Reduced short term memory in congenital adrenal hyperplasia (CAH) and its relationship to spatial and quantitative performance.
Reduced short term memory in congenital adrenal hyperplasia (CAH) and its relationship to spatial and quantitative performance.
复制标题
DOI：
10.1016/j.psyneuen.2015.11.010
复制
发表时间：
2016-02
影响因子：
3.7
通讯作者：
Hines M
中科院分区：
文献类型：
--
作者：
Collaer ML;Hindmarsh PC;Pasterski V;Fane BA;Hines M
患有典型先天性肾上腺增生症(CAH)的女孩和妇女产前雄激素水平升高，并在某些行为上表现出男性典型发育增加。此外，CAH患者在出生后接受糖皮质激素(GC)治疗，这种GC治疗可能会产生负面的认知后果。我们研究了两种可供选择的假说：(A)患有CAH的女性早期接触雄激素会男性化(提高)男性通常优于女性的空间知觉和数量能力，或者(B)CAH与这些领域的表现下降有关，可能是由于短期记忆(STM)的减少。对青少年和成年CAH患者(女40例，男29例)与正常对照(女29例，男30例)的空间知觉和数量能力、数字广度(DS)、短时记忆(STM)和词汇能力(一般智力)进行了比较。患有CAH的女性在空间知觉或数量能力上的表现并不比对照女性更好(更具男性特征)，未能支持认知男性化的假说。相反，在整个样本中，患有CAH的个体在空间知觉(p≤.009)、定量合成(p≤.036)和DS(p≤.001)方面得分较低，尽管一般智力没有差异。对青少年和成人参与者的单独分析表明，空间和数量效应可能只存在于成年CAH患者中；然而，无论年龄组，CAH患者的DS表现都有所降低。单独的回归分析显示，在控制了年龄、性别和诊断状态后，DS预测了空间知觉和定量表现(均为p≤.001)。因此，与对照组相比，CAH患者的STM减少可能会产生更普遍的认知后果，潜在地降低空间知觉和量化技能。虽然不能排除低钠血症或盐耗危机的其他方面，或额外的激素异常是潜在的因素，但GC升高似乎是STM减少的最有可能的因素。监测GC给药方案的额外努力可能有助于实现最佳的认知结果。对CAH患者的教育干预也可能是有用的。
Girls and women with classical congenital adrenal hyperplasia (CAH) experience elevated androgens prenatally and show increased male-typical development for certain behaviors. Further, individuals with CAH receive glucocorticoid (GC) treatment postnatally, and this GC treatment could have negative cognitive consequences. We investigated two alternative hypotheses, that: (a) early androgen exposure in females with CAH masculinizes (improves) spatial perception and quantitative abilities at which males typically outperform females, or (b) CAH is associated with performance decrements in these domains, perhaps due to reduced short-term-memory (STM). Adolescent and adult individuals with CAH (40 female and 29 male) were compared with relative controls (29 female and 30 male) on spatial perception and quantitative abilities as well as on Digit Span (DS) to assess STM and on Vocabulary to assess general intelligence. Females with CAH did not perform better (more male-typical) on spatial perception or quantitative abilities than control females, failing to support the hypothesis of cognitive masculinization. Rather, in the sample as a whole individuals with CAH scored lower on spatial perception (p ≤ .009), a quantitative composite (p ≤ .036), and DS (p ≤ .001), despite no differences in general intelligence. Separate analyses of adolescent and adult participants suggested the spatial and quantitative effects might be present only in adult patients with CAH; however, reduced DS performance was found in patients with CAH regardless of age group. Separate regression analyses showed that DS predicted both spatial perception and quantitative performance (both p ≤ .001), when age, sex, and diagnosis status were controlled. Thus, reduced STM in CAH patients versus controls may have more general cognitive consequences, potentially reducing spatial perception and quantitative skills. Although hyponatremia or other aspects of salt-wasting crises, or additional hormone abnormalities cannot be ruled out as potential contributors, elevated GCs appear to be the most likely contributor to reductions in STM. Additional efforts to monitor GC administration protocols may help achieve optimal cognitive outcomes. Educational intervention for individuals with CAH might also be useful.