1
|
Ibarra AJ, Butters MA, Lim G, Jeyabalan A, Li R, Balasubramani GK, Catov JM. Longitudinal cognitive evaluation before and after delivery among people with preeclampsia. Am J Obstet Gynecol MFM 2023; 5:100966. [PMID: 37084869 PMCID: PMC10876122 DOI: 10.1016/j.ajogmf.2023.100966] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 04/05/2023] [Indexed: 04/23/2023]
Abstract
BACKGROUND Cognitive impairments related to preeclampsia after pregnancy have been reported; however, it is not known if weaknesses in cognition occur before and shortly after delivery. OBJECTIVE This study aimed to assess the feasibility of longitudinal cognitive testing before and after delivery, and to investigate whether those with preeclampsia have cognitive weaknesses during the third trimester of pregnancy and at 1 and 3 months postpartum. We hypothesized that people with preeclampsia would have lower cognition scores across all time points compared with normotensive people. STUDY DESIGN This longitudinal, prospective, observational study in a single institution enrolled people (N=30) at ≥28 weeks of gestation with preeclampsia (N=16) or normotension (N=14). People with chronic hypertension, neurologic or developmental disabilities, moderate or severe depression or anxiety, or current substance use were excluded. Subjective (Everyday Cognition Scale) and objective assessment of executive function (Stroop Color-Word Interference Test, Trail-Making Test), attention and working memory (Digit Span subtest), and information processing speed (Digit Symbol Substitution Test) was conducted, and Z-scores were calculated. Baseline characteristics (eg, prepregnancy body mass index) were collected from the medical record. Generalized linear models were used to estimate associations. RESULTS We enrolled 37% (30/81) of eligible people and retained 80% (24/30) and 53% (16/30) at 1 and 3 months postpartum, respectively. People with preeclampsia reported more memory problems (ß=0.87; 95% confidence interval, 0.44-1.31), and scored worse on attention and working memory (ß=-0.94; 95% confidence interval, -1.42 to -0.45) and executive function (Stroop test ß=-0.86; 95% confidence interval, -1.53 to -0.19) domains compared with normotensive people after adjusting for time, age, education, and prepregnancy body mass index. CONCLUSION Longitudinal assessment of cognition in pregnant preeclamptic and normotensive people is feasible. People with preeclampsia reported worse subjective memory and had lower scores in attention, working memory, and executive function.
Collapse
Affiliation(s)
- Andrea J Ibarra
- Departments of Anesthesiology and Perioperative Medicine (Drs Ibarra and Lim).
| | | | - Grace Lim
- Departments of Anesthesiology and Perioperative Medicine (Drs Ibarra and Lim)
| | - Arun Jeyabalan
- Obstetrics, Gynecology and Reproductive Sciences (Drs Jeyabalan and Catov), University of Pittsburgh, Pittsburgh, PA
| | - Runjia Li
- Departments of Epidemiology (Ms Li and Dr Catov)
| | | | - Janet M Catov
- Obstetrics, Gynecology and Reproductive Sciences (Drs Jeyabalan and Catov), University of Pittsburgh, Pittsburgh, PA; Departments of Epidemiology (Ms Li and Dr Catov); Magee-Womens Research Institute, School of Medicine, University of Pittsburgh, Pittsburgh, PA (Dr Catov)
| |
Collapse
|
2
|
Wang Y, Guo B, Zhao K, Yang L, Chen T. Correlation between cognitive impairment and serum phosphorylated tau181 protein in patients with preeclampsia. Front Aging Neurosci 2023; 15:1148518. [PMID: 37056688 PMCID: PMC10086317 DOI: 10.3389/fnagi.2023.1148518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 03/06/2023] [Indexed: 03/30/2023] Open
Abstract
