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Huster RJ, Thunberg C, Solbakk AK, Gravholt CH, Fjermestad K. Inhibitory deficits in Klinefelter syndrome are secondary to deficits in the auditory and motor domain. Neuroimage Clin 2024; 44:103674. [PMID: 39366282 DOI: 10.1016/j.nicl.2024.103674] [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: 05/01/2024] [Revised: 09/16/2024] [Accepted: 09/18/2024] [Indexed: 10/06/2024]
Abstract
Deficits in several cognitive domains are prevalent in men with Klinefelter Syndrome (KS). Verbal deficits are among the most characteristic cognitive impairments of KS, yet other cognitive domains also exhibit deficits. Executive functions, especially working memory capacity and inhibitory control, are frequently affected as well. A common limitation of previous studies addressing potential deficits in inhibitory control is their potential conflation with language-related capabilities, as for example is the case with the Stroop task. Importantly, none of the prior studies utilized the best-accepted approach to study inhibition, namely the Stop Signal Task (SST). This study therefore tested for deficits in inhibitory control in individuals with KS and controls (HC) using a version of the SST with non-semantic auditory stimuli. In addition to the classic behavioral performance measures (e.g., the go reaction time, stopping accuracy, or stop signal reaction time), we also derived parameters of inhibition and attention from electromyography (EMG), electroencephalography (EEG), and Bayesian modeling. Men with KS exhibited prolonged stopping latencies (i.e., stop signal reaction times) and reduced stopping accuracies. Yet, whereas these model-based indices were indicative of attenuated inhibitory control, neither event-related brain potentials nor an EMG-measure of the stopping latency confirmed such deficits. Behavioral and EEG indices, however, provided evidence for deficits in motor response preparation and generation, as well as the early processing of auditory stimuli. In sum, the overall pattern of results does not support the existence of inhibitory deficits in KS per se, but rather suggests that behavioral indices of impaired inhibition may result from early low-level deficits in the auditory and motor domains, as well as a differential weighting in the processing of different aspects of the task.
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Affiliation(s)
- René J Huster
- Multimodal Imaging and Cognitive Control Lab, Department of Psychology, University of Oslo, Oslo, Norway; Cognitive and Translational Neuroscience Cluster, Department of Psychology, University of Oslo, Oslo, Norway.
| | - Christina Thunberg
- Multimodal Imaging and Cognitive Control Lab, Department of Psychology, University of Oslo, Oslo, Norway
| | - Anne-Kristin Solbakk
- Cognitive and Translational Neuroscience Cluster, Department of Psychology, University of Oslo, Oslo, Norway; RITMO Centre for Interdisciplinary Studies in Rhythm, Time and Motion, Norway; Department of Psychology, University of Oslo, Norway; Department of Neuropsychology, Helgeland Hospital, Mosjøen, Norway; Department of Neurosurgery, Oslo University Hospital, Norway
| | - Claus H Gravholt
- Department of Molecular Medicine, Aarhus University Hospital, Denmark; Department of Clinical Medicine, Aarhus University, Denmark; Department of Endocrinology, Aarhus University Hospital, Denmark
| | - Krister Fjermestad
- Section for Clinical Psychology, Department of Psychology, University of Oslo, Oslo, Norway; Frambu Resource Centre for Rare Disorders, Siggerud, Norway
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2
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Serrarens C, Ruiz-Fernandez J, Otter M, Campforts BCM, Stumpel CTRM, Linden DEJ, van Amelsvoort TAMJ, Kashyap S, Vingerhoets C. Intracortical myelin across laminae in adult individuals with 47,XXX: a 7 Tesla MRI study. Cereb Cortex 2024; 34:bhae343. [PMID: 39183364 PMCID: PMC11345119 DOI: 10.1093/cercor/bhae343] [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: 04/12/2024] [Revised: 07/31/2024] [Accepted: 08/12/2024] [Indexed: 08/27/2024] Open
Abstract
47,XXX (Triple X syndrome) is a sex chromosome aneuploidy characterized by the presence of a supernumerary X chromosome in affected females and is associated with a variable cognitive, behavioral, and psychiatric phenotype. The effect of a supernumerary X chromosome in affected females on intracortical microstructure is currently unknown. Therefore, we conducted 7 Tesla structural MRI and compared T1 (ms), as a proxy for intracortical myelin (ICM), across laminae of 21 adult women with 47,XXX and 22 age-matched typically developing females using laminar analyses. Relationships between phenotypic traits and T1 values in 47,XXX were also investigated. Adults with 47,XXX showed higher bilateral T1 across supragranular laminae in the banks of the superior temporal sulcus, and in the right inferior temporal gyrus, suggesting decreases of ICM primarily within the temporal cortex in 47,XXX. Higher social functioning in 47,XXX was related to larger inferior temporal gyrus ICM content. Our findings indicate an effect of a supernumerary X chromosome in adult-aged women on ICM across supragranular laminae within the temporal cortex. These findings provide insight into the role of X chromosome dosage on ICM across laminae. Future research is warranted to further explore the functional significance of altered ICM across laminae in 47,XXX.
