1
|
Miller AL, Evanson NK, Taylor JM. Use of donepezil for neurocognitive recovery after brain injury in adult and pediatric populations: a scoping review. Neural Regen Res 2024; 19:1686-1695. [PMID: 38103232 PMCID: PMC10960296 DOI: 10.4103/1673-5374.389628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 10/07/2023] [Accepted: 11/01/2023] [Indexed: 12/18/2023] Open
Abstract
There are few pharmacologic options for the treatment of cognitive deficits associated with traumatic brain injury in pediatric patients. Acetylcholinesterase inhibitors such as donepezil have been evaluated in adult patients after traumatic brain injury, but relatively less is known about the effect in pediatric populations. The goal of this review is to identify knowledge gaps in the efficacy and safety of acetylcholinesterase inhibitors as a potential adjuvant treatment for neurocognitive decline in pediatric patients with traumatic brain injury. Investigators queried PubMed to identify literature published from database inception through June 2023 describing the use of donepezil in young adult traumatic brain injury and pediatric patients with predefined conditions. Based on preselected search criteria, 340 unique papers were selected for title and abstract screening. Thirty-two records were reviewed in full after eliminating preclinical studies and papers outside the scope of the project. In adult traumatic brain injury, we review results from 14 papers detailing 227 subjects where evidence suggests donepezil is well tolerated and shows both objective and patient-reported efficacy for reducing cognitive impairment. In children, 3 papers report on 5 children recovering from traumatic brain injury, showing limited efficacy. An additional 15 pediatric studies conducted in populations at risk for cognitive dysfunction provide a broader look at safety and efficacy in 210 patients in the pediatric age group. Given its promise for efficacy in adults with traumatic brain injury and tolerability in pediatric patients, we believe further study of donepezil for children and adolescents with traumatic brain injury is warranted.
Collapse
Affiliation(s)
- Avery L. Miller
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Nathan K. Evanson
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH, USA
- Division of Pediatric Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - J. Michael Taylor
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| |
Collapse
|
2
|
Baumer NT, Capone G. Psychopharmacological treatments in Down syndrome and autism spectrum disorder: State of the research and practical considerations. AMERICAN JOURNAL OF MEDICAL GENETICS. PART C, SEMINARS IN MEDICAL GENETICS 2023; 193:e32069. [PMID: 37870763 DOI: 10.1002/ajmg.c.32069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/20/2023] [Accepted: 09/30/2023] [Indexed: 10/24/2023]
Abstract
Individuals with Down syndrome (DS) or Autism Spectrum Disorder (ASD), and especially those with both DS and co-occurring ASD (DS + ASD) commonly display behavioral and psychiatric symptoms that can impact quality of life and places increased burden on caregivers. While the mainstay of treatment in DS and ASD is focused on educational and behavioral therapies, pharmacological treatments can be used to reduce symptom burden. There is a paucity of evidence and limited clinical trials in DS and DS + ASD. Some scientific evidence is available, primarily in open label studies and case series that can guide treatment choices. Additionally, clinical decisions are often extrapolated from evidence and experience from those with ASD, or intellectual disability in those without DS. This article reviews current research in pharmacological treatment in DS, ASD, and DS + ASD, reviews co-occurring neurodevelopmental and mental health diagnoses in individuals with DS + ASD across the lifespan, and describes practical approaches to psychopharmacological management.
Collapse
Affiliation(s)
- Nicole T Baumer
- Division of Developmental Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - George Capone
- Department of Pediatrics, Johns Hopkins Medicine, Baltimore, Maryland, USA
- Kennedy Krieger Institute, Baltimore, Maryland, USA
| |
Collapse
|
3
|
Soltani A, Schworer EK, Altaye M, Fidler DJ, Beebe DW, Wiley S, Hoffman EK, Voth K, Esbensen AJ. Psychometric properties of inhibitory control measures among youth with Down syndrome. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2023; 67:753-769. [PMID: 37218393 PMCID: PMC10524385 DOI: 10.1111/jir.13043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 04/24/2023] [Accepted: 04/26/2023] [Indexed: 05/24/2023]
Abstract
BACKGROUND Inhibitory control measures have been commonly used when assessing individuals with Down syndrome. However, minimal attention has been devoted to evaluating the appropriateness of specific assessments for use in this population, potentially leading to erroneous conclusions. This study aimed to examine the psychometric properties of measures of inhibitory control among youth with Down syndrome. We sought to examine the feasibility, presence of floor or practice effects, test-retest reliability, convergent validity and correlations with broader developmental domains of a set of inhibitory control tasks. METHODS A sample of 97 youth with Down syndrome aged 6 to 17 years old participated in verbal and visuospatial tasks of inhibitory control including the Cat/dog Stroop, Neuropsychological Assessment Second Edition (NEPSY-II) Statue, National Institutes of Health (NIH) Toolbox Cognition Battery (TCB) Flanker, Leiter-3 Attention Sustained, and the Test of Attentional Performance for Children (KiTAP) Go/No-go and Distractibility subtests. Youth also completed standardised assessments of cognition and language, and caregivers completed rating scales. Psychometric properties on the tasks of inhibitory control were evaluated against a priori criteria. RESULTS Apart from demonstrating negligible practice effects, adequate psychometric properties were not observed for any inhibitory control measure within the current sample's age range. One task with low working memory demands (NEPSY-II Statue) generally had better psychometric properties than the other tasks assessed. Subgroups of participants with an IQ greater than 30 and age more than 8 years were shown to be more likely to be able to complete the inhibition tasks. CONCLUSIONS Findings suggest better feasibility for analogue tasks rather than computerised assessments of inhibitory control. Given the weak psychometrics of several common measures, future studies are required to evaluate other inhibitory control measures, specifically those with reduced working memory demands for youth with Down syndrome. Recommendations for use of the inhibitory control tasks among youth with Down syndrome are provided.
Collapse
Affiliation(s)
- Amanallah Soltani
- Department of Educational Psychology, Kerman Branch, Islamic Azad University, Kerman, Iran
| | - Emily K. Schworer
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- Waisman Center, University of Wisconsin-Madison, Madison, WI, USA
| | - Mekibib Altaye
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital, Cincinnati, OH, USA
| | - Deborah J. Fidler
- Department of Human Development and Family Studies, Colorado State University, Fort Collins, CO, USA
| | - Dean W. Beebe
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Susan Wiley
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Emily K. Hoffman
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Kellie Voth
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Anna J. Esbensen
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| |
Collapse
|
4
|
Wu C, Gaier ED, Nihalani BR, Whitecross S, Hensch TK, Hunter DG. Durable recovery from amblyopia with donepezil. Sci Rep 2023; 13:10161. [PMID: 37349338 PMCID: PMC10287641 DOI: 10.1038/s41598-023-34891-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 05/09/2023] [Indexed: 06/24/2023] Open
Abstract
An elevated threshold for neuroplasticity limits visual gains with treatment of residual amblyopia in older children and adults. Acetylcholinesterase inhibitors (AChEI) can enable visual neuroplasticity and promote recovery from amblyopia in adult mice. Motivated by these promising findings, we sought to determine whether donepezil, a commercially available AChEI, can enable recovery in older children and adults with residual amblyopia. In this open-label pilot efficacy study, 16 participants (mean age 16 years; range 9-37 years) with residual anisometropic and/or strabismic amblyopia were treated with daily oral donepezil for 12 weeks. Donepezil dosage was started at 2.5 or 5.0 mg based on age and increased by 2.5 mg if the amblyopic eye visual acuity did not improve by 1 line from the visit 4 weeks prior for a maximum dosage of 7.5 or 10 mg. Participants < 18 years of age further patched the dominant eye. The primary outcome was visual acuity in the amblyopic eye at 22 weeks, 10 weeks after treatment was discontinued. Mean amblyopic eye visual acuity improved 1.2 lines (range 0.0-3.0), and 4/16 (25%) improved by ≥ 2 lines after 12 weeks of treatment. Gains were maintained 10 weeks after cessation of donepezil and were similar for children and adults. Adverse events were mild and self-limited. Residual amblyopia improves in older children and adults treated with donepezil, supporting the concept that the critical window of visual cortical plasticity can be pharmacologically manipulated to treat amblyopia. Placebo-controlled studies are needed.
Collapse
Affiliation(s)
- Carolyn Wu
- Department of Ophthalmology, Boston Children's Hospital, Boston, MA, USA.
- Department of Ophthalmology, Harvard Medical School, Boston, MA, USA.
| | - Eric D Gaier
- Department of Ophthalmology, Boston Children's Hospital, Boston, MA, USA
- Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
- Picower Institute for Learning and Memory, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Bharti R Nihalani
- Department of Ophthalmology, Boston Children's Hospital, Boston, MA, USA
- Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Sarah Whitecross
- Department of Ophthalmology, Boston Children's Hospital, Boston, MA, USA
| | - Takao K Hensch
- Center for Brain Science, Department of Molecular Cellular Biology, Harvard University, Cambridge, MA, USA
- International Research Center for Neurointelligence, University of Tokyo Institutes for Advanced Study, Tokyo, Japan
- FM Kirby Neurobiology Center, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - David G Hunter
- Department of Ophthalmology, Boston Children's Hospital, Boston, MA, USA
- Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
- International Research Center for Neurointelligence, University of Tokyo Institutes for Advanced Study, Tokyo, Japan
| |
Collapse
|
5
|
Schworer EK, Altaye M, Fidler DJ, Beebe DW, Wiley S, Hoffman EK, Esbensen AJ. Evaluating Processing Speed and Reaction Time Outcome Measures in Children and Adolescents with Down Syndrome. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5202. [PMID: 36982110 PMCID: PMC10049659 DOI: 10.3390/ijerph20065202] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 03/06/2023] [Accepted: 03/13/2023] [Indexed: 06/18/2023]
Abstract
Reliable and valid cognitive outcome measures, including examiner-administered and computer-facilitated assessments of processing speed and reaction time, are necessary for future clinical trials that include individuals with Down syndrome (DS). The current study evaluated the score distributions and psychometric properties of four examiner-administered and three computerized processing speed and reaction time measures. Participants included 97 individuals with DS, aged 6 to 17 (M = 12.6, SD = 3.3). Two examiner-administered measures (Differential Ability Scales-II Rapid Naming and Cat/dog Stroop Congruent) met most predetermined psychometric criteria. Other assessments demonstrated good test-retest reliability and had negligible practice effects but lacked adequate feasibility. Recommendations for using processing speed and reaction time assessments in research and suggestions for modifications of measures are discussed.
Collapse
Affiliation(s)
- Emily K. Schworer
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
- Waisman Center, University of Wisconsin-Madison, Madison, WI 53705, USA
| | - Mekibib Altaye
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital, Cincinnati, OH 45229, USA
| | - Deborah J. Fidler
- Human Development and Family Studies, Colorado State University, Fort Collins, CO 80523, USA
| | - Dean W. Beebe
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Susan Wiley
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| | - Emily K. Hoffman
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Anna J. Esbensen
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| |
Collapse
|
6
|
Schworer EK, Soltani A, Altaye M, Fidler DJ, Esbensen AJ. Cognitive flexibility assessment in youth with Down syndrome: Reliability, practice effects, and validity. RESEARCH IN DEVELOPMENTAL DISABILITIES 2023; 133:104416. [PMID: 36603310 PMCID: PMC9852016 DOI: 10.1016/j.ridd.2022.104416] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 12/14/2022] [Accepted: 12/30/2022] [Indexed: 05/31/2023]
Abstract
BACKGROUND Cognitive flexibility refers to the ability to switch between different mental sets, tasks, or strategies and is challenging for some individuals with Down syndrome (DS). The lack of reliable and valid cognitive flexibility measures for individuals with DS is a major barrier to clinical trials and intervention studies designed to address cognitive challenges specific to DS. To avoid measurement limitations that could confound interpretations of performance in clinical trials in children with DS, it is critical to use phenotype-sensitive and psychometrically sound measures of cognitive flexibility. AIM This study aimed to evaluate the psychometric properties of three measures of cognitive flexibility including Rule-Shift, Weigl Sorting, and KiTAP Flexibility in a sample of 97 youth with DS aged 6-17 years old. METHOD Data were collected at two time points with a two-week interval. Parents also completed adaptive behavior and cognitive flexibility questionnaires. Child cognitive and language abilities were also assessed. RESULTS The Weigl Sorting met the most psychometric criteria, with adequate feasibility (≥ 80 %) and significant correlations with most of the broader developmental domains; however, the levels of test-retest reliability, practice effects, and convergent validity did not meet a priori criteria. Rule-Shift and KiTAP Flexibility measures did not have acceptable feasibility; although sensitivity and specificity analyses revealed that Rule-Shift may be appropriate for a subgroup of the participants. CONCLUSION No evaluated measures met all psychometric study criteria and, therefore, additional evaluation of cognitive flexibility measures is needed for use among individuals with DS.