ObjectiveTo study the cognitive function status, serum phosphorylated tau181 (P-tau181) protein level, and total tau (T-tau) protein level in patients with preeclampsia (PE), pregnant healthy controls (PHCs), and non-pregnant healthy controls (NPHCs), and to research their feasibility as serum biomarkers for evaluating cognitive functional impairment in PE patients.MethodsSixty-eight patients with PE, 48 NPHCs, and 30 PHCs were included. Cognitive functional status was assessed using standardized Symbol Digit Modalities Test (SDMT) and Montreal Cognitive Assessment (MoCA) scales. Enzyme-linked immunosorbent assay (ELISA) was used to detect the level of serum P-tau181 and T-tau protein. The concentration of serum P-tau181 and T-tau protein were compared by one-way analysis of variance in the three groups of subjects. The correlation between P-tau181, T-tau, and SDMT was explore by multiple linear regression analysis. The areas under the receiver operating characteristic (ROC) curves of serum P-tau181 and SDMT were calculated to predict the cognitive level of subjects.ResultsPE patients significantly had lower scores on SDMT (47.97 ± 7.54) and MoCA (28.00 ± 2.00) than normotensive PHCs (30.00 ± 1.25, 54.73 ± 8.55, respectively). The significant difference was found in serum P-tau181 protein levels among the three groups [H(K) = 19.101, P < 0.001]. Serum P-tau181 was thicker in PE patients than PHCs or NPHCs (both P < 0.05). According to the ROC curve, T-tau had no statistical significance in predicting the ability of cognizance, while P-tau181 and SDMT had. The DeLong test showed that P-tau181 was better than T-tau in predicting the ability of cognizance (P < 0.05).ConclusionThe patients with PE have occurred the decline of cognitive function during pregnancy. The high level of serum P-tau181 can be used as a clinical laboratory indication for non-invasive assessment of cognitive functional impairment in PE patients.
Collapse
Affiliation(s)
- Yuanyuan Wang
- Department of Radiology, Binzhou Medical University, Yantai, Shandong, China
| | - Bin Guo
- Department of Radiology, Jinan Maternity and Child Care Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Ke Zhao
- Department of Clinical Laboratory, Jinan Maternity and Child Care Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Linfeng Yang
- Department of Radiology, Jinan Maternity and Child Care Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Tao Chen
- Department of Clinical Laboratory, Jinan Maternity and Child Care Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- *Correspondence: Tao Chen,
| |
Collapse
|
3
|
Papousek I, Weiss EM, Moertl MG, Schmid-Zalaudek K, Krenn E, Lessiak V, Lackner HK. Unaffected Memory and Inhibitory Functioning Several Weeks Postpartum in Women with Pregnancy Complicated by Preeclampsia. Behav Sci (Basel) 2021; 11:bs11040055. [PMID: 33919495 PMCID: PMC8072974 DOI: 10.3390/bs11040055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/10/2021] [Accepted: 04/16/2021] [Indexed: 01/12/2023] Open
Abstract
Several studies reported impaired cognitive functioning after pregnancy complicated by preeclampsia. The present study examined cognitive and executive functioning in women with preeclampsia at a time at which immediate effects of gestation have resolved, brain damage due to other risk factors have not yet manifested, and impairments may thus primarily occur as a result of the huge stress induced by the potentially life threatening condition. Verbal learning/memory (California Verbal Learning Test) and inhibitory functioning (Mittenecker Pointing Test) of 35 women with preeclampsia and 38 women with uncomplicated pregnancy were followed over five measurement time points during the period from 16 to 48 weeks postpartum. A further control group comprised 40 women with no history of recent pregnancy. The groups did not differ in their verbal learning/memory performance. Higher levels of currently experienced everyday-life stress were associated with poorer inhibitory control/greater stereotypy in responding, but this effect was not directly connected with pregnancy complications. Taken together, the findings do not indicate rapid-onset cognitive impairment after preeclampsia, brought about by its extremely stressful nature or other factors that take effect during gestation. Deficits observed in later life may develop on a long-term basis through late-diagnosed hypertension and unfavorable lifestyle factors. The large time window in which exaggerated cognitive decline can be prevented or mitigated should be utilized for the control of risk factors and interventions to improve lifestyle where appropriate.