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Affiliation(s)
- Chaira Serrarens
- Department of Psychiatry and Neuropsychology, Mental Health and Neuroscience Institute (MHeNS), Maastricht University, Maastricht, 6200 MD, The Netherlands
| | - Julia Ruiz-Fernandez
- Department of Psychiatry and Neuropsychology, Mental Health and Neuroscience Institute (MHeNS), Maastricht University, Maastricht, 6200 MD, The Netherlands
- INSERM U1299, Centre Borelli UMR 9010, ENS-Paris-Saclay, Université Paris Saclay, Paris, France
| | - Maarten Otter
- Department of Psychiatry and Neuropsychology, Mental Health and Neuroscience Institute (MHeNS), Maastricht University, Maastricht, 6200 MD, The Netherlands
- Medical Department, SIZA, Arnhem, 6800 AM, The Netherlands
| | - Bea C M Campforts
- Department of Psychiatry and Neuropsychology, Mental Health and Neuroscience Institute (MHeNS), Maastricht University, Maastricht, 6200 MD, The Netherlands
| | - Constance T R M Stumpel
- Department of Clinical Genetics and School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, 6229 ER, The Netherlands
| | - David E J Linden
- Department of Psychiatry and Neuropsychology, Mental Health and Neuroscience Institute (MHeNS), Maastricht University, Maastricht, 6200 MD, The Netherlands
| | - Therese A M J van Amelsvoort
- Department of Psychiatry and Neuropsychology, Mental Health and Neuroscience Institute (MHeNS), Maastricht University, Maastricht, 6200 MD, The Netherlands
| | - Sriranga Kashyap
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, 6229 EV, The Netherlands
- Krembil Brain Institute, University Health Network, Toronto, ON M5T 2S8, Canada
| | - Claudia Vingerhoets
- Department of Psychiatry and Neuropsychology, Mental Health and Neuroscience Institute (MHeNS), Maastricht University, Maastricht, 6200 MD, The Netherlands
- ‘s Heeren Loo Zorggroep, Amersfoort, 3818 LA, The Netherlands
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3
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Davis SM, Teerlink CC, Lynch JA, Klamut N, Gorman BR, Pagadala MS, Panizzon MS, Merritt VC, Genovese G, Ross JL, Hauger RL. An extra X chromosome among adult women in the Million Veteran Program: A more benign perspective of trisomy X. AMERICAN JOURNAL OF MEDICAL GENETICS. PART C, SEMINARS IN MEDICAL GENETICS 2024:e32083. [PMID: 38441278 PMCID: PMC11374932 DOI: 10.1002/ajmg.c.32083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 02/10/2024] [Indexed: 09/06/2024]
Abstract
Despite affecting in 1 in every 1000 females, remarkably little is known about trisomy X syndrome (47,XXX), especially among older adults who are undiagnosed. In this study, we aimed to determine the prevalence of 47,XXX among females enrolled in the Million Veterans Program (MVP; mean age 50.2 ± 13.6 years), and compare broad health outcomes between females with 47,XXX and 46,XX matched controls. We identified 61 females with an additional X chromosome, corresponding to a prevalence of 103 per 100,000 females; 27.9% had been clinically diagnosed. Females with 47,XXX had taller stature (+6.1 cm, p < 0.001), greater rate of outpatient encounters (p = 0.026), higher odds of kidney disease (odds ratio [OR] = 12.3; 95% confidence interval [CI] 2.9-51.8), glaucoma (OR = 5.1; 95% CI 1.5-13.9), and congestive heart failure (OR = 5.6; 95% CI 1.4-24.2), and were more likely to be unemployed (p = 0.008) with lower annual income (p = 0.021) when compared with 46,XX controls of the same age and genetic ancestry. However, there were no differences in the rates of other encounter types, Charlson Comorbidity Index, all other medical and psychological diagnoses, military service history or quality of life metrics. In conclusion, in this aging and predominately undiagnosed sample, 47,XXX conferred few differences when compared with matched controls, offering a more reassuring perspective to the trisomy X literature.