Collapse
Affiliation(s)
- Emily K Schworer
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; University of Wisconsin-Madison, Waisman Center, Madison, WI, USA.
| | - Amanallah Soltani
- Department of Educational Psychology, Kerman Branch, Islamic Azad University, Kerman, Iran
| | - Mekibib Altaye
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Deborah J Fidler
- Human Development and Family Studies, Colorado State University, Fort Collins, CO, USA
| | - Anna J Esbensen
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| |
Collapse
|
7
|
Gharaylou Z, Shafaghi L, Pestehei SK, Hadjighassem M. Long-term bumetanide administration altered behavioral pattern in mosaic Down's Syndrome: A case report. APPLIED NEUROPSYCHOLOGY. CHILD 2023; 12:88-95. [PMID: 34860628 DOI: 10.1080/21622965.2021.2007481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The behavioral phenotypes emerge from cognitive architecture comprising attention, executive functions, and primary communication skills that all have shown remarkable deficits in Down's Syndrome (DS). These states arise from the proper functional interactions of the contributing neurotransmission and neuromodulation systems and other coding platforms. Gamma-aminobutyric acid (GABA) is an integral part of the neural interaction and regulation networks that its reverse action leads to broad detrimental consequences. This inhibitory substance needs an appropriate balance of co-transporters that largely shape the ionic milieu. Bumetanide, a specific NKCC1 inhibitor used for an eighteen-month interval, showed promising effects in restoring some behavior deficits in a fourteen-year-old boy diagnosed with genetically confirmed mosaic Down's Syndrome.
Collapse
Affiliation(s)
- Zeinab Gharaylou
- Department of Neuroscience and Addiction Studies, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran.,Shefa Neuroscience Research Center, Tehran, Iran
| | - Lida Shafaghi
- Department of Neuroscience and Addiction Studies, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Mahmoudreza Hadjighassem
- Department of Neuroscience and Addiction Studies, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran.,Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
8
|
Fidler DJ, Riggs N, Esbensen AJ, Jackson-Cook C, Rosser T, Cohen A. Outreach and Engagement Efforts in Research on Down Syndrome: An NIH INCLUDE Working Group Consensus Statement. INTERNATIONAL REVIEW OF RESEARCH IN DEVELOPMENTAL DISABILITIES 2022; 63:247-267. [PMID: 36545326 PMCID: PMC9762205 DOI: 10.1016/bs.irrdd.2022.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
The National Institutes of Health formulated the Outreach and Engagement Working Group in Fall of 2019 to support the objectives of the INCLUDE Project (INvestigation of Co-occurring conditions across the Lifespan to Understand Down syndromE). This Working Group consisted of a multi-disciplinary team of stakeholders in research on Down syndrome that met to discuss best practices for outreach and engagement to Down syndrome communities, with an emphasis on representation and diversity. This review and consensus paper describes the importance of increasing representation in DS research for future cohort building and summarizes the priority issues identified by the Working Group members. An overview of Working Group activities is then presented, followed by consensus recommendations and a discussion of future opportunities and challenges.
Collapse
Affiliation(s)
| | | | - Anna J Esbensen
- Cincinnati Children's Hospital Medical Campus, Cincinnati, OH, USA
| | | | | | - Annie Cohen
- University of Pittsburgh, Pittsburgh, PA, USA
| |
Collapse
|
9
|
Esbensen AJ, Schworer EK, Fidler DJ, Thurman AJ. Considerations for measuring individual outcomes across contexts in Down syndrome: Implications for research and clinical trials. INTERNATIONAL REVIEW OF RESEARCH IN DEVELOPMENTAL DISABILITIES 2022; 62:191-225. [PMID: 36213318 PMCID: PMC9536481 DOI: 10.1016/bs.irrdd.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Individuals with Down syndrome (DS) are increasingly involved in clinical trials that target developmental outcomes, like cognition and behavior. The increased focus on treatment in DS has led to ongoing discussions regarding the selection of outcome measures using syndrome-informed criteria. This discourse is warranted as clinical trials can fail if the outcome measures selected are inappropriate for individuals with DS or do not take into account the behavioral phenotype commonly associated with DS. This review focuses on the challenges present in the measurement of outcomes in DS, with a specific focus on considerations made in evaluating cognitive, language, and behavioral/psychopathology outcomes. This review also provides a summary of recommendations for assessment of outcomes in these domains as well as recommendations for future research. The impact of physical health and assessment psychometrics on the measurement of outcomes is also reviewed.
Collapse
Affiliation(s)
- Anna J Esbensen
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Emily K Schworer
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Deborah J Fidler
- Human Development and Family Studies, Colorado State University, Fort Collins, CO, USA
| | - Angela John Thurman
- University of California Davis Health, MIND Institute and Department of Psychiatry and Behavioral Sciences, Sacramento, CA, USA
| |
Collapse
|
10
|
Smeyne CN, Esbensen AJ, Schworer EK, Belizaire S, Hoffman EK, Beebe DW, Wiley S. Evaluating Verbal Fluency Outcome Measures in Children With Down Syndrome. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2022; 127:328-344. [PMID: 36122330 PMCID: PMC9487840 DOI: 10.1352/1944-7558-127.4.328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 09/28/2021] [Indexed: 05/26/2023]
Abstract
This study evaluates the psychometric properties of a verbal fluency task for potential use as an outcome measure in future clinical trials involving children with Down syndrome. Eighty-five participants attempted a modified version of the Neuropsychological Assessment of Children, Second Edition Word Generation Task at two time points. In the full sample, the measure fell below a priori reliability and feasibility criteria, though feasibility of the semantic trials were higher than feasibility of the phonemic trials. Performance on the measure correlated with chronological age and IQ scores, and no sex-related effects were found. Additional analyses suggested that the semantic verbal fluency trials might be appropriate for children with Down syndrome 10 years of age and older.
Collapse
Affiliation(s)
- Catelyn N. Smeyne
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children’s Hospital Medical Center
| | - Anna J. Esbensen
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children’s Hospital Medical Center
- Department of Pediatrics, University of Cincinnati College of Medicine
| | - Emily K. Schworer
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children’s Hospital Medical Center
| | - Shequanna Belizaire
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children’s Hospital Medical Center
| | - Emily K. Hoffman
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children’s Hospital Medical Center
| | - Dean W. Beebe
- Department of Pediatrics, University of Cincinnati College of Medicine
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center
| | - Susan Wiley
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children’s Hospital Medical Center
- Department of Pediatrics, University of Cincinnati College of Medicine
| |
Collapse
|
11
|
Bartesaghi R, Vicari S, Mobley WC. Prenatal and Postnatal Pharmacotherapy in Down Syndrome: The Search to Prevent or Ameliorate Neurodevelopmental and Neurodegenerative Disorders. Annu Rev Pharmacol Toxicol 2022; 62:211-233. [PMID: 34990205 PMCID: PMC9632639 DOI: 10.1146/annurev-pharmtox-041521-103641] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Those with Down syndrome (DS)-trisomy for chromosome 21-are routinely impacted by cognitive dysfunction and behavioral challenges in children and adults and Alzheimer's disease in older adults. No proven treatments specifically address these cognitive or behavioral changes. However, advances in the establishment of rodent models and human cell models promise to support development of such treatments. A research agenda that emphasizes the identification of overexpressed genes that contribute demonstrably to abnormalities in cognition and behavior in model systems constitutes a rational next step. Normalizing expression of such genes may usher in an era of successful treatments applicable across the life span for those with DS.
Collapse
Affiliation(s)
- Renata Bartesaghi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40126 Bologna, Italy
| | - Stefano Vicari
- Department of Life Sciences and Public Health, Catholic University of the Sacred Heart, 00168 Rome, Italy,Child and Adolescent Neuropsychiatry Unit, Department of Neuroscience, Bambino Gesù Children’s Hospital, IRCCS, 00165-00146 Rome, Italy
| | - William C. Mobley
- Department of Neurosciences, University of California, San Diego, La Jolla, California 92093, USA
| |
Collapse
|
12
|
Schworer EK, Voth K, Hoffman EK, Esbensen AJ. Short-term memory outcome measures: Psychometric evaluation and performance in youth with Down syndrome. RESEARCH IN DEVELOPMENTAL DISABILITIES 2022; 120:104147. [PMID: 34922089 PMCID: PMC8724458 DOI: 10.1016/j.ridd.2021.104147] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 12/01/2021] [Accepted: 12/05/2021] [Indexed: 05/12/2023]
Abstract
BACKGROUND Improving short-term memory (STM) performance for individuals with Down syndrome (DS) has been a target of recent clinical trials. Validation of STM outcome measures is essential for research rigor in trials among children and adolescents with DS. AIMS The current study investigated the psychometric properties of four direct STM assessments and one everyday memory parent form. METHODS AND PROCEDURES Measures were administered to a sample of 74 youth with DS at two visits, two weeks apart. Overall cognitive abilities were also assessed. OUTCOMES AND RESULTS The OMQ-PF had good feasibility and distribution of scores, but floor effects were prominent for direct measures. Test-retest reliability was poor to moderate for all measures and practice effects were problematic for the NEPSY-II List Memory and DAS-II Recall of Objects subtests. Commonalities in responses were observed, including primacy/recency effects, and some STM scores were correlated with overall cognitive abilities. CONCLUSIONS AND IMPLICATIONS The OMQ-PF met most study criteria, but no direct measure met sufficient criteria to be strongly recommended for future clinical trials. Because higher cognitive abilities were related to assessment completion, STM measures may require adaptation for use in broader samples of youth with DS across all levels of cognitive ability.
Collapse
Affiliation(s)
- Emily K Schworer
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
| | - Kellie Voth
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Emily K Hoffman
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Anna J Esbensen
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| |
Collapse
|
13
|
Schworer EK, Esbensen AJ, Fidler DJ, Beebe DW, Carle A, Wiley S. Evaluating working memory outcome measures for children with Down syndrome. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2022; 66:195-211. [PMID: 33763953 PMCID: PMC8463631 DOI: 10.1111/jir.12833] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 01/13/2021] [Accepted: 03/02/2021] [Indexed: 05/13/2023]
Abstract
BACKGROUND There is a critical need for the psychometric evaluation of outcome measures to be used in clinical trials targeting cognition in Down syndrome (DS). This study examines a specific cognitive skill that is of particular importance in DS, working memory, and the psychometric properties of a set of standardised measurements to assess working memory in individuals with DS. METHODS Ninety children and adolescents ages 6 to 18 years old with DS were assessed on a selection of verbal and visuospatial working memory subtests of standardised clinical assessments at two time points to examine feasibility, distributional qualities, test-retest reliability and convergent validity against a priori criteria. Caregivers also completed an adaptive behaviour questionnaire to address working memory subtests' associations with broader developmental functioning. RESULTS The Stanford Binet-5 Verbal Working Memory, Differential Ability Scales-2 Recognition of Pictures, Stanford Binet-5 Nonverbal Working Memory and Wechsler Intelligence Scale for Children-5 Picture Span measures met the most psychometric criteria overall across the full age and IQ range of the study. Although Differential Ability Scales-2 Recall of Sequential Order and Differential Ability Scales-2 Recall of Digits Backward met the fewest a priori criteria, follow-up analyses suggested greater feasibility in specific age and IQ ranges. CONCLUSIONS Several working memory measures appear to be psychometrically sound and appropriate for use in clinical trials for children with DS, especially when focusing on raw scores. However, floor effects on standard scores and feasibility of some measures were problematic. Guidelines for use of the working memory subtests with this population are provided.
