,Collaborative Initiative on Fetal Alcohol Spectrum Disorders
| | - R. Sowell Elizabeth
- Developmental Cognitive Neuroimaging Laboratory, Department of Pediatrics, Keck School of Medicine, University of Southern California; Division of Research on Children, Youth, and Families, Department of Pediatrics, Children’s Hospital Los Angeles, Los Angeles, California,Collaborative Initiative on Fetal Alcohol Spectrum Disorders
| | - Jeffrey R. Wozniak
- Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota,Collaborative Initiative on Fetal Alcohol Spectrum Disorders
| | - Sarah N. Mattson
- Center for Behavioral Teratology, Department of Psychology, San Diego State University, San Diego, California,Collaborative Initiative on Fetal Alcohol Spectrum Disorders
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Panczakiewicz AL, Glass L, Coles CD, Kable JA, Sowell ER, Wozniak JR, Jones KL, Riley EP, Mattson SN. Neurobehavioral Deficits Consistent Across Age and Sex in Youth with Prenatal Alcohol Exposure. Alcohol Clin Exp Res 2016; 40:1971-81. [PMID: 27430360 DOI: 10.1111/acer.13153] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 06/08/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Neurobehavioral consequences of heavy prenatal alcohol exposure are well documented; however, the role of age or sex in these effects has not been studied. The current study examined the effects of prenatal alcohol exposure, sex, and age on neurobehavioral functioning in children. METHODS Subjects were 407 youth with prenatal alcohol exposure (n = 192) and controls (n = 215). Two age groups (child [5 to 7 years] or adolescent [10 to 16 years]) and both sexes were included. All subjects completed standardized neuropsychological testing, and caregivers completed parent-report measures of psychopathology and adaptive behavior. Neuropsychological functioning, psychopathology, and adaptive behavior were analyzed with separate 2 (exposure history) × 2 (sex) × 2 (age) multivariate analyses of variance (MANOVAs). Significant effects were followed by univariate analyses. RESULTS No 3-way or 2-way interactions were significant. The main effect of group was significant in all 3 MANOVAs, with the control group performing better than the alcohol-exposed group on all measures. The main effect of age was significant for neuropsychological performance and adaptive functioning across exposure groups with younger children performing better than older children on 3 measures (language, communication, socialization). Older children performed better than younger children on a different language measure. The main effect of sex was significant for neuropsychological performance and psychopathology; across exposure groups, males had stronger language and visual spatial scores and fewer somatic complaints than females. CONCLUSIONS Prenatal alcohol exposure resulted in impaired neuropsychological and behavioral functioning. Although adolescents with prenatal alcohol exposure may perform more poorly than younger exposed children, the same was true for nonexposed children. Thus, these cross-sectional data indicate that the developmental trajectory for neuropsychological and behavioral performance is not altered by prenatal alcohol exposure, but rather, deficits are consistent across the 2 age groups tested. Similarly, observed sex differences on specific measures were consistent across the groups and do not support sexually dimorphic effects in these domains.
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Affiliation(s)
- Amy L Panczakiewicz
- Department of Psychology, Center for Behavioral Teratology, San Diego State University, San Diego, California
| | - Leila Glass
- Department of Psychology, Center for Behavioral Teratology, San Diego State University, San Diego, California
| | - Claire D Coles
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia.,Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Julie A Kable
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Elizabeth R Sowell
- Department of Pediatrics, Developmental Cognitive Neuroimaging Laboratory, Keck School of Medicine, University of Southern California, Los Angeles, California.,Division of Research on Children, Youth, and Families, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California
| | - Jeffrey R Wozniak
- Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota
| | - Kenneth Lyons Jones
- Department of Pediatrics, School of Medicine, University of California, San Diego, San Diego, California
| | - Edward P Riley
- Department of Psychology, Center for Behavioral Teratology, San Diego State University, San Diego, California
| | - Sarah N Mattson
- Department of Psychology, Center for Behavioral Teratology, San Diego State University, San Diego, California
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Valenzuela CF, Medina AE, Wozniak JR, Klintsova AY. Proceedings of the 2015 Annual Meeting of the Fetal Alcohol Spectrum Disorders Study Group. Alcohol 2016; 50:37-42. [PMID: 26695590 DOI: 10.1016/j.alcohol.2015.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 10/17/2015] [Accepted: 10/21/2015] [Indexed: 10/22/2022]
Abstract
The 2015 Fetal Alcohol Spectrum Disorders Study Group (FASDSG) meeting was titled "Basic Mechanisms and Translational Implications." Despite decades of basic science and clinical research, our understanding of the mechanisms by which ethanol affects fetal development is still in its infancy. The first keynote presentation focused on the role of heat shock protein pathways in the actions of ethanol in the developing brain. The second keynote presentation addressed the use of magnetoencephalography to characterize brain function in children with FASD. The conference also included talks by representatives from several government agencies, short presentations by junior and senior investigators that showcased the latest in FASD research, and award presentations. An important part of the meeting was the presentation of the 2015 Henry Rosett award to Dr. Michael Charness in honor of his achievements in research on FASD.