Collapse
Affiliation(s)
- Ilona Papousek
- Biological Psychology Unit, Department of Psychology, University of Graz, 8010 Graz, Austria; (I.P.); (E.K.)
| | - Elisabeth M. Weiss
- Clinical Psychology Unit, Department of Psychology, University of Innsbruck, 6020 Innsbruck, Austria;
| | - Manfred G. Moertl
- Clinical Center, Department of Obstetrics and Gynecology, 9020 Klagenfurt, Austria; (M.G.M.); (V.L.)
| | - Karin Schmid-Zalaudek
- Biological Psychology Unit, Department of Psychology, University of Graz, 8010 Graz, Austria; (I.P.); (E.K.)
| | - Edina Krenn
- Biological Psychology Unit, Department of Psychology, University of Graz, 8010 Graz, Austria; (I.P.); (E.K.)
| | - Verena Lessiak
- Clinical Center, Department of Obstetrics and Gynecology, 9020 Klagenfurt, Austria; (M.G.M.); (V.L.)
| | - Helmut K. Lackner
- Otto Loewi Research Center, Division of Physiology, Medical University of Graz, 8010 Graz, Austria;
- Correspondence: ; Tel.: +43-316-385-73863
| |
Collapse
|
4
|
Bergman L, Thorgeirsdottir L, Elden H, Hesselman S, Schell S, Ahlm E, Aukes A, Cluver C. Cognitive impairment in preeclampsia complicated by eclampsia and pulmonary edema after delivery. Acta Obstet Gynecol Scand 2021; 100:1280-1287. [PMID: 33492667 DOI: 10.1111/aogs.14100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 01/18/2021] [Accepted: 01/20/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION We aimed to assess cognitive function in women with preeclampsia stratified by severity, before and after onset of disease. MATERIAL AND METHODS Prospective study performed at a referral hospital in Cape Town, South Africa. Pregnant women between 20 and 42 weeks of gestation with eclampsia, pulmonary edema and preeclampsia without severe features, and a normotensive pregnancy were approached. Women were included at diagnosis of preeclampsia or at admission for delivery (women with normotensive pregnancies). Two cognitive assessments, the Cognitive Failure Questionnaire to assess the cognitive function subjectively before inclusion in the study, and Montreal Cognitive Assessment to assess the current cognitive function objectively before discharge from the hospital after delivery, were performed. RESULTS We included 61 women with eclampsia, 28 with preeclampsia complicated by pulmonary edema, 38 with preeclampsia without severe features, and 26 with normotensive pregnancies. There was no difference in cognitive function from early pregnancy between groups. Women with eclampsia and preeclampsia complicated by pulmonary edema scored lower on the Montreal Cognitive Assessment at time of discharge compared with women with normotensive pregnancies. The results were attenuated in pulmonary edema after adjustment for confounders. CONCLUSIONS Women with preeclampsia complicated by pulmonary edema and in particular eclampsia had impaired cognitive function after onset of disease compared with women with normotensive pregnancies. The impairment did not seem to be present before onset of disease. Women with preeclampsia without severe features did not have impaired cognitive function.
Collapse
Affiliation(s)
- Lina Bergman
- Department of Obstetrics and Gynecology, Stellenbosch University, Cape Town, South Africa.,Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Lilja Thorgeirsdottir
- Department of Reproductive and Perinatal Health, Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Helen Elden
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Reproductive and Perinatal Health, Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Susanne Hesselman
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Center for Clinical Research, Uppsala University, Uppsala, Sweden
| | - Sonja Schell
- Department of Obstetrics and Gynecology, Stellenbosch University, Cape Town, South Africa
| | - Evelina Ahlm
- Department of Obstetrics and Gynecology, Faculty of Medicine, Lund University, Lund, Sweden
| | - Annet Aukes
- Department of Obstetrics and Gynecology, University Medical Center Groningen, Groningen, the Netherlands
| | - Catherine Cluver
- Department of Obstetrics and Gynecology, Stellenbosch University, Cape Town, South Africa.,Mercy Perinatal, Melbourne University, Melbourne, Australia
| |
Collapse
|
5
|
Morel V, Joly D, Villatte C, Pereira B, Pickering G. Preventive effect of oral magnesium in postmastectomy pain: protocol for a randomised, double-blind, controlled clinical trial. BMJ Open 2018; 8:e017986. [PMID: 30287600 PMCID: PMC6173239 DOI: 10.1136/bmjopen-2017-017986] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Breast cancer affects 1 in 10 women worldwide, and mastectomy is a cause of chronic pain with neuropathic characteristics. N-methyl-D-aspartate receptor (NMDAR) antagonists such as ketamine, memantine, dextromethorphan or magnesium are used to treat refractory pain by blocking NMDAR. Oral memantine has been shown to prevent postmastectomy pain and cognitive impact and to maintain quality of life. Likewise, the present study is intended to assess the preventive effect of oral magnesium, administered ahead of mastectomy, on the development of neuropathic pain. As a physiological blocker of NMDAR, magnesium could be an interesting candidate to prevent postoperative pain and associated comorbidities, including cognitive and emotional disorders, multiple analgesic consumption and impaired quality of life. METHODS AND ANALYSIS A randomised double-blind controlled clinical trial (NCT03063931) will include 100 women with breast cancer undergoing mastectomy at the Oncology Hospital, Clermont-Ferrand, France. Magnesium (100 mg/day; n=50) or placebo (n=50) will be administered for 6 weeks, starting 2 weeks before surgery. Intensity of pain, cognitive and emotional function and quality of life will be assessed by questionnaires. The primary endpoint is pain intensity on a 0-10 numerical rating scale at 1 month postmastectomy. Data analysis will use mixed models; all tests will be two-tailed, with type-I error set at α=0.05. ETHICS AND DISSEMINATION The study protocol and informed consent form were approved in December 2016 by the French Research Ethics Committee (South East VI Committee). Results will be communicated in various congresses and published in international publications. TRIAL REGISTRATION NUMBER NCT03063931.