Collapse
Affiliation(s)
- Emily K. Schworer
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Anna J. Esbensen
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Deborah J. Fidler
- Human Development and Family Studies, Colorado State University, Fort Collins, CO, USA
| | - Dean W. Beebe
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Adam Carle
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- James M Anderson Center for Health Systems Excellence, Cincinnati, OH, USA
- Department of Psychology, University of Cincinnati, Cincinnati, OH, USA
| | - Susan Wiley
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| |
Collapse
|
14
|
Schworer EK, Belizaire S, Hoffman EK, Esbensen AJ. Semantic Verbal Fluency in Youth with Down Syndrome: Analysis of Conventional and Contextual Cluster Formation. Brain Sci 2021; 12:9. [PMID: 35053754 PMCID: PMC8773708 DOI: 10.3390/brainsci12010009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/15/2021] [Accepted: 12/22/2021] [Indexed: 11/16/2022] Open
Abstract
Expressive language delays and executive functioning challenges are common in youth with Down syndrome (DS). Verbal fluency is one method to investigate these constructs. We examined semantic verbal fluency responses to determine patterns in response generation and the psychometric properties of coded cluster formations. Participants were 97 children and adolescents with DS ranging in age from 6 to 19 years old. The semantic verbal fluency task was administered at two time points, two weeks apart. Heterogeneity in performance was observed for responses when coded either with conventional or contextual classifications. Overall, the number of switches in conventional classifications was greater than contextual classifications. This implies that participants did not use traditional (conventional) categories to organize their semantic verbal fluency responses, but may have been using contextual strategies. However, the number of switches and cluster size variables had poor to moderate test-retest reliability, which indicated that participants did not stay consistent with their performance over the two-week testing interval, regardless of the strategies used. Therefore, conventional and contextual clusters and switches as a measure of executive control may not be appropriate for all individuals with DS and additional attention is warranted to determine the utility of response coding in this population.
Collapse
Affiliation(s)
- Emily K. Schworer
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA; (S.B.); (E.K.H.); (A.J.E.)
| | - Shequanna Belizaire
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA; (S.B.); (E.K.H.); (A.J.E.)
| | - Emily K. Hoffman
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA; (S.B.); (E.K.H.); (A.J.E.)
| | - Anna J. Esbensen
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA; (S.B.); (E.K.H.); (A.J.E.)
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| |
Collapse
|
15
|
Psychometric Evaluation of Social Cognition and Behavior Measures in Children and Adolescents with Down Syndrome. Brain Sci 2021; 11:brainsci11070836. [PMID: 34202453 PMCID: PMC8301941 DOI: 10.3390/brainsci11070836] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/12/2021] [Accepted: 06/22/2021] [Indexed: 11/17/2022] Open
Abstract
Individuals with Down syndrome (DS) are often described as socially engaged; however, challenges with social cognition, expressive language, and social interaction are also common in DS and are prospective outcomes of interest for clinical trials. The current study evaluates the psychometric properties of standardized measurements of social cognition and social behavior for potential use as outcome measures for children and adolescents with DS. Seventy-three youth ages 6 to 17 years old (M = 12.67, SD = 3.16) with DS were assessed on social cognition subtests of a neuropsychological assessment at two time points. Caregivers also completed a parent-report measure of social behavior. Measures were evaluated for feasibility, test-retest reliability, practice effects, convergent validity, and associations with broader developmental domains (i.e., age, cognition, and language). All social cognition and behavior measures met criteria for a portion of the psychometric indices evaluated, yet feasibility limitations were identified for the Developmental Neuropsychological Assessment, Second Edition (NEPSY-II) Affect Recognition subtest, and the NEPSY-II Theory of Mind subtest had problematic floor effects for percentile ranks. The Social Responsiveness Scale, Second Edition (SRS-2; T-scores) had high feasibility, moderate to excellent test-retest reliability, and no practice effects, suggesting this measure could be appropriate for use in clinical trials involving youth with DS.
Collapse
|
16
|
Anagnostopoulou A, Styliadis C, Kartsidis P, Romanopoulou E, Zilidou V, Karali C, Karagianni M, Klados M, Paraskevopoulos E, Bamidis PD. Computerized physical and cognitive training improves the functional architecture of the brain in adults with Down syndrome: A network science EEG study. Netw Neurosci 2021; 5:274-294. [PMID: 33688615 PMCID: PMC7935030 DOI: 10.1162/netn_a_00177] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 12/01/2020] [Indexed: 01/31/2023] Open
Abstract
Understanding the neuroplastic capacity of people with Down syndrome (PwDS) can potentially reveal the causal relationship between aberrant brain organization and phenotypic characteristics. We used resting-state EEG recordings to identify how a neuroplasticity-triggering training protocol relates to changes in the functional connectivity of the brain's intrinsic cortical networks. Brain activity of 12 PwDS before and after a 10-week protocol of combined physical and cognitive training was statistically compared to quantify changes in directed functional connectivity in conjunction with psychosomatometric assessments. PwDS showed increased connectivity within the left hemisphere and from left-to-right hemisphere, as well as increased physical and cognitive performance. Our findings reveal a strong adaptive neuroplastic reorganization as a result of the training that leads to a less-random network with a more pronounced hierarchical organization. Our results go beyond previous findings by indicating a transition to a healthier, more efficient, and flexible network architecture, with improved integration and segregation abilities in the brain of PwDS. Resting-state electrophysiological brain activity is used here for the first time to display meaningful relationships to underlying Down syndrome processes and outcomes of importance in a translational inquiry. This trial is registered with ClinicalTrials.gov Identifier NCT04390321.
Collapse
Affiliation(s)
- Alexandra Anagnostopoulou
- Medical Physics Laboratory, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
| | - Charis Styliadis
- Medical Physics Laboratory, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
| | - Panagiotis Kartsidis
- Medical Physics Laboratory, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
| | - Evangelia Romanopoulou
- Medical Physics Laboratory, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
| | - Vasiliki Zilidou
- Medical Physics Laboratory, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
| | - Chrysi Karali
- School of Biology, Faculty of Science, Aristotle University of Thessaloniki, Greece
| | - Maria Karagianni
- Medical Physics Laboratory, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
| | - Manousos Klados
- Department of Psychology, The University of Sheffield International Faculty, City College, Thessaloniki, Greece
| | - Evangelos Paraskevopoulos
- Medical Physics Laboratory, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
| | - Panagiotis D Bamidis
- Medical Physics Laboratory, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
| |
Collapse
|
17
|
Thurm A, Kelleher B, Wheeler A. Outcome Measures for Core Symptoms of Intellectual Disability: State of the Field. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2020; 125:418-433. [PMID: 33211819 DOI: 10.1352/1944-7558-125.6.418] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 07/28/2020] [Indexed: 06/11/2023]
Abstract
Intellectual disability (ID) is defined by impairments in intellectual and adaptive functioning. As such, tools designed to assess these domains would theoretically be ideal outcome measures for treatment trials targeting core symptoms of ID. However, measures of intellectual and adaptive functioning have rarely been used as primary outcome measures to date and further study is needed regarding their usefulness to measure change. This area of inquiry is important because promising, mechanism-modifying treatments for conditions leading to ID are being initiated. To show efficacy, these treatments need to demonstrate an impact on core features of ID. After reviewing literature on this topic, we suggest solutions to several problems outlined, including use of out-of-age-range testing, alternative metrics, and development of new measures.
Collapse
Affiliation(s)
- Audrey Thurm
- Audrey Thurm, National Institute of Mental Health
| | | | | |
Collapse
|
18
|
Dávila G, Moyano MP, Edelkraut L, Moreno-Campos L, Berthier ML, Torres-Prioris MJ, López-Barroso D. Pharmacotherapy of Traumatic Childhood Aphasia: Beneficial Effects of Donepezil Alone and Combined With Intensive Naming Therapy. Front Pharmacol 2020; 11:1144. [PMID: 32848757 PMCID: PMC7411310 DOI: 10.3389/fphar.2020.01144] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 07/13/2020] [Indexed: 12/14/2022] Open
Abstract
At present, language therapy is the only available treatment for childhood aphasia (CA). Studying new interventions to augment and hasten the benefits provided by language therapy in children is strongly needed. CA frequently emerges as a consequence of traumatic brain injury and, as in the case of adults, it may be associated with dysfunctional activity of neurotransmitter systems. The use of cognitive-enhancing drugs, alone or combined with aphasia therapy, promotes improvement of language deficits in aphasic adults. In this study we report the case of a 9-year-old right-handed girl, subject P, who had chronic anomic aphasia associated with traumatic lesions in the left temporal-parietal cortex. We performed a single-subject, open-label study encompassing administration of the cholinergic agent donepezil (DP) alone during 12 weeks, followed by a combination of DP and intensive naming therapy (INT) for 2 weeks and thereafter by a continued treatment of DP alone during 12 weeks, a 4-week washout period, and another 2 weeks of INT. Four comprehensive language and neuropsychological evaluations were performed at different timepoints along the study, and multiple naming evaluations were performed after each INT in order to assess performance in treated and untreated words. Structural magnetic resonance imaging (MRI) was performed at baseline. MRI revealed two focal lesions in the left hemisphere, one large involving the posterior inferior and middle temporal gyri and another comprising the angular gyrus. Overall, baseline evaluation disclosed marked impairment in naming with mild-to-moderate compromise of spontaneous speech, repetition, and auditory comprehension. Executive and attention functions were also affected, but memory, visuoconstructive, and visuoperceptive functions were preserved. Treatment with DP alone significantly improved spontaneous speech, auditory comprehension, repetition, and picture naming, in addition to processing speed, selective, and sustained attention. Combined DP-INT further improved naming. After washout of both interventions, most of these beneficial changes remained. Importantly, DP produced no side effects and subject P attained the necessary level of language competence to return to regular schooling. In conclusion, the use of DP alone and in combination with INT improved language function and related cognitive posttraumatic deficits in a child with acquired aphasia. Further studies in larger samples are warranted.
Collapse
Affiliation(s)
- Guadalupe Dávila
- Cognitive Neurology and Aphasia Unit, Centro de Investigaciones Médico-Sanitarias, University of Malaga, Malaga, Spain.,Instituto de Investigación Biomédica de Málaga - IBIMA, Málaga, Spain.,Department of Psychobiology and Methodology of Behavioural Sciences, Faculty of Psychology and Speech Therapy, University of Malaga, Malaga, Spain.,Language Neuroscience Research Laboratory, Faculty of Psychology and Speech Therapy, University of Malaga, Malaga, Spain
| | - María Pilar Moyano
- Cognitive Neurology and Aphasia Unit, Centro de Investigaciones Médico-Sanitarias, University of Malaga, Malaga, Spain
| | - Lisa Edelkraut
- Cognitive Neurology and Aphasia Unit, Centro de Investigaciones Médico-Sanitarias, University of Malaga, Malaga, Spain.,Instituto de Investigación Biomédica de Málaga - IBIMA, Málaga, Spain.,Department of Psychobiology and Methodology of Behavioural Sciences, Faculty of Psychology and Speech Therapy, University of Malaga, Malaga, Spain.,Language Neuroscience Research Laboratory, Faculty of Psychology and Speech Therapy, University of Malaga, Malaga, Spain
| | - Lorena Moreno-Campos
- Cognitive Neurology and Aphasia Unit, Centro de Investigaciones Médico-Sanitarias, University of Malaga, Malaga, Spain
| | - Marcelo L Berthier
- Cognitive Neurology and Aphasia Unit, Centro de Investigaciones Médico-Sanitarias, University of Malaga, Malaga, Spain.,Instituto de Investigación Biomédica de Málaga - IBIMA, Málaga, Spain.,Language Neuroscience Research Laboratory, Faculty of Psychology and Speech Therapy, University of Malaga, Malaga, Spain
| | - María José Torres-Prioris
- Cognitive Neurology and Aphasia Unit, Centro de Investigaciones Médico-Sanitarias, University of Malaga, Malaga, Spain.,Instituto de Investigación Biomédica de Málaga - IBIMA, Málaga, Spain.,Department of Psychobiology and Methodology of Behavioural Sciences, Faculty of Psychology and Speech Therapy, University of Malaga, Malaga, Spain.,Language Neuroscience Research Laboratory, Faculty of Psychology and Speech Therapy, University of Malaga, Malaga, Spain
| | - Diana López-Barroso
- Cognitive Neurology and Aphasia Unit, Centro de Investigaciones Médico-Sanitarias, University of Malaga, Malaga, Spain.,Instituto de Investigación Biomédica de Málaga - IBIMA, Málaga, Spain.,Department of Psychobiology and Methodology of Behavioural Sciences, Faculty of Psychology and Speech Therapy, University of Malaga, Malaga, Spain.,Language Neuroscience Research Laboratory, Faculty of Psychology and Speech Therapy, University of Malaga, Malaga, Spain
| |
Collapse
|
19
|
Abstract
Experimental work regarding corrective actions on chromosomes and genes, and control of gene products is yielding promising results. It opens the way to advances in dealing with the etiological aspects of Down syndrome and may lead to important changes in the life of individuals affected with this condition. A small number of molecules are being investigated in pharmacological research that may have positive effects on intellectual functioning. Studies of the pathological consequences of the amyloid cascade and the TAU pathology in the etiology of Alzheimer disease (AD), which is more frequent and occuring earlier in life in persons with Down syndrome (DS), are presented. The search for biological markers of AD and ways for constrasting its early manifestations are also discussed.