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Affiliation(s)
- Shanlee M Davis
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
- eXtraOrdinarY Kids Clinic, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Craig C Teerlink
- VA Informatics and Computing Infrastructure (VINCI), VA Salt Lake City Healthcare System, Salt Lake City, Utah, USA
- Department of Internal Medicine, University of Utah Health, Salt Lake City, Utah, USA
| | - Julie A Lynch
- VA Informatics and Computing Infrastructure (VINCI), VA Salt Lake City Healthcare System, Salt Lake City, Utah, USA
- Department of Internal Medicine, University of Utah Health, Salt Lake City, Utah, USA
- College of Nursing and Health Sciences, University of Massachusetts, Lowell, Massachusetts, USA
| | - Natalia Klamut
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
- eXtraOrdinarY Kids Clinic, Children's Hospital Colorado, Aurora, Colorado, USA
| | | | - Meghana S Pagadala
- Medical Scientist Training Program, University of California San Diego, La Jolla, California, USA
- Biomedical Science Program, University of California San Diego, La Jolla, California, USA
| | - Matthew S Panizzon
- Center for Behavioral Genetics of Aging, School of Medicine, University of California San Diego, La Jolla, California, USA
| | - Victoria C Merritt
- VA San Diego Healthcare System, San Diego, California, USA
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, California, USA
| | - Giulio Genovese
- Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Boston, Massachusetts, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
- Department of Genetics, Harvard Medical School, Boston, Massachusetts, USA
| | - Judith L Ross
- Nemours Children's Hospital DE, Wilmington, Delaware, USA
- Department of Pediatrics, School of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Richard L Hauger
- Center for Behavioral Genetics of Aging, School of Medicine, University of California San Diego, La Jolla, California, USA
- VA San Diego Healthcare System, San Diego, California, USA
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, California, USA
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Foland-Ross LC, Ghasemi E, Lozano Wun V, Aye T, Kowal K, Ross J, Reiss AL. Executive Dysfunction in Klinefelter Syndrome: Associations With Brain Activation and Testicular Failure. J Clin Endocrinol Metab 2023; 109:e88-e95. [PMID: 37595261 PMCID: PMC10735320 DOI: 10.1210/clinem/dgad487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 08/09/2023] [Accepted: 08/15/2023] [Indexed: 08/20/2023]
Abstract
CONTEXT Executive dysfunction is a well-recognized component of the cognitive phenotype of Klinefelter syndrome (KS), yet the neural basis of KS-associated cognitive weaknesses, and their association with testicular failure is unknown. OBJECTIVE We investigated executive function, brain activation, and pubertal development in adolescents with and without KS. METHODS Forty-three adolescents with KS (mean age 12.3 ± 2.3 years) and 41 typically developing boys (mean age 11.9 ± 1.8 years) underwent pubertal evaluation, behavioral assessment, and completed functional magnetic resonance imaging (fMRI) as they performed an executive function task, the go/no-go task. Group differences in activation were examined. Associations among activation, executive function, and pubertal development measures were tested in secondary analyses. RESULTS Boys with KS exhibited reduced executive function, as well as lower activation in brain regions subserving executive function, including the inferior frontal gyrus, anterior insula, dorsal anterior cingulate cortex, and caudate nucleus. Secondary analyses indicated that the magnitude of activation differences in boys with KS was associated with severity of pubertal developmental delay, as indexed by lower testosterone (t(36) = 2.285; P = .028) and lower testes volume (t(36) = 2.238; P = .031). Greater parent-reported attention difficulties were additionally associated with lower testicular volume (t(36) = -2.028; P = .050). CONCLUSION These findings indicate a neural basis for executive dysfunction in KS and suggest alterations in pubertal development may contribute to increased severity of this cognitive weakness. Future studies that examine whether these patterns change with testosterone replacement therapy are warranted.