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39
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Wozniak JR, Fuglestad AJ, Eckerle JK, Fink BA, Hoecker HL, Boys CJ, Radke JP, Kroupina MG, Miller NC, Brearley AM, Zeisel SH, Georgieff MK. Choline supplementation in children with fetal alcohol spectrum disorders: a randomized, double-blind, placebo-controlled trial. Am J Clin Nutr 2015; 102:1113-25. [PMID: 26447156 PMCID: PMC4625582 DOI: 10.3945/ajcn.114.099168] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 09/09/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Fetal alcohol spectrum disorders (FASDs) are conditions characterized by physical anomalies, neurodevelopmental abnormalities, and neurocognitive deficits, including intellectual, executive, and memory deficits. There are no specific biological treatments for FASDs, but rodent models have shown that prenatal or postnatal choline supplementation reduces cognitive and behavioral deficits. Potential mechanisms include phospholipid production for axonal growth and myelination, acetylcholine enhancement, and epigenetic effects. OBJECTIVE Our primary goal was to determine whether postnatal choline supplementation has the potential to improve neurocognitive functioning, particularly hippocampal-dependent memory, in children with FASDs. DESIGN The study was a double-blind, randomized, placebo-controlled pilot trial in children (aged 2.5-5 y at enrollment) with FASDs (n = 60) who received 500 mg choline or a placebo daily for 9 mo. Outcome measures were Mullen Scales of Early Learning (primary) and the elicited imitation (EI) memory paradigm (secondary). RESULTS The administration proved feasible, and choline was well tolerated. Participants received a dose on 88% of enrolled days. The only adverse event linked to choline was a fishy body odor. Choline supplementation improved the secondary outcome (EI) only after immediate recall performance was controlled for, and the outcome was moderated by age. The treatment effect on EI items recalled was significant in the younger participants (2.5- to ≤4.0-y-olds); the young choline group showed an increase of 12-14 percentage points greater than that of the young placebo group on delayed recall measures during treatment. However, there was a marginal baseline difference in delayed item recall between the young choline and placebo groups as well as a potential ceiling effect for item recall, both of which likely contributed to the observed treatment effect. We also observed a trend toward a negative effect of choline supplementation on the immediate EI recall of ordered pairs; the young placebo group showed an increase of 8-17 percentage points greater than that of the choline group during treatment. There was an inverse relation between choline dose (in mg/kg) and memory improvement (P = 0.041); the data suggest that weight-adjusted doses may be a better alternative to a fixed dose in future studies. Limitations included trend-level baseline differences in performance, the post-hoc determination of age moderation, and potential ceiling effects for the memory measure. CONCLUSIONS This pilot study suggests that an additional evaluation of choline supplementation as an intervention for memory functioning in children with FASDs is warranted. The observed interaction between age and choline's effect on EI suggests that potential sensitive periods should be considered in future work. This trial was registered at clinicaltrials.gov as NCT01149538.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Ann M Brearley
- Biostatistical Design and Analysis Center, University of Minnesota Twin Cities, Minneapolis, MN
| | - Steven H Zeisel
- University of North Carolina at Chapel Hill Nutrition Research Institute, Kannapolis, NC
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40
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Reynolds JN, Valenzuela CF, Medina AE, Wozniak JR. Proceedings of the 2014 Annual Meeting of the Fetal Alcohol Spectrum Disorders Study Group. Alcohol 2015; 49:453-60. [PMID: 25979530 DOI: 10.1016/j.alcohol.2015.02.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 02/12/2015] [Accepted: 02/13/2015] [Indexed: 11/29/2022]
Abstract
The 2014 Fetal Alcohol Spectrum Disorders Study Group (FASDSG) meeting focused on the dual themes of the risks associated with low to moderate alcohol exposure during pregnancy and knowledge translation practices to enhance the impact of scientific research. The meeting theme was titled "Low drinking versus no drinking: Matching science with policy and public perception." Despite decades of basic science and clinical evidence that has documented the risks associated with prenatal alcohol exposure, there still exists confusion and uncertainty on the part of health professionals and the public regarding the question of whether or not there is a "safe" level of alcohol consumption during pregnancy. The first keynote presentation reviewed the data obtained from large-scale epidemiological studies that have attempted to address the question of relative risk associated with low to moderate alcohol exposure during pregnancy. This presentation was followed by an expert panel discussion of the state of scientific evidence obtained from clinical and basic science investigations concerning this question, and strategies for moving research evidence into policy and practice. The second keynote presentation presented a framework for knowledge translation and mobilization to move research discoveries toward implementation. The conference also featured updates by government agencies, FASt data talks that highlighted new and innovative findings in FASD research, and award presentations, including a lifetime achievement award presented to Dr. Kenneth Warren to acknowledge his longstanding support for FASD research. A highlight of the meeting was the presentation of the 2014 Henry Rosett award to Dr. Philip May in recognition of his substantial contributions to epidemiological studies on FASD.