Collapse
Affiliation(s)
- Jean A. Rondal
- University of Liège, Cognitive Sciences, Building 32, Sart Tilman, Liège 4000, Belgium
| |
Collapse
|
20
|
Rueda N, Flórez J, Dierssen M, Martínez-Cué C. Translational validity and implications of pharmacotherapies in preclinical models of Down syndrome. PROGRESS IN BRAIN RESEARCH 2019; 251:245-268. [PMID: 32057309 DOI: 10.1016/bs.pbr.2019.10.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Neurodevelopmental disorders are challenging to study in the laboratory, and despite a large investment, few novel treatments have been developed in the last decade. While animal models have been valuable in elucidating disease mechanisms and in providing insights into the function of specific genes, the predictive validity of preclinical models to test potential therapies has been questioned. In the last two decades, diverse new murine models of Down syndrome (DS) have been developed and numerous studies have demonstrated neurobiological alterations that could be responsible for the cognitive and behavioral phenotypes found in this syndrome. In many cases, similar alterations were found in murine models and in individuals with DS, although several phenotypes shown in animals have yet not been confirmed in the human condition. Some of the neurobiological alterations observed in mice have been proposed to account for their changes in cognition and behavior, and have received special attention because of being putative therapeutic targets. Those include increased oxidative stress, altered neurogenesis, overexpression of the Dyrk1A gene, GABA-mediated overinhibition and Alzheimer's disease-related neurodegeneration. Subsequently, different laboratories have tested the efficacy of pharmacotherapies targeting these alterations. Unfortunately, animal models are limited in their ability to mimic the extremely complex process of human neurodevelopment and neuropathology. Therefore, the safety and efficacy identified in animal studies are not always translated to humans, and most of the drugs tested have not demonstrated any positive effect or very limited efficacy in clinical trials. Despite their limitations, though, animal trials give us extremely valuable information for developing and testing drugs for human use that cannot be obtained from molecular or cellular experiments alone. This chapter reviews some of these therapeutic approaches and discusses some reasons that could account for the discrepancy between the findings in mouse models of DS and in humans, including: (i) the incomplete resemble of the genetic alterations of available mouse models of DS and human trisomy 21, (ii) the lack of evidence that some of the phenotypic alterations found in mice (e.g., GABA-mediated overinhibition, and alterations in adult neurogenesis) are also present in DS individuals, and (iii) the inaccuracy and/or inadequacy of the methods used in clinical trials to detect changes in the cognitive and behavioral functions of people with DS. Despite the shortcomings of animal models, animal experimentation remains an invaluable tool in developing drugs. Thus, we will also discuss how to increase predictive validity of mouse models.
Collapse
Affiliation(s)
- Noemí Rueda
- Department of Physiology and Pharmacology, University of Cantabria, Santander, Spain
| | - Jesús Flórez
- Department of Physiology and Pharmacology, University of Cantabria, Santander, Spain
| | - Mara Dierssen
- Cellular and Systems Neurobiology, Systems Biology Program, Centre for Genomic Regulation (CRG), Barcelona Institute of Science and Technology, Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Carmen Martínez-Cué
- Department of Physiology and Pharmacology, School of Medicine, University of Cantabria, Santander, Spain.
| |
Collapse
|
21
|
Esbensen AJ, Hoffman EK, Shaffer R, Chen E, Patel L, Jacola L. Reliability of Informant-Report Measures of Executive Functioning in Children With Down Syndrome. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2019; 124:220-233. [PMID: 31026204 PMCID: PMC6487878 DOI: 10.1352/1944-7558-124.3.220] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The current study evaluates the psychometric properties of the Behavior Rating Inventory of Executive Function (BRIEF) with children with Down syndrome. Caregivers of 84 children with Down syndrome rated their child's behavior with the BRIEF. Teacher ratings were obtained for 57 children. About 40% of children with Down syndrome were reported by parents, and 70% by teachers, to exhibit clinically significant challenges with executive functioning. Distribution of scores was normal, internal consistency for subscales was questionable to primarily excellent, and inter-rater reliability was poor to good. Normative data conversions controlled for age, IQ, and gender differences, with some exceptions. The study findings suggest that the BRIEF and its subscales generally performed in a psychometrically sound manner among children with Down syndrome.
Collapse
Affiliation(s)
- Anna J. Esbensen
- Department of Pediatrics, University of Cincinnati College of Medicine
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children’s Hospital Medical Center
| | - Emily K. Hoffman
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children’s Hospital Medical Center
| | - Rebecca Shaffer
- Department of Pediatrics, University of Cincinnati College of Medicine
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children’s Hospital Medical Center
| | - Elizabeth Chen
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children’s Hospital Medical Center
| | - Lina Patel
- Sie Center for Down Syndrome, Children’s Hospital Colorado
| | - Lisa Jacola
- Department of Psychology, St Jude Children’s Research Hospital
| |
Collapse
|
22
|
Down syndrome: Neurobiological alterations and therapeutic targets. Neurosci Biobehav Rev 2019; 98:234-255. [DOI: 10.1016/j.neubiorev.2019.01.001] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 01/02/2019] [Accepted: 01/02/2019] [Indexed: 12/12/2022]
|
23
|
Abstract
Down syndrome (DS; Trisomy 21) is the most common chromosomal disorder in humans. It has numerous associated neurologic phenotypes including intellectual disability, sleep apnea, seizures, behavioral problems, and dementia. With improved access to medical care, people with DS are living longer than ever before. As more individuals with DS reach old age, the necessity for further life span research is essential and cannot be overstated. There is currently a scarcity of information on common medical conditions encountered as individuals with DS progress into adulthood and old age. Conflicting information and uncertainty about the relative risk of dementia for adults with DS is a source of distress for the DS community that creates a major obstacle to proper evaluation and treatment. In this chapter, we discuss the salient neurologic phenotypes of DS, including Alzheimer's disease (AD), and current understanding of their biologic bases and management.
Collapse
Affiliation(s)
- Michael S Rafii
- Department of Neurology, Keck School of Medicine of the University of Southern California, San Diego, CA, United States
| | | | - Mariko Sawa
- Department of Neurosciences, University of California San Diego, La Jolla, CA, United States
| | - William C Mobley
- Department of Neurosciences, University of California San Diego, La Jolla, CA, United States.
| |
Collapse
|
24
|
Spiridigliozzi GA, Goeldner C, Edgin J, Hart SJ, Noeldeke J, Squassante L, Visootsak J, Heller JH, Khwaja O, Kishnani PS, Liogier d'Ardhuy X. Adaptive behavior in adolescents and adults with Down syndrome: Results from a 6-month longitudinal study. Am J Med Genet A 2018; 179:85-93. [PMID: 30569586 DOI: 10.1002/ajmg.a.60685] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 09/09/2018] [Accepted: 10/10/2018] [Indexed: 11/10/2022]
Abstract
Measures of adaptive behavior are important in the assessment and treatment of individuals with intellectual disabilities (ID). The purpose of the current study was to evaluate the stability of an established and a novel measure of adaptive behavior over time, and their suitability as outcome measures in clinical trials targeting individuals with Down syndrome (DS). This 6-month, longitudinal, noninterventional, multinational study included adolescents (12-17 years) and adults (18-30 years) with DS. Participants were from seven countries (11 different sites) with English, Spanish and French as their native language. The Vineland Adaptive Behavior Scales-II (VABS-II) and a newly developed Clinician Global Impression (CGI) scale were administered at baseline, 1 and 6 months. Adults had lower composite standard scores on all domains of the VABS-II compared with adolescents. The communication domain was a weakness relative to the socialization and daily living skills domains on the VABS-II and the CGI-Severity scale. These findings were stable over 6 months, as exhibited by high intraclass correlations (>0.75). These results provide valuable baseline data for use in trial design and endpoint selection for studies including individuals with DS. ClinicalTrials.gov identifier: NCT01580384.
Collapse
Affiliation(s)
- Gail A Spiridigliozzi
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
| | - Celia Goeldner
- F. Hoffmann-La Roche, Roche Pharma Research and Early Development, Neuroscience, Roche Innovation Center Basel, Basel, Switzerland
| | - Jamie Edgin
- Department of Psychology, University of Arizona, Tucson, Arizona
| | - Sarah J Hart
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
| | - Jana Noeldeke
- F. Hoffmann-La Roche, Roche Pharma Research and Early Development, Neuroscience, Roche Innovation Center Basel, Basel, Switzerland
| | - Lisa Squassante
- F. Hoffmann-La Roche, Roche Pharma Research and Early Development, Neuroscience, Roche Innovation Center Basel, Basel, Switzerland
| | - Jeannie Visootsak
- F. Hoffmann-La Roche, Roche Pharma Research and Early Development, Neuroscience, Roche Innovation Center, New York, New York
| | | | - Omar Khwaja
- F. Hoffmann-La Roche, Roche Pharma Research and Early Development, Neuroscience, Roche Innovation Center Basel, Basel, Switzerland
| | - Priya S Kishnani
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
| | - Xavier Liogier d'Ardhuy
- F. Hoffmann-La Roche, Roche Pharma Research and Early Development, Neuroscience, Roche Innovation Center Basel, Basel, Switzerland
| |
Collapse
|
25
|
On the Design of Broad-Based Neuropsychological Test Batteries to Assess the Cognitive Abilities of Individuals with Down Syndrome in the Context of Clinical Trials. Brain Sci 2018; 8:brainsci8120205. [PMID: 30486228 PMCID: PMC6315396 DOI: 10.3390/brainsci8120205] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 11/14/2018] [Accepted: 11/21/2018] [Indexed: 12/29/2022] Open
Abstract
Down syndrome (DS) is the most common genetically-defined cause of intellectual disability. Neurodevelopmental deficits displayed by individuals with DS are generally global, however, disproportionate deficits in cognitive processes that depend heavily on the hippocampus and prefrontal cortex are also well documented. Additionally, DS is associated with relative strengths in visual processing and visuospatial short-term memory, and weaknesses in the verbal domain. Although reports of pharmacological rescuing of learning and memory deficits in mouse models of DS abound in the literature, proving the principle that cognitive ability of persons with DS can be boosted through pharmacological means is still an elusive goal. The design of customized batteries of neuropsychological efficacy outcome measures is essential for the successful implementation of clinical trials of potential cognitive enhancing strategies. Here, we review the neurocognitive phenotype of individuals with DS and major broad-based test batteries designed to quantify specific cognitive domains in these individuals, including the one used in a pilot trial of the drug memantine. The main goal is to illustrate the essential considerations in planning trials to enhance cognitive functions in individuals with DS, which should also have implications for the design of similar studies in individuals with other forms of intellectual disability.
Collapse
|
26
|
Feng B, Hoskins W, Zhang Y, Meng Z, Samuels DC, Wang J, Xia R, Liu C, Tang J, Guo Y. Bi-stream CNN Down Syndrome screening model based on genotyping array. BMC Med Genomics 2018; 11:105. [PMID: 30453947 PMCID: PMC6245487 DOI: 10.1186/s12920-018-0416-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Human Down syndrome (DS) is usually caused by genomic micro-duplications and dosage imbalances of human chromosome 21. It is associated with many genomic and phenotype abnormalities. Even though human DS occurs about 1 per 1,000 births worldwide, which is a very high rate, researchers haven't found any effective method to cure DS. Currently, the most efficient ways of human DS prevention are screening and early detection. METHODS In this study, we used deep learning techniques and analyzed a set of Illumina genotyping array data. We built a bi-stream convolutional neural networks model to screen/predict the occurrence of DS. Firstly, we built image input data by converting the intensities of each SNP site into chromosome SNP maps. Next, we proposed a bi-stream convolutional neural network (CNN) architecture with nine layers and two branch models. We further merged two CNN branch models into one model in the fourth convolutional layer, and output the prediction in the last layer. RESULTS Our bi-stream CNN model achieved 99.3% average accuracies, and very low false-positive and false-negative rates, which was necessary for further applications in disease prediction and medical practice. We further visualized the feature maps and learned filters from intermediate convolutional layers, which showed the genomic patterns and correlated SNPs variations in human DS genomes. We also compared our methods with other CNN and traditional machine learning models. We further analyzed and discussed the characteristics and strengths of our bi-stream CNN model. CONCLUSIONS Our bi-stream model used two branch CNN models to learn the local genome features and regional patterns among adjacent genes and SNP sites from two chromosomes simultaneously. It achieved the best performance in all evaluating metrics when compared with two single-stream CNN models and three traditional machine-learning algorithms. The visualized feature maps also provided opportunities to study the genomic markers and pathway components associated with Human DS, which provided insights for gene therapy and genomic medicine developments.
