1
|
Duerden EG, Guo T, Chau C, Chau V, Synnes A, Grunau RE, Miller SP. Association of Neonatal Midazolam Exposure With Hippocampal Growth and Working Memory Performance in Children Born Preterm. Neurology 2023; 101:e1863-e1872. [PMID: 37748888 PMCID: PMC10663014 DOI: 10.1212/wnl.0000000000207817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 07/26/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Early exposure to analgesics and sedatives is a key concern for later learning disorders in children. The hippocampus, a key region for learning and memory, may be selectively affected by exposure to benzodiazepines that are commonly used for sedation, particularly in the neonatal period. In this prospective cohort study, the long-term association of neonatal midazolam exposure, a widely used benzodiazepine in neonatal intensive care, with school age hippocampal growth was examined. Higher-order cognitive function in preterm born children was assessed in relation to hippocampal volumes. METHODS Very preterm born children underwent MRI to characterize the hippocampus and its subfields and neuropsychological testing. Generalized linear models were used to determine the predictors of 8-year hippocampal volumes. Children were assessed on the Wechsler Abbreviated Scales of Intelligence, Second Edition, and the Wechsler Intelligence Scales for Children, Fifth Edition (WISC-V). RESULTS A total of 140 preterm children who were 8 years of age participated, and 25 (18%) were exposed to midazolam as neonates. Reduced hippocampal volumes at age 8 years were associated with neonatal midazolam exposure (B = -400.2, 95% CI -14.37 to -786.03, p = 0.04), adjusting for neonatal clinical care factors. Boys exposed to higher doses of midazolam as neonates had smaller hippocampal volumes (χ2 = 14.4, p = 0.002) compared with nonexposed boys and girls (both, p < 0.03). Analysis of the hippocampal subfields in relation to neonatal midazolam dose revealed that higher doses were associated with smaller volumes of the subiculum (p = 0.008), a hippocampal-cortical relay region implicated in memory processes. Furthermore, smaller school age subiculum volumes predicted significantly lower working memory scores on the WISC-V (B = 0.04, 95% CI 0.01-0.07, p = 0.017). DISCUSSION Early midazolam exposure and the association with impaired hippocampal growth seem long-lasting and are most apparent in boys. Alterations in subiculum volumes may underlie hippocampus-dependent memory formation processes in preterm born children exposed to midazolam as neonates.
Collapse
Affiliation(s)
- Emma G Duerden
- From the Western University (E.G.D.), London; Hospital for Sick Children (T.G.), Toronto, Ontario; University of British Columbia (C.C., A.S., R.E.G., S.P.M.), Vancouver; and The Hospital for Sick Children and University of Toronto (V.C.), Ontario, Canada.
| | - Ting Guo
- From the Western University (E.G.D.), London; Hospital for Sick Children (T.G.), Toronto, Ontario; University of British Columbia (C.C., A.S., R.E.G., S.P.M.), Vancouver; and The Hospital for Sick Children and University of Toronto (V.C.), Ontario, Canada
| | - Cecil Chau
- From the Western University (E.G.D.), London; Hospital for Sick Children (T.G.), Toronto, Ontario; University of British Columbia (C.C., A.S., R.E.G., S.P.M.), Vancouver; and The Hospital for Sick Children and University of Toronto (V.C.), Ontario, Canada
| | - Vann Chau
- From the Western University (E.G.D.), London; Hospital for Sick Children (T.G.), Toronto, Ontario; University of British Columbia (C.C., A.S., R.E.G., S.P.M.), Vancouver; and The Hospital for Sick Children and University of Toronto (V.C.), Ontario, Canada
| | - Anne Synnes
- From the Western University (E.G.D.), London; Hospital for Sick Children (T.G.), Toronto, Ontario; University of British Columbia (C.C., A.S., R.E.G., S.P.M.), Vancouver; and The Hospital for Sick Children and University of Toronto (V.C.), Ontario, Canada
| | - Ruth E Grunau
- From the Western University (E.G.D.), London; Hospital for Sick Children (T.G.), Toronto, Ontario; University of British Columbia (C.C., A.S., R.E.G., S.P.M.), Vancouver; and The Hospital for Sick Children and University of Toronto (V.C.), Ontario, Canada
| | - Steven P Miller
- From the Western University (E.G.D.), London; Hospital for Sick Children (T.G.), Toronto, Ontario; University of British Columbia (C.C., A.S., R.E.G., S.P.M.), Vancouver; and The Hospital for Sick Children and University of Toronto (V.C.), Ontario, Canada
| |
Collapse
|
2
|
Bonfim THFD, Tavares RL, de Vasconcelos MHA, Gouveia M, Nunes PC, Soares NL, Alves RC, de Carvalho JLP, Alves AF, Pereira RDA, Cardoso GA, Silva AS, Aquino JDS. Potentially obesogenic diets alter metabolic and neurobehavioural parameters in Wistar rats: a comparison between two dietary models. J Affect Disord 2021; 279:451-461. [PMID: 33120246 DOI: 10.1016/j.jad.2020.10.034] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 08/28/2020] [Accepted: 10/13/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Clinical studies related to the obesity pandemic have intensified in recent years, being the animal studies are also considered of great relevance. However, despite the fact that many diets have been reported in the literature to induce obesity in animal models, there is still a gap regarding evidence of the efficacy of these models, considering not only changes in somatic parameters, but also the triggering of comorbidities associated with obesity. In this scenario, the aim of this study was to compare the effectiveness of western and cafeteria diets as obesity-inducing protocols, focusing on the evaluation of metabolic, somatic, oxidative, histological and behavioural parameters of Wistar rats. METHODS The rats were fed a control (CON), western (WTD) or cafeteria (CAF) diet for 16 weeks. RESULTS The CAF diet caused anxiogenic-like behaviour. Body mass (BMI), Lee and adiposity indices increased in the CAF group. CAF and WTD diets reduced glucose and insulin tolerance, caused dyslipidemia, increased lipid peroxidation and decrease antioxidant capacity in the liver, kidneys and brain. The WTD and CAF groups shows greater IL-6 protein expression in adipose tissue, developed hepatic steatosis and ischaemic neurons, whereas interstitial nephritis was observed only in the CAF group. CONCLUSION The CAF diet was most effective in inducing obesity, as shown both by the somatic parameters and by the greater number of obesity-related metabolic and neurobehavioural disorders in the evaluated rats.