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Affiliation(s)
- James N Reynolds
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada K7L 3N6.
| | - C Fernando Valenzuela
- Department of Neurosciences, School of Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Alex E Medina
- Department of Pediatrics, University of Maryland, School of Medicine, Baltimore, MD, USA
| | - Jeffrey R Wozniak
- Department of Psychiatry, University of Minnesota, School of Medicine, Minneapolis, MN, USA
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Abstract
Resting-state functional magnetic resonance imaging allows one to study brain functional connectivity, partly motivated by evidence that patients with complex disorders, such as Alzheimer's disease, may have altered functional brain connectivity patterns as compared with healthy subjects. A functional connectivity network describes statistical associations of the neural activities among distinct and distant brain regions. Recently, there is a major interest in group-level functional network analysis; however, there is a relative lack of studies on statistical inference, such as significance testing for group comparisons. In particular, it is still debatable which statistic should be used to measure pairwise associations as the connectivity weights. Many functional connectivity studies have used either (full or marginal) correlations or partial correlations for pairwise associations. This article investigates the performance of using either correlations or partial correlations for testing group differences in brain connectivity, and how sparsity levels and topological structures of the connectivity would influence statistical power to detect group differences. Our results suggest that, in general, testing group differences in networks deviates from estimating networks. For example, high regularization in both covariance matrices and precision matrices may lead to higher statistical power; in particular, optimally selected regularization (e.g., by cross-validation or even at the true sparsity level) on the precision matrices with small estimation errors may have low power. Most importantly, and perhaps surprisingly, using either correlations or partial correlations may give very different testing results, depending on which of the covariance matrices and the precision matrices are sparse. Specifically, if the precision matrices are sparse, presumably and arguably a reasonable assumption, then using correlations often yields much higher powered and more stable testing results than using partial correlations; the conclusion is reversed if the covariance matrices, not the precision matrices, are sparse. These results may have useful implications to future studies on testing functional connectivity differences.
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Affiliation(s)
- Junghi Kim
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Jeffrey R. Wozniak
- Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota
| | - Bryon A. Mueller
- Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota
| | - Wei Pan
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota
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42
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Yund B, Rudser K, Ahmed A, Kovac V, Nestrasil I, Raiman J, Mamak E, Harmatz P, Steiner R, Lau H, Vekaria P, Wozniak JR, Lim KO, Delaney K, Whitley C, Shapiro EG. Cognitive, medical, and neuroimaging characteristics of attenuated mucopolysaccharidosis type II. Mol Genet Metab 2015; 114:170-7. [PMID: 25541100 PMCID: PMC4312717 DOI: 10.1016/j.ymgme.2014.12.299] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 12/01/2014] [Accepted: 12/01/2014] [Indexed: 10/24/2022]
Abstract
UNLABELLED The phenotype of attenuated mucopolysaccharidosis type II (MPS II), also called Hunter syndrome, has not been previously studied in systematic manner. In contrast to the "severe" phenotype, the "attenuated" phenotype does not present with behavioral or cognitive impairment; however, the presence of mild behavior and cognitive impairment that might impact long-term functional outcomes is unknown. Previously, significant MRI abnormalities have been found in MPS II. Recent evidence suggests white matter abnormalities in many MPS disorders. METHODS As the initial cross-sectional analysis of a longitudinal study, we studied the association of brain volumes and somatic disease burden with neuropsychological outcomes, including measures of intelligence, memory, and attention in 20 patients with attenuated MPS II with a mean age of 15.8. MRI volumes were compared to 55 normal controls. RESULTS While IQ and memory were average, measures of attention were one standard deviation below the average range. Corpus callosum volumes were significantly different from age-matched controls, differing by 22%. Normal age-related volume increases in white matter were not seen in MPS II patients as they were in controls. Somatic disease burden and white matter and corpus callosum volumes were significantly associated with attention deficits. Neither age at evaluation nor age at starting treatment predicted attention outcomes. CONCLUSIONS Despite average intelligence, attention is compromised in attenuated MPS II. Results confirm an important role of corpus callosum and cortical white matter abnormality in MPS II as well as the somatic disease burden in contributing to attention difficulties. Awareness by the patient and caregivers with appropriate management and symptomatic support will benefit the attenuated MPS II patient.