Collapse
Affiliation(s)
- Bing Feng
- College of Education, Zhejiang University, Hangzhou, Zhejiang, 310058, People's Republic of China.,Department of Computer Science and Engineering,University of South Carolina, Columbia, 29208, SC, USA
| | - William Hoskins
- Department of Computer Science and Engineering,University of South Carolina, Columbia, 29208, SC, USA
| | - Yan Zhang
- Department of Computer Science and Engineering,University of South Carolina, Columbia, 29208, SC, USA.,School of Computer Science and Technology, Tianjin University, 300072, Tianjin, 300072, People's Republic of China
| | - Zibo Meng
- Department of Computer Science and Engineering,University of South Carolina, Columbia, 29208, SC, USA
| | - David C Samuels
- Vanderbilt University School of Medicine,Vanderbilt University, Nashville, 37232, TN, USA
| | - Jiandong Wang
- Department of Computer Science and Engineering,University of South Carolina, Columbia, 29208, SC, USA
| | - Ruofan Xia
- Department of Computer Science and Engineering,University of South Carolina, Columbia, 29208, SC, USA
| | - Chao Liu
- College of Education, Zhejiang University, Hangzhou, Zhejiang, 310058, People's Republic of China
| | - Jijun Tang
- College of Education, Zhejiang University, Hangzhou, Zhejiang, 310058, People's Republic of China. .,Department of Computer Science and Engineering,University of South Carolina, Columbia, 29208, SC, USA. .,School of Computer Science and Technology, Tianjin University, 300072, Tianjin, 300072, People's Republic of China.
| | - Yan Guo
- School of Medicine,The University of New Mexico, Albuquerque, 87131, NM, USA.
| |
Collapse
|
27
|
Daunhauer LA, Gerlach-McDonald B, Will E, Fidler DJ. Performance and Ratings Based Measures of Executive Function in School-Aged Children with Down Syndrome. Dev Neuropsychol 2017; 42:351-368. [DOI: 10.1080/87565641.2017.1360303] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Lisa A. Daunhauer
- Human Development and Family Studies, Colorado State University, Fort Collins, Colorado
| | - Brianne Gerlach-McDonald
- Frank Porter Graham Child Development Institute, University of North Carolina, Chapel Hill, North Carolina
| | - Elizabeth Will
- Department of Psychology, University of South Carolina, Columbia, South Carolina
| | - Deborah J. Fidler
- Human Development and Family Studies, Colorado State University, Fort Collins, Colorado
| |
Collapse
|
28
|
Hart SJ, Visootsak J, Tamburri P, Phuong P, Baumer N, Hernandez MC, Skotko BG, Ochoa-Lubinoff C, Liogier D'Ardhuy X, Kishnani PS, Spiridigliozzi GA. Pharmacological interventions to improve cognition and adaptive functioning in Down syndrome: Strides to date. Am J Med Genet A 2017; 173:3029-3041. [PMID: 28884975 DOI: 10.1002/ajmg.a.38465] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 06/02/2017] [Accepted: 08/10/2017] [Indexed: 12/21/2022]
Abstract
Although an increasing number of clinical trials have been developed for cognition in Down syndrome, there has been limited success to date in identifying effective interventions. This review describes the progression from pre-clinical studies with mouse models to human clinical trials research using pharmacological interventions to improve cognition and adaptive functioning in Down syndrome. We also provide considerations for investigators when conducting human clinical trials and describe strategies for the pharmaceutical industry to advance the field in drug discovery for Down syndrome. Future research focusing on earlier pharmaceutical interventions, development of appropriate outcome measures, and greater collaboration between industry, academia, advocacy, and regulatory groups will be important for addressing limitations from prior studies and developing potential effective interventions for cognition in Down syndrome.
Collapse
Affiliation(s)
- Sarah J Hart
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
| | - Jeannie Visootsak
- F. Hoffmann-La Roche, Roche Pharma Research and Early Development, Neuroscience, Roche Innovation Center New York, New York, New York
| | - Paul Tamburri
- F. Hoffmann-La Roche, Roche Pharma Research and Early Development, Neuroscience, Roche Innovation Center New York, New York, New York
| | - Patrick Phuong
- F. Hoffmann-La Roche, Roche Pharma Research and Early Development, Neuroscience, Roche Innovation Center New York, New York, New York
| | - Nicole Baumer
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts.,Down Syndrome Program, Developmental Medicine Center, Boston Children's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Maria-Clemencia Hernandez
- F. Hoffmann-La Roche, Roche Pharma Research and Early Development, Neuroscience, Roche Innovation Center Basel, Basel, Switzerland
| | - Brian G Skotko
- Harvard Medical School, Boston, Massachusetts.,Down Syndrome Program, Division of Medical Genetics, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts
| | - Cesar Ochoa-Lubinoff
- Section of Developmental-Behavioral Pediatrics, Department of Pediatrics, Rush University Medical Center, Chicago, Illinois
| | - Xavier Liogier D'Ardhuy
- F. Hoffmann-La Roche, Roche Pharma Research and Early Development, Neuroscience, Roche Innovation Center Basel, Basel, Switzerland
| | - Priya S Kishnani
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
| | - Gail A Spiridigliozzi
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
| |
Collapse
|
29
|
Keeling LA, Spiridigliozzi GA, Hart SJ, Baker JA, Jones HN, Kishnani PS. Challenges in measuring the effects of pharmacological interventions on cognitive and adaptive functioning in individuals with Down syndrome: A systematic review. Am J Med Genet A 2017; 173:3058-3066. [PMID: 28857390 DOI: 10.1002/ajmg.a.38416] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 07/24/2017] [Accepted: 07/29/2017] [Indexed: 12/16/2022]
Abstract
We systematically reviewed the measures used in pharmaceutical trials in children/adults with Down syndrome without dementia. Our purpose was to identify developmentally appropriate outcome measures capable of detecting changes in cognitive and adaptive functioning in this population. Eleven studies were included and used diverse outcome measures across the domains of language, memory, attention, behavior, and executive/adaptive functioning. Our results highlight the challenges in selecting measures capable of capturing improvements in pharmaceutical trials in individuals with DS. We offer suggestions to enhance future research, including: conducting studies with larger samples of participants with a range of developmental abilities; modifying existing/developing novel outcome measures; incorporating advances from related areas and DS observational studies; and considering alternative analytic techniques to characterize treatment effects.
Collapse
Affiliation(s)
- Lori A Keeling
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
| | - Gail A Spiridigliozzi
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
| | - Sarah J Hart
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
| | - Jane A Baker
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
| | - Harrison N Jones
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Priya S Kishnani
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
| |
Collapse
|
30
|
Esbensen AJ. Introduction to the Special Issue on the Development of People With Down Syndrome Throughout the Lifespan (Part 1). AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2017; 122:213-214. [PMID: 28452582 DOI: 10.1352/1944-7558-122.3.213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
|
31
|
Esbensen AJ, Hooper SR, Fidler D, Hartley S, Edgin J, d’Ardhuy XL, Capone G, Conners F, Mervis CB, Abbeduto L, Rafii M, Krinsky-McHale SJ, Urv T. Outcome Measures for Clinical Trials in Down Syndrome. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2017; 122:247-281. [PMID: 28452584 PMCID: PMC5424621 DOI: 10.1352/1944-7558-122.3.247] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Increasingly individuals with intellectual and developmental disabilities, including Down syndrome, are being targeted for clinical trials. However, a challenge exists in effectively evaluating the outcomes of these new pharmacological interventions. Few empirically evaluated, psychometrically sound outcome measures appropriate for use in clinical trials with individuals with Down syndrome have been identified. To address this challenge, the National Institutes of Health (NIH) assembled leading clinicians and scientists to review existing measures and identify those that currently are appropriate for trials; those that may be appropriate after expansion of age range addition of easier items, and/or downward extension of psychometric norms; and areas where new measures need to be developed. This article focuses on measures in the areas of cognition and behavior.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | - Leonard Abbeduto
- MIND Institute, University of California, Davis School of Medicine
| | | | | | - Tiina Urv
- Eunice Kennedy Shriver National Institute of Child Health and Human Development
| | | |
Collapse
|
32
|
Jensen KB, Kirsch I, Pontén M, Rosén A, Yang K, Gollub RL, des Portes V, Kaptchuk TJ, Curie A. Certainty of genuine treatment increases drug responses among intellectually disabled patients. Neurology 2017; 88:1912-1918. [PMID: 28424273 PMCID: PMC5444309 DOI: 10.1212/wnl.0000000000003934] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Accepted: 02/28/2017] [Indexed: 02/06/2023] Open
Abstract
Objective: To determine the placebo component of treatment responses in patients with intellectual disability (ID). Methods: A statistical meta-analysis comparing bias-corrected effect sizes (Hedges g) of drug responses in open-label vs placebo-controlled clinical trials was performed, as these trial types represent different certainty of receiving genuine treatment (100% vs 50%). Studies in fragile X, Down, Prader-Willi, and Williams syndrome published before June 2015 were considered. Results: Seventeen open-label trials (n = 261, 65% male; mean age 23.6 years; mean trial duration 38 weeks) and 22 placebo-controlled trials (n = 721, 62% male; mean age 17.1 years; mean trial duration 35 weeks) were included. The overall effect size from pre to post treatment in open-label studies was g = 0.602 (p = 0.001). The effect of trial type was statistically significant (p = 0.001), and revealed higher effect sizes in studies with 100% likelihood of getting active drug, compared to both the drug and placebo arm of placebo-controlled trials. We thus provide evidence for genuine placebo effects, not explainable by natural history or regression toward the mean, among patients with ID. Conclusions: Our data suggest that clinical trials in patients with severe cognitive deficits are influenced by the certainty of receiving genuine medication, and open-label design should thus not be used to evaluate the effect of pharmacologic treatments in ID, as the results will be biased by an enhanced placebo component.
Collapse
Affiliation(s)
- Karin B Jensen
- From the Department of Clinical Neuroscience (K.B.J., M.P., A.R.), Karolinska Institute, Sweden; Program in Placebo Studies (I.K., T.J.K.), BIDMC, Harvard Medical School; Department of Psychiatry (K.Y., R.L.G.), Massachusetts General Hospital, Boston; Institut des Sciences Cognitives (V.d.P., A.C.), Bron; Université Claude Bernard Lyon 1 (V.d.P., A.C.); Centre de Référence Déficiences Intellectuelles de Causes Rares (V.d.P., A.C.), Hôpital Femmes Mères Enfants, Hospices Civils de Lyon; and EPICIME-CIC1407/INSERM (A.C.), Bron, France.