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Affiliation(s)
- Lara C Foland-Ross
- Center for Interdisciplinary Brain Sciences Research, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94304, USA
| | - Elnaz Ghasemi
- Center for Interdisciplinary Brain Sciences Research, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94304, USA
| | - Vanessa Lozano Wun
- Department of Psychology, University of Minnesota, Minneapolis, MN 55455, USA
| | - Tandy Aye
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA 93405, USA
| | - Karen Kowal
- Department of Pediatrics, Nemours Children's Hospital Delaware, Wilmington, DE 19803, USA
- Department of Pediatrics, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Judith Ross
- Department of Pediatrics, Nemours Children's Hospital Delaware, Wilmington, DE 19803, USA
- Department of Pediatrics, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Allan L Reiss
- Center for Interdisciplinary Brain Sciences Research, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94304, USA
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA 93405, USA
- Department of Radiology, Stanford University School of Medicine, Stanford, CA 94304, USA
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Hamzik MP, Gropman AL, Brooks MR, Powell S, Sadeghin T, Samango-Sprouse CA. The Effect of Hormonal Therapy on the Behavioral Outcomes in 47,XXY (Klinefelter Syndrome) between 7 and 12 Years of Age. Genes (Basel) 2023; 14:1402. [PMID: 37510306 PMCID: PMC10379663 DOI: 10.3390/genes14071402] [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: 05/22/2023] [Revised: 06/23/2023] [Accepted: 07/04/2023] [Indexed: 07/30/2023] Open
Abstract
47,XXY, also known as Klinefelter syndrome, is the most commonly occurring sex chromosomal aneuploidy (SCA). Hormonal replacement therapy (HRT) has been associated with improved neurodevelopmental capabilities in boys with 47,XXY, although studies investigating HRT's possible positive effect on behavioral outcomes are scarce. This study explores the association between behavioral outcomes and HRT in boys ages 7-12. Patients were divided into 4 groups based on HRT status: untreated, early hormonal treatment (EHT), hormonal booster therapy (HBT), and both EHT and HBT. Analysis of Variance (ANOVA) and Kruskal-Wallis tests were conducted to determine group differences on the Child Behavior Checklist (CBCL) and the Behavior Rating Inventory of Executive Function (BRIEF). The treated groups were found to have better scores in emotional control, initiative, organization of materials, behavioral rating index, metacognition index, and global executive composite than the untreated group on the BRIEF. On the CBCL, the treated groups presented better scores for somatic complaints, social problems, thought problems, attention problems, aggressive behavior, internalizing problems, total problems, affective problems, somatic problems, ADHD problems, oppositional defiant problems, and sluggish problems in comparison to the untreated group. These results offer evidence that HRT, specifically the combination of both EHT and HBT, may be successful in mitigating some undesirable behavioral outcomes. Further research is necessary to determine the efficacy of the combination of EHT and HBT regarding dosage, specific ages, and long-term benefits.