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Affiliation(s)
- Brianna Yund
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Kyle Rudser
- Division of Biostatistics, University of Minnesota, Minneapolis, MN, USA
| | - Alia Ahmed
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Victor Kovac
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Igor Nestrasil
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Julian Raiman
- Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Eva Mamak
- Hospital for Sick Children, Toronto, ON, Canada
| | - Paul Harmatz
- UCSF Benioff Children's Hospital Oakland, Oakland, CA, USA
| | - Robert Steiner
- Department of Pediatrics, Oregon Health and Science University, Portland, OR, USA
| | - Heather Lau
- Department of Neurology, New York University, New York, NY, USA
| | - Pooja Vekaria
- Department of Child and Adolescent Psychiatry, New York University, New York, NY, USA
| | - Jeffrey R Wozniak
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA
| | - Kelvin O Lim
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA
| | - Kathleen Delaney
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Chester Whitley
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Elsa G Shapiro
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA.
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Kim J, Wozniak JR, Mueller BA, Shen X, Pan W. Comparison of statistical tests for group differences in brain functional networks. Neuroimage 2014; 101:681-94. [PMID: 25086298 PMCID: PMC4165845 DOI: 10.1016/j.neuroimage.2014.07.031] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 06/30/2014] [Accepted: 07/21/2014] [Indexed: 01/13/2023] Open
Abstract
Brain functional connectivity has been studied by analyzing time series correlations in regional brain activities based on resting-state fMRI data. Brain functional connectivity can be depicted as a network or graph defined as a set of nodes linked by edges. Nodes represent brain regions and an edge measures the strength of functional correlation between two regions. Most of existing work focuses on estimation of such a network. A key but inadequately addressed question is how to test for possible differences of the networks between two subject groups, say between healthy controls and patients. Here we illustrate and compare the performance of several state-of-the-art statistical tests drawn from the neuroimaging, genetics, ecology and high-dimensional data literatures. Both real and simulated data were used to evaluate the methods. We found that Network Based Statistic (NBS) performed well in many but not all situations, and its performance critically depends on the choice of its threshold parameter, which is unknown and difficult to choose in practice. Importantly, two adaptive statistical tests called adaptive sum of powered score (aSPU) and its weighted version (aSPUw) are easy to use and complementary to NBS, being higher powered than NBS in some situations. The aSPU and aSPUw tests can also be applied to adjust for covariates. Between the aSPU and aSPUw tests, they often, but not always, performed similarly with neither one as a uniform winner. On the other hand, Multivariate Matrix Distance Regression (MDMR) has been applied to detect group differences for brain connectivity; with the usual choice of the Euclidean distance, MDMR is a special case of the aSPU test. Consequently NBS, aSPU and aSPUw tests are recommended to test for group differences in functional connectivity.
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Affiliation(s)
- Junghi Kim
- Division of Biostatistics, University of Minnesota, USA
| | | | | | | | - Wei Pan
- Division of Biostatistics, University of Minnesota, USA.