| | - Irving Kirsch
- From the Department of Clinical Neuroscience (K.B.J., M.P., A.R.), Karolinska Institute, Sweden; Program in Placebo Studies (I.K., T.J.K.), BIDMC, Harvard Medical School; Department of Psychiatry (K.Y., R.L.G.), Massachusetts General Hospital, Boston; Institut des Sciences Cognitives (V.d.P., A.C.), Bron; Université Claude Bernard Lyon 1 (V.d.P., A.C.); Centre de Référence Déficiences Intellectuelles de Causes Rares (V.d.P., A.C.), Hôpital Femmes Mères Enfants, Hospices Civils de Lyon; and EPICIME-CIC1407/INSERM (A.C.), Bron, France
| | - Moa Pontén
- From the Department of Clinical Neuroscience (K.B.J., M.P., A.R.), Karolinska Institute, Sweden; Program in Placebo Studies (I.K., T.J.K.), BIDMC, Harvard Medical School; Department of Psychiatry (K.Y., R.L.G.), Massachusetts General Hospital, Boston; Institut des Sciences Cognitives (V.d.P., A.C.), Bron; Université Claude Bernard Lyon 1 (V.d.P., A.C.); Centre de Référence Déficiences Intellectuelles de Causes Rares (V.d.P., A.C.), Hôpital Femmes Mères Enfants, Hospices Civils de Lyon; and EPICIME-CIC1407/INSERM (A.C.), Bron, France
| | - Annelie Rosén
- From the Department of Clinical Neuroscience (K.B.J., M.P., A.R.), Karolinska Institute, Sweden; Program in Placebo Studies (I.K., T.J.K.), BIDMC, Harvard Medical School; Department of Psychiatry (K.Y., R.L.G.), Massachusetts General Hospital, Boston; Institut des Sciences Cognitives (V.d.P., A.C.), Bron; Université Claude Bernard Lyon 1 (V.d.P., A.C.); Centre de Référence Déficiences Intellectuelles de Causes Rares (V.d.P., A.C.), Hôpital Femmes Mères Enfants, Hospices Civils de Lyon; and EPICIME-CIC1407/INSERM (A.C.), Bron, France
| | - Kathy Yang
- From the Department of Clinical Neuroscience (K.B.J., M.P., A.R.), Karolinska Institute, Sweden; Program in Placebo Studies (I.K., T.J.K.), BIDMC, Harvard Medical School; Department of Psychiatry (K.Y., R.L.G.), Massachusetts General Hospital, Boston; Institut des Sciences Cognitives (V.d.P., A.C.), Bron; Université Claude Bernard Lyon 1 (V.d.P., A.C.); Centre de Référence Déficiences Intellectuelles de Causes Rares (V.d.P., A.C.), Hôpital Femmes Mères Enfants, Hospices Civils de Lyon; and EPICIME-CIC1407/INSERM (A.C.), Bron, France
| | - Randy L Gollub
- From the Department of Clinical Neuroscience (K.B.J., M.P., A.R.), Karolinska Institute, Sweden; Program in Placebo Studies (I.K., T.J.K.), BIDMC, Harvard Medical School; Department of Psychiatry (K.Y., R.L.G.), Massachusetts General Hospital, Boston; Institut des Sciences Cognitives (V.d.P., A.C.), Bron; Université Claude Bernard Lyon 1 (V.d.P., A.C.); Centre de Référence Déficiences Intellectuelles de Causes Rares (V.d.P., A.C.), Hôpital Femmes Mères Enfants, Hospices Civils de Lyon; and EPICIME-CIC1407/INSERM (A.C.), Bron, France
| | - Vincent des Portes
- From the Department of Clinical Neuroscience (K.B.J., M.P., A.R.), Karolinska Institute, Sweden; Program in Placebo Studies (I.K., T.J.K.), BIDMC, Harvard Medical School; Department of Psychiatry (K.Y., R.L.G.), Massachusetts General Hospital, Boston; Institut des Sciences Cognitives (V.d.P., A.C.), Bron; Université Claude Bernard Lyon 1 (V.d.P., A.C.); Centre de Référence Déficiences Intellectuelles de Causes Rares (V.d.P., A.C.), Hôpital Femmes Mères Enfants, Hospices Civils de Lyon; and EPICIME-CIC1407/INSERM (A.C.), Bron, France
| | - Ted J Kaptchuk
- From the Department of Clinical Neuroscience (K.B.J., M.P., A.R.), Karolinska Institute, Sweden; Program in Placebo Studies (I.K., T.J.K.), BIDMC, Harvard Medical School; Department of Psychiatry (K.Y., R.L.G.), Massachusetts General Hospital, Boston; Institut des Sciences Cognitives (V.d.P., A.C.), Bron; Université Claude Bernard Lyon 1 (V.d.P., A.C.); Centre de Référence Déficiences Intellectuelles de Causes Rares (V.d.P., A.C.), Hôpital Femmes Mères Enfants, Hospices Civils de Lyon; and EPICIME-CIC1407/INSERM (A.C.), Bron, France
| | - Aurore Curie
- From the Department of Clinical Neuroscience (K.B.J., M.P., A.R.), Karolinska Institute, Sweden; Program in Placebo Studies (I.K., T.J.K.), BIDMC, Harvard Medical School; Department of Psychiatry (K.Y., R.L.G.), Massachusetts General Hospital, Boston; Institut des Sciences Cognitives (V.d.P., A.C.), Bron; Université Claude Bernard Lyon 1 (V.d.P., A.C.); Centre de Référence Déficiences Intellectuelles de Causes Rares (V.d.P., A.C.), Hôpital Femmes Mères Enfants, Hospices Civils de Lyon; and EPICIME-CIC1407/INSERM (A.C.), Bron, France
| |
Collapse
|
33
|
Epigenomic engineering for Down syndrome. Neurosci Biobehav Rev 2016; 71:323-327. [DOI: 10.1016/j.neubiorev.2016.09.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 08/11/2016] [Accepted: 09/15/2016] [Indexed: 12/27/2022]
|
34
|
Spiridigliozzi GA, Hart SJ, Heller JH, Schneider HE, Baker JA, Weadon C, Capone GT, Kishnani PS. Safety and efficacy of rivastigmine in children with Down syndrome: A double blind placebo controlled trial. Am J Med Genet A 2016; 170:1545-55. [PMID: 27061338 DOI: 10.1002/ajmg.a.37650] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 03/11/2016] [Indexed: 11/06/2022]
Abstract
Individuals with Down syndrome (DS) have decreased cholinergic function and an uneven profile of cognitive abilities, with more pronounced deficits in learning, memory, and expressive language. Cholinesterase inhibitors may improve cognitive function in adults and adolescents with DS, but studies in children with DS have been limited. This study aimed to: (i) investigate the safety and efficacy of rivastigmine treatment; (ii) build upon our open-label studies in children with DS in a double-blind, placebo-controlled clinical trial; and (iii) investigate specific cognitive domains that may respond to rivastigmine treatment. We conducted a 20-week double-blind, placebo-controlled trial to investigate the safety and efficacy of rivastigmine in 22 children and adolescents with DS aged 10-17 years. Safety measures included reports of adverse events, laboratory parameters, and electrocardiograms. Efficacy measures included parental assessments of adaptive behavior and executive function, and direct measures of language and memory. No group differences were found on safety measures and 22 of 24 participants that passed study screening completed the study. The results did not demonstrate evidence for significant improvement in aspects of cognition, language, or overall function in the children receiving rivastigmine. Our results suggest that rivastigmine is safe and well-tolerated for children and adolescents with DS, but may not be effective for improving performance on the selected measures in this study. However, larger samples and/or alternate measures could possibly reveal improvements in cognitive function with rivastigmine treatment. Further research is needed to define a battery of cognitive measures that is sensitive to treatment effects in DS. © 2016 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Gail A Spiridigliozzi
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
| | - Sarah J Hart
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
| | - James H Heller
- Formerly of Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Heather E Schneider
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, Maryland
| | - Jane Ann Baker
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
| | - Cathleen Weadon
- Down Syndrome Clinic and Research Center, Kennedy Krieger Institute, Baltimore, Maryland
| | - George T Capone
- Down Syndrome Clinic and Research Center, Kennedy Krieger Institute, Baltimore, Maryland.,Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Priya S Kishnani
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
| |
Collapse
|
35
|
Abstract
PURPOSE OF REVIEW Psychotropic medications are commonly prescribed to people with intellectual disability. We reviewed current evidence-based pharmacotherapy options and recent updates to guide clinicians in their medication management plans. RECENT FINDINGS Antipsychotics, particularly risperidone, appear to be effective in reducing problem behaviors in children with intellectual disability. Evidence in adults is inconclusive. Methylphenidate appears to be effective, and α-agonists appear promising in reducing attention-deficit hyperactivity disorder symptoms. Lithium might be effective in reducing aggression. Evidence is limited to support the use of antiepileptic drugs, anxiolytics, and naltrexone for management of problem behaviors. Antidepressants may be poorly tolerated and might not be effective in reducing repetitive/stereotypic behaviors.In recent trials, glutamatergic and GABAergic agents for fragile X syndrome, and acetylcholinesterase inhibitors for Down's syndrome, failed to show efficacy. Growth hormone treatment might improve cognition and behavior in Prader-Willi syndrome population. Results from oxytocin trials on social behaviors are inconclusive albeit promising. Melatonin appears to improve sleep. Most trials of dietary supplements did not show benefits. SUMMARY Evidence-based pharmacotherapy options in people with intellectual disability are limited, and many agents can cause substantial adverse events. For this reason, clinicians should consider pharmacotherapy as only a part of comprehensive treatment, and regularly assess drug effects, adverse events, and the feasibility of decreasing dose or withdrawing medications.
Collapse
|
36
|
Tamasaki A, Saito Y, Ueda R, Ohno K, Yokoyama K, Satake T, Sakuma H, Takahashi Y, Kondoh T, Maegaki Y. Effects of donepezil and serotonin reuptake inhibitor on acute regression during adolescence in Down syndrome. Brain Dev 2016; 38:113-7. [PMID: 26143664 DOI: 10.1016/j.braindev.2015.06.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Revised: 06/11/2015] [Accepted: 06/24/2015] [Indexed: 11/25/2022]
Abstract
A 14-year-old boy with Down syndrome (DS) showed a gradual decline in his daily activities and feeding capacities, and a marked deterioration triggered by a streptococcal infection was observed at the age of 15 years. He became bedridden, accompanied by sleep disturbance, sustained upward gaze, and generalized rigidity. Magnetic resonance imaging showed unremarkable findings, but antiglutamate receptor autoantibodies were positive in his cerebrospinal fluid. Treatment with thiamine infusion and steroid pulse therapy showed little effect, but gross motor dysfunction and appetite loss were ameliorated by the administration of l-DOPA and serotonin reuptake inhibitors. Thereafter, autistic behaviors predominated, including loss of social interaction, oral tendency, water phobia, and aggressiveness. Initiation of donepezil, an acetylcholinesterase inhibitor, resulted in the disappearance of these symptoms and total recovery of the patient to his previous psychosocial levels. We hypothesize that the acute regression in adolescence represents a process closely related to the defects of serotonergic and cholinergic systems that are innate to DS brains and not just a nonspecific comorbidity of depression or limbic encephalitis.
Collapse
Affiliation(s)
- Akiko Tamasaki
- Division of Child Neurology, Institute of Neurological Science, Faculty of Medicine, Tottori University, Yonago, Japan.
| | - Yoshiaki Saito
- Division of Child Neurology, Institute of Neurological Science, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Riyo Ueda
- Division of Child Neurology, Institute of Neurological Science, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Koyo Ohno
- Division of Child Neurology, Institute of Neurological Science, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Katsutoshi Yokoyama
- Division of Neuropsychiatry, Institute of Neurological Science, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Takahiro Satake
- Division of Neuropsychiatry, Institute of Neurological Science, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Hiroshi Sakuma
- Department of Brain Development and Neural Regeneration, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Yukitoshi Takahashi
- National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorder, Shizuoka, Japan
| | - Tatsuro Kondoh
- Division of Developmental Disabilities, The Misakaenosono Mutsumi Developmental, Medical, and Welfare Center, Isahaya, Japan
| | - Yoshihiro Maegaki
- Division of Child Neurology, Institute of Neurological Science, Faculty of Medicine, Tottori University, Yonago, Japan
| |
Collapse
|
37
|
Witton J, Padmashri R, Zinyuk L, Popov V, Kraev I, Line S, Jensen T, Tedoldi A, Cummings D, Tybulewicz V, Fisher E, Bannerman D, Randall A, Brown J, Edwards F, Rusakov D, Stewart M, Jones M. Hippocampal circuit dysfunction in the Tc1 mouse model of Down syndrome. Nat Neurosci 2015; 18:1291-1298. [PMID: 26237367 PMCID: PMC4552261 DOI: 10.1038/nn.4072] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 06/29/2015] [Indexed: 12/11/2022]
Abstract
Hippocampal pathology is likely to contribute to cognitive disability in Down syndrome, yet the neural network basis of this pathology and its contributions to different facets of cognitive impairment remain unclear. Here we report dysfunctional connectivity between dentate gyrus and CA3 networks in the transchromosomic Tc1 mouse model of Down syndrome, demonstrating that ultrastructural abnormalities and impaired short-term plasticity at dentate gyrus-CA3 excitatory synapses culminate in impaired coding of new spatial information in CA3 and CA1 and disrupted behavior in vivo. These results highlight the vulnerability of dentate gyrus-CA3 networks to aberrant human chromosome 21 gene expression and delineate hippocampal circuit abnormalities likely to contribute to distinct cognitive phenotypes in Down syndrome.