Collapse
Affiliation(s)
- Véronique Morel
- CHU Clermont-Ferrand, Inserm CIC Inserm 1405, Centre de Pharmacologie Clinique, Clermont-Ferrand, France
| | - Dominique Joly
- CHU Clermont-Ferrand, Centre Jean Perrin, Centre de Lutte contre le Cancer, Clermont-Ferrand, Auvergne, France
| | - Christine Villatte
- CHU Clermont-Ferrand, Centre Jean Perrin, Centre de Lutte contre le Cancer, Clermont-Ferrand, Auvergne, France
| | - Bruno Pereira
- CHU de Clermont-Ferrand, Délégation Recherche Clinique & Innovation - Villa annexe IFSI, Clermont-Ferrand, France
| | - Gisèle Pickering
- CHU Clermont-Ferrand, Inserm CIC Inserm 1405, Centre de Pharmacologie Clinique, Clermont-Ferrand, France
- Université Clermont Auvergne, Laboratoire de Pharmacologie, Facultés de Médecine/Pharmacie, Clermont-Ferrand, France
- Inserm, U1107 Neuro-Dol, Pharmacologie Fondamentale et Clinique de la Douleur, Clermont-Ferrand, France
| |
Collapse
|
6
|
Ouellette SJ, Hampson E. Memory and affective changes during the antepartum: A narrative review and integrative hypothesis. J Clin Exp Neuropsychol 2018; 41:87-107. [DOI: 10.1080/13803395.2018.1485881] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- Sarah J. Ouellette
- Department of Psychology, University of Western Ontario, London, ON, Canada
| | - Elizabeth Hampson
- Department of Psychology, University of Western Ontario, London, ON, Canada
- Graduate Program in Neuroscience, University of Western Ontario, London, ON, Canada
| |
Collapse
|
7
|
Johnson AC, Cipolla MJ. Impaired function of cerebral parenchymal arterioles in experimental preeclampsia. Microvasc Res 2018; 119:64-72. [PMID: 29705580 DOI: 10.1016/j.mvr.2018.04.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 04/20/2018] [Accepted: 04/20/2018] [Indexed: 01/17/2023]
Abstract
Preeclampsia (PE), a dangerous hypertensive complication of pregnancy, is associated with widespread maternal vascular dysfunction. However, the effect of PE on the cerebral vasculature that can lead to stroke and cognitive decline is not well understood. We hypothesized that function of cortical parenchymal arterioles (PAs) would be impaired during PE. Using a high cholesterol diet to induce experimental PE in rats (ePE), we studied the function and structure of isolated and pressurized PAs supplying frontoparietal white matter (WM) tracts and cortex and compared to normal pregnant (Preg) and nonpregnant (Nonpreg) Sprague Dawley rats (n = 8/group). Myogenic reactivity and tone were similar between groups; however, constriction to intermediate-conductance calcium-activated potassium (IK) channel inhibition was diminished and dilation to inward-rectifying K+ (KIR) channel activation was impaired in PAs from ePE rats, suggesting altered ion channel function. Conducted vasodilation was significantly delayed in response to 12 mM KCl, but not 10 μM adenosine, in PAs from ePE rats versus Preg and Nonpreg rats (940 ± 300 ms vs. 70 ± 50 ms and 370 ± 90 ms; p < 0.05). Overall, dysfunction of PAs supplying frontoparietal WM and gray matter was present in ePE. If persistent these changes could potentiate neuronal injury that over time could contribute to WM lesions and early-onset cognitive decline.