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44
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Fuglestad AJ, Boys CJ, Chang PN, Miller BS, Eckerle JK, Deling L, Fink BA, Hoecker HL, Hickey MK, Jimenez-Vega JM, Wozniak JR. Overweight and obesity among children and adolescents with fetal alcohol spectrum disorders. Alcohol Clin Exp Res 2014; 38:2502-8. [PMID: 25159809 PMCID: PMC4691582 DOI: 10.1111/acer.12516] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 06/19/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND Because prenatal alcohol exposure is associated with growth deficiency, little attention has been paid to the potential for overweight and obesity in children with fetal alcohol spectrum disorders (FASD). This study examined the prevalence of overweight/obesity (body mass index [BMI]) in a large clinical sample of children with FASD. METHODS Children, aged 2 to 19 years, who were evaluated for FASD at University Clinics, included 445 with an FASD diagnosis and 171 with No-FASD diagnosis. Prevalence of overweight/obesity (BMI ≥ 85 percentile) was compared to national and state prevalence. BMI was examined in relation to FASD diagnosis, gender, and age. Dietary intake data were examined for a young subsample (n = 42). RESULTS Thirty-four percent with any FASD diagnosis were overweight or obese, which did not differ from the No-FASD group or U.S. prevalence. Underweight was prevalent in those with fetal alcohol syndrome (FAS) (17%). However, increased rates of overweight/obesity were seen in those with partial FAS (40%). Among adolescents, those with any FASD diagnosis had increased overweight/obesity (42%), particularly among females (50%). The rate in adolescent females with FASD (50%) was nearly 3 times higher than state prevalence for adolescent females (17 to 18%), p < 0.001. In the young subsample, those who were overweight/obese consumed more calories, protein, and total fat per day than those who were not overweight or obese. CONCLUSIONS Rates of overweight/obesity are increased in children with partial FAS. In adolescents, rates are increased for any FASD diagnosis (particularly in females). Results are suggestive of possible metabolic/endocrine disruption in FASD-a hypothesis for which there is evidence from animal models. These data suggest that clinicians may consider prenatal alcohol exposure as a risk factor for metabolic/endocrine disruption, should evaluate diet as a risk in this population, and may need to target interventions to females prior to puberty to effect changes in overweight-related outcomes.
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Affiliation(s)
- Anita J Fuglestad
- Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota
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45
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Wozniak JR, Thies ML, Bytheway JA, Lutterschmidt WI. A hydrologic retention system and water quality monitoring program for a human decomposition research facility: concept and design. J Forensic Sci 2014; 60:54-60. [PMID: 25041409 DOI: 10.1111/1556-4029.12537] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Revised: 08/28/2013] [Accepted: 09/14/2013] [Indexed: 11/29/2022]
Abstract
Forensic taphonomy is an essential research field; however, the decomposition of human cadavers at forensic science facilities may lead to nutrient loading and the introduction of unique biological compounds to adjacent areas. The infrastructure of a water retention system may provide a mechanism for the biogeochemical processing and retention of nutrients and compounds, ensuring the control of runoff from forensic facilities. This work provides a proof of concept for a hydrologic retention system and an autonomous water quality monitoring program designed to mitigate runoff from The Southeast Texas Applied Forensic Science (STAFS) Facility. Water samples collected along a sample transect were analyzed for total phosphorous, total nitrogen, NO3-, NO2-, NH4, F(-), and Cl(-). Preliminary water quality analyses confirm the overall effectiveness of the water retention system. These results are discussed with relation to how this infrastructure can be expanded upon to monitor additional, more novel, byproducts of forensic science research facilities.
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Affiliation(s)
- Jeffrey R Wozniak
- Texas Research Institute for Environmental Studies, Sam Houston State University, Huntsville, TX, 77341-2506; Department of Biological Sciences, Sam Houston State University, Huntsville, TX, 77341-2116
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Fuglestad AJ, Whitley ML, Carlson SM, Boys CJ, Eckerle JK, Fink BA, Wozniak JR. Executive functioning deficits in preschool children with Fetal Alcohol Spectrum Disorders. Child Neuropsychol 2014; 21:716-31. [PMID: 25011516 DOI: 10.1080/09297049.2014.933792] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Executive function (EF) deficit is a hallmark of Fetal Alcohol Spectrum Disorders (FASD), but the vast majority of available evidence comes from school-age children and adolescents. Very little is known about EF during the critical developmental period prior to 6 years of age in FASD. We evaluated EF in 39 children with FASD (3.0-5.5 years) and a comparison group of 50 age-matched, nonexposed controls. Measures included the EF Scale for Early Childhood and a Delay of Gratification task. Compared to age-matched controls, preschool children with FASD had impairments on the EF Scale and showed more impulsivity on the Delay of Gratification task. To confirm the EF Scale finding, FASD group performance was compared to a separate normative dataset (N = 1,400). Those with FASD performed below normal (M = -0.57, SD = 0.92). Within the FASD group, IQ was correlated with the EF Scale (partial r = .60, p = .001) and Delay of Gratification (partial r = .58, p = .005). EF Scale performance did not differ significantly across levels of FASD severity (fetal alcohol syndrome [FAS], partial FAS, or alcohol-related neurobehavioral disorder [ARND]). However, compared to normative data, those with FAS had the largest deficits (M = -0.91 SD from the mean, SE = 0.23), followed by partial FAS (M = -0.66 SD from the mean, SE = 0.26), then ARND (M = -0.36 SD from the mean, SE = 0.20). These novel data show that EF deficits manifest well before the age of 6 years in children with FASD, that they occur across the spectrum, and that EF may be most impaired in children with more severe forms of FASD and/or lower IQs.
