Cognitive functions in children at risk for congenital adrenal hyperplasia treated prenatally with dexamethasone
Cognitive functions in children at risk for congenital adrenal hyperplasia treated prenatally with dexamethasone
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DOI：
10.1210/jc.2006-1340
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发表时间：
2007-02-01
影响因子：
5.8
通讯作者：
Lajic, Svetlana
中科院分区：
文献类型：
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作者：
Hirvikoski, Tatja;Nordenstrom, Anna;Lajic, Svetlana
背景和目标：在瑞典，从1985年到1995年，40个胎儿在先天性肾上腺增生症（CAH）的风险与地塞米松（DEX）治疗，以防止男性化的影响女性。我们报告长期影响神经心理功能和学业表现的这一有争议的treatment.Design和患者：产前治疗的儿童，7至17岁，进行了评估与标准化的神经心理测试（发展神经心理评估和韦氏儿童智力量表）和儿童完成的问卷测量自我感知的学业能力（自我感知的儿童）。家长填写的问卷（儿童行为检查表/4-18学校量表）用于评估治疗是否对儿童的学校表现有任何影响。此外，一个孩子完成的问卷调查测量社交焦虑（社会焦虑量表的儿童修订版）完成了产前治疗的儿童年龄8至17岁（n = 21）和年龄和性别匹配的控制（n = 26）。35名性别和年龄相匹配的健康儿童作为对照。在心理智力、大脑偏侧化、记忆编码和长期记忆方面，组间无差异。短期治疗，CAH未受影响的儿童表现较差，比对照组的测试评估言语工作记忆（P = 0.003），他们的评分较低的问卷评估自我认知的学业能力（P = 0.003）。该组也表现出增加的自评社交焦虑儿童社交焦虑量表修订（P = 0.026）。产前治疗，CAH影响的儿童进行测试测量言语处理速度比对照组差，虽然这种差异消失时，控制孩子的全面iQ.Conclusions：这项研究表明，产前DEX治疗与以前没有描述的长期影响言语工作记忆和自我认知的某些方面，可能与较差的言语工作记忆。因此，这些发现可能会质疑先天性肾上腺皮质增生症的未来DEX治疗。因此，我们鼓励对更大的队列进行更多的回顾性研究，以证实或挑战目前的发现。
Context and Objective: In Sweden, from 1985 through 1995, 40 fetuses at risk for congenital adrenal hyperplasia (CAH) were treated with dexamethasone (DEX) to prevent virilization of affected females. We report long-term effects on neuropsychological functions and scholastic performance of this controversial treatment.Design and Patients: Prenatally treated children, 7 to 17 yr old, were assessed with standardized neuropsychological tests (A Developmental Neuropsychological Assessment and Wechsler Intelligence Scales for Children) and child-completed questionnaires measuring self-perceived scholastic competence (Self-Perception Profile for Children). A parent-completed questionnaire (Child Behavior Checklist/4-18 School Scale) was used to evaluate whether the treatment had any impact on the children's school performance. In addition, a child-completed questionnaire measuring social anxiety (The Social Anxiety Scale for Children-Revised) was completed by the prenatally treated children aged 8 to 17 yr (n = 21) and age- and sex-matched controls (n = 26).Results: Of 40 DEX-treated children, 26 (median age, 11 yr) participated in the study. Thirty-five sex- and age- matched healthy children were controls. There were no between-group differences concerning psychometric intelligence, measures of cerebral lateralization, memory encoding, and long-term memory. Short-term treated, CAH-unaffected children performed poorer than the control group on a test assessing verbal working memory (P = 0.003), and they rated lower on a questionnaire assessing self-perception of scholastic competence (P = 0.003). This group also showed increased self-rated social anxiety assessed by The Social Anxiety Scale for Children-Revised (P = 0.026). Prenatally treated, CAH-affected children performed poorer than controls on tests measuring verbal processing speed, although this difference disappeared when controlling for the child's full-scale IQ.Conclusions: This study indicates that prenatal DEX treatment is associated with previously not described long-term effects on verbal working memory and on certain aspects of self-perception that could be related to poorer verbal working memory. These findings may thus question future DEX treatment of congenital adrenal hyperplasia. Therefore, we encourage additional retrospective studies of larger cohorts to either confirm or challenge the present findings.