Collapse
Affiliation(s)
- Abbie C Johnson
- Department of Neurological Sciences, University of Vermont Larner College of Medicine, Burlington, VT 05405, USA.
| | - Marilyn J Cipolla
- Department of Neurological Sciences, University of Vermont Larner College of Medicine, Burlington, VT 05405, USA; Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Vermont Larner College of Medicine, Burlington, VT 05405, USA; Department of Pharmacology, University of Vermont Larner College of Medicine, Burlington, VT 05405, USA
| |
Collapse
|
8
|
Anderson MV, Rutherford MD. Cognitive reorganization during pregnancy and the postpartum period: an evolutionary perspective. EVOLUTIONARY PSYCHOLOGY 2012; 10:659-687. [PMID: 23052608 PMCID: PMC10426941 DOI: 10.1177/147470491201000402] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Accepted: 09/02/2012] [Indexed: 06/22/2024] Open
Abstract
Where the non-human animal research investigating reproduction-induced cognitive reorganization has focused on neural plasticity and adaptive advantage in response to the demands associated with pregnancy and parenting, human studies have primarily concentrated on pregnancy-induced memory decline. The current review updates Henry and Rendell's 2007 meta-analysis, and examines cognitive reorganization as the result of reproductive experience from an adaptationist perspective. Investigations of pregnancy-induced cognitive change in human females may benefit by focusing on areas, such as social cognition, where a cognitive advantage would serve a protective function, and by extending the study duration beyond pregnancy into the postpartum period.
Collapse
Affiliation(s)
- Marla V Anderson
- Department of Psychology, Neuroscience, and Behaviour, McMaster University, Hamilton, Canada.
| | | |
Collapse
|
9
|
Ozdemir I, Yilmaz S, Albayrak M, Yıldızbas S, Guven DG, Yaman H, Guclu E. Hearing Evaluation in Preeclamptic Patients. Gynecol Obstet Invest 2011; 72:1-4. [DOI: 10.1159/000321380] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2010] [Accepted: 09/17/2010] [Indexed: 11/19/2022]
|
10
|
Baecke M, Spaanderman MEA, van der Werf SP. Cognitive function after pre-eclampsia: an explorative study. J Psychosom Obstet Gynaecol 2009; 30:58-64. [PMID: 19308784 DOI: 10.1080/01674820802546212] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Pre-eclampsia and eclampsia relate to cerebral damage. Memory and concentration problems are frequently reported after these pregnancy-related vascular complications. We tested the hypothesis that in formerly pre-eclamptic women cognitive functioning is impaired as compared with healthy parous controls. METHODS Women with a recent history of pre-term pre-eclampsia (PPE; n = 47), term pre-eclampsia (TPE; N = 18), pre-term birth (PBI; n = 32) or an uneventful pregnancy (UPR; n = 72) completed a set of questionnaires, measuring cognitive problems, PTSD, depression, anxiety and fatigue. In addition, in PPE and UPR participants we tested neuropsychological performance. RESULTS PBI is related to higher levels of post-traumatic distress symptoms, which in turn diminished the neuropsychological test performance of PPE women. Nonetheless, women in the PPE and TPE groups did not report more cognitive problems than women in the PBI and UPR groups, but PPE raised the need for psychosocial cared. CONCLUSIONS Cognitive complaints are common amongst young mothers. When tested, only those with psychological co-morbidity have neuropsychological impairment.