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Affiliation(s)
- Anita J Fuglestad
- a Department of Psychiatry , University of Minnesota , Minneapolis , MN , USA
| | - Marisa L Whitley
- a Department of Psychiatry , University of Minnesota , Minneapolis , MN , USA
| | - Stephanie M Carlson
- b Institute of Child Development , University of Minnesota , Minneapolis , MN , USA
| | - Christopher J Boys
- a Department of Psychiatry , University of Minnesota , Minneapolis , MN , USA
| | - Judith K Eckerle
- c Department of Pediatrics , University of Minnesota , Minneapolis , MN , USA
| | - Birgit A Fink
- a Department of Psychiatry , University of Minnesota , Minneapolis , MN , USA
| | - Jeffrey R Wozniak
- a Department of Psychiatry , University of Minnesota , Minneapolis , MN , USA
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47
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Gross AC, Deling LA, Wozniak JR, Boys CJ. Objective measures of executive functioning are highly discrepant with parent-report in fetal alcohol spectrum disorders. Child Neuropsychol 2014; 21:531-8. [DOI: 10.1080/09297049.2014.911271] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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48
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Wozniak JR, Mueller BA, Lim KO, Hemmy LS, Day JW. Tractography reveals diffuse white matter abnormalities in Myotonic Dystrophy Type 1. J Neurol Sci 2014; 341:73-8. [PMID: 24768314 DOI: 10.1016/j.jns.2014.04.005] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 04/03/2014] [Accepted: 04/05/2014] [Indexed: 11/25/2022]
Abstract
Cerebral involvement in Myotonic Dystrophy Type 1 (DM1) is well-established but not well characterized. This study applied new Diffusion Tensor Imaging (DTI) tractography to characterize white matter disturbance in adults with DM1. Forty-five participants with DM1 and 44 control participants had MRIs on a Siemens 3T TIM Trio scanner. Data were processed with TRActs Constrained by UnderLying Anatomy (TRACULA) and 7 tracts were evaluated. Bilateral disturbances in white matter integrity were seen in all tracts in participants with DM1 compared to controls. There were no right-left hemisphere differences. The resulting DTI metrics were correlated with cognitive functioning, particularly working memory and processing speed. Motor speed was not significantly correlated with white matter microstructural integrity and, thus, was not the core explanation for the working memory and processing speed findings. White matter integrity was correlated with important clinical variables including the muscular impairment rating scale (MIRS). CTG repeat length was moderately associated with white matter status in corticospinal tract and cingulum. Sleepiness (Epworth Sleepiness Scale) was moderately associated with white matter status in the superior longitudinal fasciculus and cingulum. Overall, the results add to an emerging literature showing widespread white matter disturbances in both early-onset and adult-onset DM1. Results suggest that further investigation of white matter pathology is warranted in DM1 and that non-invasive measures such as DTI have a potentially important clinical value in characterizing the status of individuals with DM1.