Collapse
Affiliation(s)
- J. Witton
- School of Physiology & Pharmacology, University of Bristol, University Walk, Bristol BS8 1TD, UK
| | - R. Padmashri
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, University College London, Queen Square, London WC1N 3BG, UK
| | - L.E. Zinyuk
- School of Physiology & Pharmacology, University of Bristol, University Walk, Bristol BS8 1TD, UK
| | - V.I. Popov
- Institute of Cell Biophysics, Russian Academy of Sciences, Pushchino, Moscow Reg. 142290, Russia
- The Open University, Department of Life Sciences, Walton Hall, Milton Keynes, MK7 6AA, UK
| | - I. Kraev
- The Open University, Department of Life Sciences, Walton Hall, Milton Keynes, MK7 6AA, UK
| | - S.J. Line
- Department of Experimental Psychology, University of Oxford, Oxford OX1 3UD, UK
| | - T.P. Jensen
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, University College London, Queen Square, London WC1N 3BG, UK
| | - A. Tedoldi
- Department of Neuroscience, Physiology and Pharmacology, University College London, Gower Street, London WC1E 6BT, UK
| | - D.M. Cummings
- Department of Neuroscience, Physiology and Pharmacology, University College London, Gower Street, London WC1E 6BT, UK
| | - V.L.J. Tybulewicz
- MRC National Institute for Medical Research, The Ridgeway, Mill Hill, London NW7 1AA, UK
| | - E.M.C. Fisher
- Department of Neurodegenerative Disease, UCL Institute of Neurology, University College London, Queen Square, London WC1N 3BG, UK
| | - D.M. Bannerman
- Department of Experimental Psychology, University of Oxford, Oxford OX1 3UD, UK
| | - A.D. Randall
- School of Physiology & Pharmacology, University of Bristol, University Walk, Bristol BS8 1TD, UK
| | - J.T. Brown
- School of Physiology & Pharmacology, University of Bristol, University Walk, Bristol BS8 1TD, UK
| | - F.A. Edwards
- Department of Neuroscience, Physiology and Pharmacology, University College London, Gower Street, London WC1E 6BT, UK
| | - D.A. Rusakov
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, University College London, Queen Square, London WC1N 3BG, UK
- Laboratory of Brain Microcircuits, Institute of Biology and Biomedicine, University of Nizhny Novgorod, Nizhny Novgorod 603950, Russia
| | - M.G. Stewart
- The Open University, Department of Life Sciences, Walton Hall, Milton Keynes, MK7 6AA, UK
| | - M.W. Jones
- School of Physiology & Pharmacology, University of Bristol, University Walk, Bristol BS8 1TD, UK
| |
Collapse
|
38
|
Curie A, Yang K, Kirsch I, Gollub RL, des Portes V, Kaptchuk TJ, Jensen KB. Placebo Responses in Genetically Determined Intellectual Disability: A Meta-Analysis. PLoS One 2015; 10:e0133316. [PMID: 26226597 PMCID: PMC4520690 DOI: 10.1371/journal.pone.0133316] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 06/25/2015] [Indexed: 12/01/2022] Open
Abstract
Background Genetically determined Intellectual Disability (ID) is an intractable condition that involves severe impairment of mental abilities such as learning, reasoning and predicting the future. As of today, little is known about the placebo response in patients with ID. Objective To determine if placebo response exists in patients with genetically determined ID. Data sources and Study selection We searched Medline/PubMed, EMBASE, CENTRAL and PsycINFO to find all placebo-controlled double-blind randomized clinical trials (RCTs) in patients with genetically determined ID, published up to April 2013, focusing on core ID symptoms. Data extraction and synthesis Two investigators extracted outcome data independently. Main outcomes and measures Bias-corrected standardized mean difference (Hedge’s g) was computed for each outcome measure, using the Comprehensive Meta-Analysis software. A priori defined patient sub-groups were analyzed using a mixed-effect model. The relationship between pre-defined continuous variable moderators (age, IQ, year of publication and trial duration) and effect size was analyzed using meta-regression Results Twenty-two placebo-controlled double-blind RCTs met the inclusion criteria (n = 721, mean age = 17.1 years, 62% men, mean trial duration = 35 weeks). There was a significant overall placebo response from pre- to post-treatment in patients with ID (g = 0.468, p = 0.002), both for “subjective outcomes” (a third-person’s evaluation of the patient) (g = 0.563, p = 0.022) and “objective outcomes” (direct evaluation of the patient’s abilities) (g = 0.434, p = 0.036). Individuals with higher IQ had higher response to placebo (p = 0.02) and no placebo response was observed in ID patients with comorbid dementia. A significant effect of age (p = 0.02) was found, indicating higher placebo responses in treatment of younger patients. Conclusions and relevance Results suggest that patients with genetically determined ID improve in the placebo arm of RCTs. Several mechanisms may contribute to placebo effects in ID, including expectancy, implicit learning and “placebo-by-proxy” induced by clinicians/family members. As the condition is refractory, there is little risk that improvements are explained by spontaneous remission. While new avenues for treatment of genetically determined ID are emerging, our results demonstrate how contextual factors can affect clinical outcomes and emphasize the importance of being vigilant on the role of placebos when testing novel treatments in ID.
Collapse
Affiliation(s)
- Aurore Curie
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Martinos Center for Biomedical Imaging, Boston, Massachusetts, United States of America
- L2C2, Institut des Sciences Cognitives, CNRS UMR5304, Bron, France
- Centre de Référence Déficiences Intellectuelles de Causes Rares, Hôpital Femmes Mères Enfants, Hospices Civils de Lyon, Bron, France
- Université Claude Bernard Lyon1, Lyon, France
- EPICIME-CIC1407/INSERM, Bron, France
- * E-mail:
| | - Kathy Yang
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Martinos Center for Biomedical Imaging, Boston, Massachusetts, United States of America
| | - Irving Kirsch
- Program in Placebo Studies, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts, United States of America
- School of Psychology, Plymouth University, Plymouth, United Kingdom
| | - Randy L. Gollub
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Martinos Center for Biomedical Imaging, Boston, Massachusetts, United States of America
| | - Vincent des Portes
- L2C2, Institut des Sciences Cognitives, CNRS UMR5304, Bron, France
- Centre de Référence Déficiences Intellectuelles de Causes Rares, Hôpital Femmes Mères Enfants, Hospices Civils de Lyon, Bron, France
- Université Claude Bernard Lyon1, Lyon, France
| | - Ted J. Kaptchuk
- Program in Placebo Studies, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts, United States of America
| | - Karin B. Jensen
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Martinos Center for Biomedical Imaging, Boston, Massachusetts, United States of America
- Program in Placebo Studies, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| |
Collapse
|
39
|
Sabbagh MN, Chen K, Rogers J, Fleisher AS, Liebsack C, Bandy D, Belden C, Protas H, Thiyyagura P, Liu X, Roontiva A, Luo J, Jacobson S, Malek-Ahmadi M, Powell J, Reiman EM. Florbetapir PET, FDG PET, and MRI in Down syndrome individuals with and without Alzheimer's dementia. Alzheimers Dement 2015; 11:994-1004. [PMID: 25849033 DOI: 10.1016/j.jalz.2015.01.006] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2014] [Revised: 01/07/2015] [Accepted: 01/28/2015] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Down syndrome (DS) is associated with amyloid b (Ab) deposition. METHODS We characterized imaging measurements of regional fibrillar Ab burden, cerebral metabolic rate for glucose (rCMRgl), gray matter volumes (rGMVs), and age associations in 5 DS with dementia (DS/AD1), 12 DS without dementia (DS/AD2), and 9 normal controls (NCs). RESULTS There were significant group differences in mean standard uptake value ratios (SUVRs) for florbetapir with DS/AD1 having the highest, followed by DS/AD2, followed by NC. For [18F]-fluorodeoxyglucose positron emission tomography, posterior cingulate rCMRgl in DS/AD1 was significantly reduced compared with DS/AD2 and NC. For volumetric magnetic resonance imaging (vMRI), hippocampal volumes were significantly reduced for the DS/AD1 compared with DS/AD2 and NC. Age-related SUVR increases and rCMRgl reductions were greater in DS participants than in NCs. DISCUSSION DS is associated with fibrillar Ab, rCMRgl, and rGMV alterations in the dementia stage and before the presence of clinical decline. This study provides a foundation for the studies needed to inform treatment and prevention in DS.
Collapse
Affiliation(s)
- Marwan N Sabbagh
- Banner Sun Health Research Institute, Sun City, AZ, USA; Arizona Alzheimer's Consortium, Phoenix, AZ, USA; College of Medicine, University of Arizona, Phoenix, AZ, USA.
| | - Kewei Chen
- Arizona Alzheimer's Consortium, Phoenix, AZ, USA; Banner Alzheimer's Institute, Phoenix, AZ, USA; Arizona State University, Tempe, AZ, USA
| | | | - Adam S Fleisher
- Arizona Alzheimer's Consortium, Phoenix, AZ, USA; Banner Alzheimer's Institute, Phoenix, AZ, USA
| | - Carolyn Liebsack
- Banner Sun Health Research Institute, Sun City, AZ, USA; Arizona Alzheimer's Consortium, Phoenix, AZ, USA
| | - Dan Bandy
- Arizona Alzheimer's Consortium, Phoenix, AZ, USA; Banner Alzheimer's Institute, Phoenix, AZ, USA
| | - Christine Belden
- Banner Sun Health Research Institute, Sun City, AZ, USA; Arizona Alzheimer's Consortium, Phoenix, AZ, USA
| | - Hillary Protas
- Arizona Alzheimer's Consortium, Phoenix, AZ, USA; Banner Alzheimer's Institute, Phoenix, AZ, USA
| | - Pradeep Thiyyagura
- Arizona Alzheimer's Consortium, Phoenix, AZ, USA; Banner Alzheimer's Institute, Phoenix, AZ, USA
| | - Xiaofen Liu
- Arizona Alzheimer's Consortium, Phoenix, AZ, USA; Banner Alzheimer's Institute, Phoenix, AZ, USA
| | - Auttawut Roontiva
- Arizona Alzheimer's Consortium, Phoenix, AZ, USA; Banner Alzheimer's Institute, Phoenix, AZ, USA
| | - Ji Luo
- Arizona Alzheimer's Consortium, Phoenix, AZ, USA; Banner Alzheimer's Institute, Phoenix, AZ, USA
| | - Sandra Jacobson
- Banner Sun Health Research Institute, Sun City, AZ, USA; Arizona Alzheimer's Consortium, Phoenix, AZ, USA
| | - Michael Malek-Ahmadi
- Banner Sun Health Research Institute, Sun City, AZ, USA; Arizona Alzheimer's Consortium, Phoenix, AZ, USA
| | - Jessica Powell
- Banner Sun Health Research Institute, Sun City, AZ, USA; Arizona Alzheimer's Consortium, Phoenix, AZ, USA
| | - Eric M Reiman
- Arizona Alzheimer's Consortium, Phoenix, AZ, USA; College of Medicine, University of Arizona, Phoenix, AZ, USA; Banner Alzheimer's Institute, Phoenix, AZ, USA; Translational Genomics Research Institute, Phoenix, AZ, USA
| |
Collapse
|
40
|
Gardiner KJ. Pharmacological approaches to improving cognitive function in Down syndrome: current status and considerations. Drug Des Devel Ther 2014; 9:103-25. [PMID: 25552901 PMCID: PMC4277121 DOI: 10.2147/dddt.s51476] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Down syndrome (DS), also known as trisomy 21, is the most common genetic cause of intellectual disability (ID). Although ID can be mild, the average intelligence quotient is in the range of 40-50. All individuals with DS will also develop the neuropathology of Alzheimer's disease (AD) by the age of 30-40 years, and approximately half will display an AD-like dementia by the age of 60 years. DS is caused by an extra copy of the long arm of human chromosome 21 (Hsa21) and the consequent elevated levels of expression, due to dosage, of trisomic genes. Despite a worldwide incidence of one in 700-1,000 live births, there are currently no pharmacological treatments available for ID or AD in DS. However, over the last several years, very promising results have been obtained with a mouse model of DS, the Ts65Dn. A diverse array of drugs has been shown to rescue, or partially rescue, DS-relevant deficits in learning and memory and abnormalities in cellular and electrophysiological features seen in the Ts65Dn. These results suggest that some level of amelioration or prevention of cognitive deficits in people with DS may be possible. Here, we review information from the preclinical evaluations in the Ts65Dn, how drugs were selected, how efficacy was judged, and how outcomes differ, or not, among studies. We also summarize the current state of human clinical trials for ID and AD in DS. Lastly, we describe the genetic limitations of the Ts65Dn as a model of DS, and in the preclinical testing of pharmacotherapeutics, and suggest additional targets to be considered for potential pharmacotherapies.