Collapse
Affiliation(s)
| | - Renata Leite Tavares
- Laboratory of Experimental Nutrition, Department of Nutrition, Federal University of Paraíba (UFPB), João Pessoa, Paraíba, Brazil
| | | | - Mirela Gouveia
- Laboratory of Experimental Nutrition, Department of Nutrition, Federal University of Paraíba (UFPB), João Pessoa, Paraíba, Brazil
| | - Polyana Campos Nunes
- Laboratory of Experimental Nutrition, Department of Nutrition, Federal University of Paraíba (UFPB), João Pessoa, Paraíba, Brazil
| | - Naís Lira Soares
- Laboratory of Experimental Nutrition, Department of Nutrition, Federal University of Paraíba (UFPB), João Pessoa, Paraíba, Brazil
| | - Raquel Coutinho Alves
- Laboratory of Experimental Nutrition, Department of Nutrition, Federal University of Paraíba (UFPB), João Pessoa, Paraíba, Brazil
| | - Jader Luciano Pinto de Carvalho
- Laboratory of Experimental Nutrition, Department of Nutrition, Federal University of Paraíba (UFPB), João Pessoa, Paraíba, Brazil
| | - Adriano Francisco Alves
- Laboratory of Pathology, Department of Physiology and Pathology, Federal University of Paraíba (UFPB), João Pessoa, Paraíba, Brazil
| | - Ramon de Alencar Pereira
- Laboratory of Pathology, Department of Pathology, Federal University of Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Glêbia Alexa Cardoso
- Associate Graduate Program in Physical Education - UPE / UFPB, Department of Physical Education, Federal University of Paraíba, João Pessoa, Brazil; Laboratory of Physical Training Applied to Performance and Health, Department of Physical Education, Federal University of Paraíba (UFPB), João Pessoa, Paraíba, Brazil
| | - Alexandre Sergio Silva
- Laboratory of Physical Training Applied to Performance and Health, Department of Physical Education, Federal University of Paraíba (UFPB), João Pessoa, Paraíba, Brazil
| | - Jailane de Souza Aquino
- Laboratory of Experimental Nutrition, Department of Nutrition, Federal University of Paraíba (UFPB), João Pessoa, Paraíba, Brazil.
| |
Collapse
|
3
|
Nehls M. Unified theory of Alzheimer's disease (UTAD): implications for prevention and curative therapy. J Mol Psychiatry 2016; 4:3. [PMID: 27429752 PMCID: PMC4947325 DOI: 10.1186/s40303-016-0018-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 07/03/2016] [Indexed: 12/14/2022] Open
Abstract
The aim of this review is to propose a Unified Theory of Alzheimer's disease (UTAD) that integrates all key behavioural, genetic and environmental risk factors in a causal chain of etiological and pathogenetic events. It is based on three concepts that emanate from human's evolutionary history: (1) The grandmother-hypothesis (GMH), which explains human longevity due to an evolutionary advantage in reproduction by trans-generational transfer of acquired knowledge. Consequently it is argued that mental health at old-age must be the default pathway of humans' genetic program and not development of AD. (2) Therefore, mechanism like neuronal rejuvenation (NRJ) and adult hippocampal neurogenesis (AHN) that still function efficiently even at old age provide the required lifelong ability to memorize personal experiences important for survival. Cumulative evidence from a multitude of experimental and epidemiological studies indicate that behavioural and environmental risk factors, which impair productive AHN, result in reduced episodic memory performance and in reduced psychological resilience. This leads to avoidance of novelty, dysregulation of the hypothalamic-pituitary-adrenal (HPA)-axis and cortisol hypersecretion, which drives key pathogenic mechanisms of AD like the accumulation and oligomerization of synaptotoxic amyloid beta, chronic neuroinflammation and neuronal insulin resistance. (3) By applying to AHN the law of the minimum (LOM), which defines the basic requirements of biological growth processes, the UTAD explains why and how different lifestyle deficiencies initiate the AD process by impairing AHN and causing dysregulation of the HPA-axis, and how environmental and genetic risk factors such as toxins or ApoE4, respectively, turn into disease accelerators under these unnatural conditions. Consequently, the UTAD provides a rational strategy for the prevention of mental decline and a system-biological approach for the causal treatment of AD, which might even be curative if the systemic intervention is initiated early enough in the disease process. Hence an individualized system-biological treatment of patients with early AD is proposed as a test for the validity of UTAD and outlined in this review.
Collapse
Affiliation(s)
- Michael Nehls
- Independent Researcher, Allmendweg 1, 79279 Vörstetten, Germany
| |
Collapse
|