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Affiliation(s)
- Jeffrey R Wozniak
- Department of Psychiatry, University of Minnesota-Twin Cities, F256/2B West, 2450 Riverside Ave., Minneapolis, MN 55454, United States.
| | - Bryon A Mueller
- Department of Psychiatry, University of Minnesota-Twin Cities, F256/2B West, 2450 Riverside Ave., Minneapolis, MN 55454, United States
| | - Kelvin O Lim
- Department of Psychiatry, University of Minnesota-Twin Cities, F256/2B West, 2450 Riverside Ave., Minneapolis, MN 55454, United States
| | - Laura S Hemmy
- Department of Psychiatry, University of Minnesota-Twin Cities, F256/2B West, 2450 Riverside Ave., Minneapolis, MN 55454, United States
| | - John W Day
- Department of Neurology, Stanford University, 300 Pasteur Drive, Room A301, MC 5325, Stanford, CA 94305, United States
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Wozniak JR, Fuglestad AJ, Eckerle JK, Kroupina MG, Miller NC, Boys CJ, Brearley AM, Fink BA, Hoecker HL, Zeisel SH, Georgieff MK. Choline supplementation in children with fetal alcohol spectrum disorders has high feasibility and tolerability. Nutr Res 2013; 33:897-904. [PMID: 24176229 DOI: 10.1016/j.nutres.2013.08.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Revised: 08/10/2013] [Accepted: 08/12/2013] [Indexed: 10/26/2022]
Abstract
There are no biological treatments for fetal alcohol spectrum disorders (FASDs), lifelong conditions associated with physical anomalies, brain damage, and neurocognitive abnormalities. In preclinical studies, choline partially ameliorates memory and learning deficits from prenatal alcohol exposure. This phase I pilot study evaluated the feasibility, tolerability, and potential adverse effects of choline supplementation in children with FASD. We hypothesized that choline would be well tolerated with minimal adverse events. The study design was a double-blind, randomized, placebo-controlled trial. Participants included 20 children aged 2.5 to 4.9 years with prenatal alcohol exposure and FASD diagnoses. Participants were randomly assigned to 500 mg choline or placebo daily for 9 months (10 active, 10 placebo). Primary outcome measures included feasibility, tolerability, adverse effects, and serum choline levels. Seventeen participants completed the study. Compliance was 82% to 87%, as evidenced by parent-completed log sheets and dose counts. Periodic 24-hour dietary recalls showed no evidence of dietary confounding. Adverse events were minimal and were equivalent in the active and placebo arms with the exception of fishy body odor, which occurred only in the active group. There were no serious adverse events to research participants. This phase I pilot study demonstrates that choline supplementation at 500 mg/d for 9 months in children aged 2 to 5 years is feasible and has high tolerability. Further examination of the efficacy of choline supplementation in FASD is currently underway.
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Affiliation(s)
- Jeffrey R Wozniak
- Department of Psychiatry, University of Minnesota, Minneapolis, MN 55454, USA.
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Fuglestad AJ, Fink BA, Eckerle JK, Boys CJ, Hoecker HL, Kroupina MG, Zeisel SH, Georgieff MK, Wozniak JR. Inadequate intake of nutrients essential for neurodevelopment in children with fetal alcohol spectrum disorders (FASD). Neurotoxicol Teratol 2013; 39:128-32. [PMID: 23871794 DOI: 10.1016/j.ntt.2013.06.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Revised: 06/12/2013] [Accepted: 06/13/2013] [Indexed: 11/28/2022]
Abstract
This study evaluated dietary intake in children with fetal alcohol spectrum disorders (FASD). Pre-clinical research suggests that nutrient supplementation may attenuate cognitive and behavioral deficits in FASD. Currently, the dietary adequacy of essential nutrients in children with FASD is unknown. Dietary data were collected as part of a randomized, double-blind controlled trial of choline supplementation in FASD. Participants included 31 children with FASD, ages 2.5-4.9 years at enrollment. Dietary intake data was collected three times during the nine-month study via interview-administered 24-hour recalls with the Automated Self-Administered 24-hour Recall. Dietary intake of macronutrients and 17 vitamins/minerals from food was averaged across three data collection points. Observed nutrient intakes were compared to national dietary intake data of children ages 2-5 years (What we Eat in America, NHANES 2007-2008) and to the Dietary Reference Intakes. Compared to the dietary intakes of children in the NHANES sample, children with FASD had lower intakes of saturated fat, vitamin D, and calcium. The majority (>50%) of children with FASD did not meet the Recommended Dietary Allowance (RDA) or Adequate Intake (AI) for fiber, n-3 fatty acids, vitamin D, vitamin E, vitamin K, choline, and calcium. This pattern of dietary intake in children with FASD suggests that there may be opportunities to benefit from nutritional intervention. Supplementation with several nutrients, including choline, vitamin D, and n-3 fatty acids, has been shown in animal models to attenuate the cognitive deficits of FASD. These results highlight the potential of nutritional clinical trials in FASD.
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