Collapse
Affiliation(s)
- Martina Baecke
- Department of Clinical Psychology, Medical Centre Spectrum, Enschede, The Netherlands.
| | | | | |
Collapse
|
11
|
Mickes L, Wixted JT, Shapiro A, Scarff JM. The effects of pregnancy on memory: recall is worse but recognition is not. J Clin Exp Neuropsychol 2008; 31:754-61. [PMID: 19105075 DOI: 10.1080/13803390802488111] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Women who are pregnant frequently complain of memory problems. Past research suggests that pregnancy is associated with a measurable decline when memory is tested using free recall but not when memory is tested using recognition. However, no prior studies on recognition memory tested performance across two time periods (e.g., pregnant vs. postpartum). A repeated measures design has greater power than a between-subject design to detect any difference in recognition memory performance that might exist. We administered a standardized memory test to 37 women during pregnancy and then again during the postpartum period 3 to 12 months later. Our results show that during pregnancy free-recall performance was somewhat worse (in agreement with prior research) than postpartum but that recognition performance was not worse and was, if anything, slightly enhanced. These results weigh against a purely biological explanation of the memory difficulties associated with pregnancy and instead point to a strategic explanation. In particular, the results suggest that when women are pregnant they rely more on item-specific processing (which can enhance recognition) but when they are no longer pregnant they rely more on relational processing (which enhances recall).
Collapse
Affiliation(s)
- Laura Mickes
- University of California, 9500 Gilman Drive, San Diego, La Jolla, CA 92093-0109, USA.
| | | | | | | |
Collapse
|
12
|
Shah AK, Rajamani K, Whitty JE. Eclampsia: a neurological perspective. J Neurol Sci 2008; 271:158-67. [PMID: 18495165 DOI: 10.1016/j.jns.2008.04.010] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2007] [Revised: 03/28/2008] [Accepted: 04/08/2008] [Indexed: 01/17/2023]
Abstract
Eclampsia is a poorly understood disorder characterized by seizures or unexplained coma in setting of gestational hypertension. Its neurological manifestations are varied and are an important cause of the morbidity and mortality associated. We present a comprehensive prospective study of forty women recruited over four years describing neurological symptoms and signs, neuroimaging and laboratory studies as well as prognosis including 3-6 months follow-up. The seizures occurred in the postpartum period in majority of women (55%), while 45% had seizures before labor, and the rest (5%) during labor. Interestingly, one third of the women suffered their first seizures more than 48 h postpartum (late postpartum eclampsia). A sizable minority suffered more than one seizure and some had documented partial seizures. Headache preceded seizures by more than a day and was described as throbbing or pounding pain by most. The visual symptoms in decreasing frequency were blurring, blindness, scotoma and visual processing deficits. The most common finding during the neurological exam was memory deficits, followed by increased deep tendon reflexes (asymmetric in some), visual perception deficits, visual information processing deficits, altered mental status and cranial nerve deficits. Intracranial or intraspinal pressure when examined was elevated. Among neuroimaging studies, MRI was more sensitive compared to CT scan. The MRI abnormalities included both white as well as gray matter and the most common location of abnormalities was high frontal/parietal lobe. The laboratory studies revealed proteinuria in majority, but not in all. The liver function tests were abnormal in many, while few patients had HELLP syndrome. The neurological deficits resolved by the time of discharge in all. At follow-up, some patients developed new neurological problems such as recurrent headaches or seizures.
Collapse
Affiliation(s)
- A K Shah
- Department of Neurology, Wayne State University/Detroit Medical Center, Detroit, MI 48201, United States.
| | | | | |
Collapse
|
13
|
Henry JD, Rendell PG. A review of the impact of pregnancy on memory function. J Clin Exp Neuropsychol 2008; 29:793-803. [PMID: 18030631 DOI: 10.1080/13803390701612209] [Citation(s) in RCA: 139] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Although until recently much of the evidence for pregnancy-related deficits in memory was anecdotal or based on self-report, a number of studies have now been conducted that have tested whether these subjective appraisals of memory difficulties reflect objective impairment. However, these studies have failed to yield consistent results. A meta-analysis of the 14 studies that have been conducted over the past 17 years comparing pregnant and/or postpartum women with healthy matched controls on behavioral measures of memory was conducted. The results indicate that pregnant women are significantly impaired on some, but not all, measures of memory, and, specifically, memory measures that place relatively high demands on executive cognitive control may be selectively disrupted. The same specific deficits associated with pregnancy are also observed postpartum. These findings highlight the need for exploration of the etiologies and functional consequences of pregnancy-related memory difficulties and may help to guide the interpretation of neuropsychological data for the purpose of determining cognitive status in individuals who are pregnant or postpartum.
Collapse
|