Collapse
Affiliation(s)
- Katheleen J Gardiner
- Linda Crnic Institute for Down Syndrome, Department of Pediatrics, Department of Biochemistry and Molecular Genetics, Human Medical Genetics and Genomics Program, Neuroscience Program, University of Colorado School of Medicine, Aurora, CO, USA
| |
Collapse
|
41
|
|
42
|
Das D, Phillips C, Hsieh W, Sumanth K, Dang V, Salehi A. Neurotransmitter-based strategies for the treatment of cognitive dysfunction in Down syndrome. Prog Neuropsychopharmacol Biol Psychiatry 2014; 54:140-8. [PMID: 24842803 DOI: 10.1016/j.pnpbp.2014.05.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 05/08/2014] [Accepted: 05/08/2014] [Indexed: 01/10/2023]
Abstract
Down syndrome (DS) is a multisystem disorder affecting the cardiovascular, respiratory, gastrointestinal, neurological, hematopoietic, and musculoskeletal systems and is characterized by significant cognitive disability and a possible common pathogenic mechanism with Alzheimer's disease. During the last decade, numerous studies have supported the notion that the triplication of specific genes on human chromosome 21 plays a significant role in cognitive dysfunction in DS. Here we reviewed studies in trisomic mouse models and humans, including children and adults with DS. In order to identify groups of genes that contribute to cognitive disability in DS, multiple mouse models of DS with segmental trisomy have been generated. Over-expression of these particular genes in DS can lead to dysfunction of several neurotransmitter systems. Therapeutic strategies for DS have either focused on normalizing the expression of triplicated genes with important roles in DS or restoring the function of these systems. Indeed, our extensive review of studies on the pathogenesis of DS suggests that one plausible strategy for the treatment of cognitive dysfunction is to target the cholinergic, serotonergic, GABA-ergic, glutamatergic, and norepinephrinergic system. However, a fundamental strategy for treatment of cognitive dysfunction in DS would include reducing to normal levels the expression of specific triplicated genes in affected systems before the onset of neurodegeneration.
Collapse
Affiliation(s)
- Devsmita Das
- VA Palo Alto Health Care System, 3801 Miranda Ave., Palo Alto, CA, USA; Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94304, USA
| | - Cristy Phillips
- Department of Physical Therapy, P.O. Box 910, Arkansas State University, State University, AR, USA
| | - Wayne Hsieh
- VA Palo Alto Health Care System, 3801 Miranda Ave., Palo Alto, CA, USA
| | - Krithika Sumanth
- VA Palo Alto Health Care System, 3801 Miranda Ave., Palo Alto, CA, USA
| | - Van Dang
- VA Palo Alto Health Care System, 3801 Miranda Ave., Palo Alto, CA, USA; Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94304, USA
| | - Ahmad Salehi
- VA Palo Alto Health Care System, 3801 Miranda Ave., Palo Alto, CA, USA; Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94304, USA.
| |
Collapse
|
43
|
Dekker AD, De Deyn PP, Rots MG. Epigenetics: The neglected key to minimize learning and memory deficits in Down syndrome. Neurosci Biobehav Rev 2014; 45:72-84. [DOI: 10.1016/j.neubiorev.2014.05.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Revised: 05/04/2014] [Accepted: 05/13/2014] [Indexed: 10/25/2022]
|
44
|
Abstract
Down syndrome is the commonest chromosomal disorder causing mild to moderate intellectual disability, yet it is one of the neglected disorder amongst practicing physicians. Children with Down syndrome when intervened early by speech therapy, physiotherapy and occupational therapy and given proper medical attention for different health issues, can have a better long term outcome as compared to other genetic causes of intellectual disability. This paper would help the general practitioners to identify children with Down syndrome and to manage the common problems associated with this condition.
Collapse
|
45
|
Garlich FM, Balakrishnan K, Shah SK, Howland MA, Fong J, Nelson LS. Prolonged altered mental status and bradycardia following pediatric donepezil ingestion. Clin Toxicol (Phila) 2014; 52:291-4. [DOI: 10.3109/15563650.2014.900182] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
46
|
Abstract
PURPOSE OF REVIEW Down syndrome affects more than 5 million people globally. During the last 10 years, there has been a dramatic increase in the research efforts focused on therapeutic interventions to improve learning and memory in Down syndrome. RECENT FINDINGS This review summarizes the different functional abnormalities targeted by researchers in mouse models of Down syndrome. Three main strategies have been used: neural stem cell implantation; environmental enrichment and physical exercise; and pharmacotherapy. Pharmacological targets include the choline pathway, GABA and NMDA receptors, DYRK1A protein, oxidative stress and pathways involved in development and neurogenesis. Many strategies have improved learning and memory as well as electrophysiological and molecular alterations in affected animals. To date, eight molecules have been tested in human adult clinical trials. No studies have yet been performed on infants. However, compelling studies reveal that permanent brain alterations originate during fetal life in Down syndrome. Early prenatal diagnosis offers a 28 weeks window to positively impact brain development and improve postnatal cognitive outcome in affected individuals. Only a few approaches (Epigallocatechine gallate, NAP/SAL, fluoxetine, and apigenin) have been used to treat mice in utero; these showed therapeutic effects that persisted to adulthood. SUMMARY In this article, we discuss the challenges, recent progress, and lessons learned that pave the way for new therapeutic approaches in Down syndrome.
Collapse
Affiliation(s)
- Fayçal Guedj
- aMother Infant Research Institute, Tufts Medical Center and the Floating Hospital for Children, Boston, Massachusetts, USA bUniv Paris Diderot, Sorbonne Paris Cité, CNRS UMR 8251, Adaptive Functional Biology, Paris, France
| | | | | |
Collapse
|
47
|
Inglis A, Lohn Z, Austin JC, Hippman C. A 'cure' for Down syndrome: what do parents want? Clin Genet 2014; 86:310-7. [PMID: 24548046 DOI: 10.1111/cge.12364] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Revised: 02/11/2014] [Accepted: 02/16/2014] [Indexed: 12/12/2022]
Abstract
Recent advancements in molecular genetics raise the possibility that therapeutics or a 'cure' for Down syndrome (DS) may become available. However, there are no data regarding how parents of children with DS perceive the possibility of mitigating specific manifestations such as the intellectual disability (ID) associated with DS, or curing the condition entirely. To explore these issues, we distributed a questionnaire to members of the Lower Mainland Down Syndrome Society in British Columbia, Canada. Questionnaires were completed by 101 parents (response rate=41%). A majority (61%) viewed the possibility of reversing ID in DS positively, but only 41% said that they would 'cure' their child of DS if it were possible. Twenty-seven percent of respondents said they would not 'cure' their child, and 32% were unsure if they would 'cure' their child. The most commonly cited motivation for opting for a 'cure' was to increase their child's independence. However, parental attitudes' towards a 'cure' for DS were complex, affected by ethical issues, perceived societal values, and pragmatic factors such as the age of the individual and long-term care-giving burden. These findings could be used by healthcare professionals supporting families who include a member with DS and to direct future research.
Collapse
Affiliation(s)
- A Inglis
- Department of Psychiatry, University of British Columbia, Vancouver, Canada; Department of Medical Genetics, University of British Columbia, Vancouver, Canada
| | | | | | | |
Collapse
|
48
|
Abstract
Down syndrome (DS), which results from an extra copy of chromosome 21 (trisomy 21), is the most common genetically defined cause of intellectual disability. Although no pharmacotherapy aimed at counteracting the cognitive and adaptive deficits associated with this genetic disorder has been approved at present, there have been several new promising studies on pharmacological agents capable of rescuing learning/memory deficits seen in mouse models of DS. Here, we will review the available mouse models for DS and provide a comprehensive, albeit not exhaustive review of the following preclinical research strategies: (1) SOD1 and antioxidant agents; (2) APP and γ-secretase inhibitors; (3) DYRK1A and the polyphenol epigallocatechin gallate (EGCG); (4) GIRK2 and fluoxetine; (5) adrenergic receptor agonists; (6) modulation of GABAA and GABAB receptors; (7) agonism of the hedgehog signaling pathway; (8) nerve growth factor (NGF) and other neurotrophic factors; (9) anticholinesterase (AChE) agents; and (10) antagonism of NMDA receptors. Finally, we will review briefly five different strategies in DS that have led to clinical studies that either have been concluded or are currently underway: (1) antioxidant therapy; (2) AChE therapy; (3) green tea extract therapy; (4) RG1662 therapy; and (5) memantine therapy. These are exciting times in DS research. Within a decade or so, it is well into the realm of possibility that new forms of pharmacotherapies might become valuable tools in the armamentarium of developmental clinicians, as adjutants to more traditional and proven forms of habilitative interventions aimed at improving the quality of life of individuals with DS.
Collapse
|
49
|
Goodman MJ, Brixner DI. New therapies for treating Down syndrome require quality of life measurement. Am J Med Genet A 2013; 161A:639-41. [PMID: 23495233 DOI: 10.1002/ajmg.a.35705] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Accepted: 09/14/2012] [Indexed: 11/10/2022]
Abstract
Down syndrome (DS) is the most common genetic cause of cognitive deficits. Using mouse models and therapies for Alzheimer disease, researchers are exploring therapies that may improve cognitive function in people with DS. These developments shift the health economic paradigm of understanding DS from determining the appropriate screening tool to the effect of therapy on quality of life in those with DS. To date, there are no validated quality of life instruments for DS. Research should begin to develop instruments that can evaluate changes in quality of life in therapeutic trials and beyond.
Collapse
Affiliation(s)
- Michael J Goodman
- Department of Pharmacotherapy, Pharmacotherapy Outcomes Research Center, University of Utah, Salt Lake City, UT 84108, USA.
| | | |
Collapse
|
50
|
Castellino SM, Tooze JA, Flowers L, Hill DF, McMullen KP, Shaw EG, Parsons SK. Toxicity and efficacy of the acetylcholinesterase (AChe) inhibitor donepezil in childhood brain tumor survivors: a pilot study. Pediatr Blood Cancer 2012; 59:540-7. [PMID: 22238217 PMCID: PMC3345166 DOI: 10.1002/pbc.24078] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Accepted: 12/21/2011] [Indexed: 12/31/2022]
Abstract
BACKGROUND Neurocognitive deficits are a recognized late effect of curative brain tumor therapy. We evaluated the feasibility, tolerance, and impact of a pilot pharmacologic intervention with the acetylcholinesterase (AChe) inhibitor, donepezil, in pediatric brain tumor (BT) survivors at risk for neurocognitive dysfunction. PROCEDURE A single institution open-label pilot study was conducted in childhood BT survivors: ≥1 year from cancer treatment; and who received >23.5 Gy cranial radiation therapy (RT). Toxicity, adherence and neurocognitive outcomes were evaluated at baseline and serially during 24 weeks of donepezil, and following a 12-week washout period off drug. RESULTS From a pool of subjects, 13 were successfully contacted and screened, and 11 met all eligibility criteria to initiate donepezil at a median of 4.7 (1.9-11.9) years from RT. Seventy-two percent of patients completed the 24-week drug study visit. Despite transient gastrointestinal toxicity (vomiting and diarrhea) in 30% of patients there was no weight loss on donepezil. Significant improvement in performance was noted at 24 weeks on the Dellis-Kaplan Executive Function (D-KEF) Tower test (P < 0.001), the Wide Range Assessment of Memory and Learning, 2nd Edition (WRAML-2) Visual memory (P = 0.007), and the Number/Letter task (P = 0.018). CONCLUSIONS Donepezil was well tolerated among childhood BT survivors who had received substantial prior therapy. Based on improved executive function and memory performance in this pilot trial, a randomized placebo controlled trial of this pharmacologic agent is warranted to fully evaluate its efficacy in remediating neurocognitive dysfunction.
Collapse
Affiliation(s)
| | - Janet A. Tooze
- Wake Forest University Health Sciences, Department of Public Health Sciences
| | - Lynn Flowers
- Wake Forest University Health Sciences, Department of Neurology
| | - Debbie F. Hill
- Wake Forest University Health Sciences, Department of Public Health Sciences
| | - Kevin P. McMullen
- Wake Forest University Health Sciences, Department of Radiation Oncology
| | - Edward G. Shaw
- Wake Forest University Health Sciences, Department of Radiation Oncology
| | - Susan K. Parsons
- Tufts University School of Medicine, Boston, MA,Tufts Medical Center, Boston, MA
| |
Collapse
|