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Affiliation(s)
- Mary P Hamzik
- Department of Research, The Focus Foundation, 1251 W Central Ave. Suite A #190, Davidsonville, MD 21035, USA
| | - Andrea L Gropman
- Division of Neurogenetics and Developments Pediatrics, Children's National Health System, 111 Michigan Ave. NW, Washington, DC 20010, USA
- Department of Neurology, George Washington University, Washington, DC 20052, USA
| | - Michaela R Brooks
- Department of Research, The Focus Foundation, 1251 W Central Ave. Suite A #190, Davidsonville, MD 21035, USA
| | - Sherida Powell
- Department of Economics, George Washington University, Washington, DC 20052, USA
| | - Teresa Sadeghin
- Department of Research, The Focus Foundation, 1251 W Central Ave. Suite A #190, Davidsonville, MD 21035, USA
| | - Carole A Samango-Sprouse
- Department of Research, The Focus Foundation, 1251 W Central Ave. Suite A #190, Davidsonville, MD 21035, USA
- Department of Human and Molecular Genetics, Florida International University, 11200 SW 8th St., Miami, FL 33199, USA
- Department of Pediatrics, George Washington University, 2121 I St. NW, Washington, DC 20052, USA
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6
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Kuiper KC, Swaab H, Tartaglia N, Cordeiro L, van Rijn S. [Formula: see text] Emotional reactivity and expressivity in young children with sex chromosome trisomies: evidence from psychophysiological and observational data. Child Neuropsychol 2023; 29:569-587. [PMID: 35876333 DOI: 10.1080/09297049.2022.2102161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Although sex chromosomal trisomies (SCT) in children are highly prevalent and associated with an increased risk for neurodevelopmental difficulties including socio-emotional problems, little is known about underlying mechanisms that could drive this risk. Studying emotional reactivity and expressivity of young children with SCT in early childhood could identify deviations in early emotional development and potentially serve as risk markers to guide clinical care in developing interventions. Participants in the current study were 90 SCT children and 97 population-based controls, aged 1 to 7 years, who experienced a stress-inducing event in which physiological (heart rate) and observational data (expression of negative emotions) were collected. Results showed early disturbances in the emotion system of young children with SCT, in terms of blunted but prolonged emotional reactivity and a reduced emotional expressivity in response to stress. Further, the concordance between emotional reactivity (arousal response) and expressivity was significantly lower in SCT, compared to controls. Given the significant impact of emotions on adaptive day-to-day functioning, deviations in processing emotions could be an important underlying mechanism in explaining the heterogeneity and variability in developmental outcomes often described in individuals with SCT.
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Affiliation(s)
- Kimberly C Kuiper
- Clinical Neurodevelopmental Sciences, Leiden University, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition, Leiden, The Netherlands
| | - Hanna Swaab
- Clinical Neurodevelopmental Sciences, Leiden University, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition, Leiden, The Netherlands
| | - Nicole Tartaglia
- eXtraordinarY Kids Clinic, Developmental Pediatrics, Children's Hospital Colorado, Aurora, Colorado, USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Lisa Cordeiro
- eXtraordinarY Kids Clinic, Developmental Pediatrics, Children's Hospital Colorado, Aurora, Colorado, USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Sophie van Rijn
- Clinical Neurodevelopmental Sciences, Leiden University, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition, Leiden, The Netherlands
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7
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Riggan KA, Gross B, Close S, Steinberg A, Allyse MA. "Knowledge is Power": Parent Views on the Benefits of Early Diagnosis and Awareness of Sex Chromosome Multisomy Among Pediatric Professionals. J Dev Behav Pediatr 2023; 44:e119-e125. [PMID: 36454640 PMCID: PMC10117700 DOI: 10.1097/dbp.0000000000001153] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 10/04/2022] [Indexed: 12/05/2022]
Abstract
OBJECTIVE Pediatric diagnoses of sex chromosome multisomies (SCMs) have increased as genetic testing has expanded. However, depending on SCM presentation, there may be significant delays between symptom recognition and diagnosis. We conducted a survey of parents of children diagnosed with SCMs to understand their experiences receiving an SCM diagnosis and their support needs. METHODS We conducted an inductive qualitative analysis of open-ended survey responses for iterative themes related to presenting symptoms, diagnostic odyssey, immediate and long-term support needs, and awareness of SCMs. RESULTS Of the 323 parents who completed the survey, 185 parents received a pediatric diagnosis (0-21 years) in a child. Many parents expressed feelings of relief when receiving the diagnosis, especially if it occurred after a lengthy diagnostic odyssey. Parents reported frustration that their child's nonmedical symptoms, including learning disabilities, speech delays, attention deficits, and behavioral issues, were not flagged as potential indications for SCMs and suggested that greater awareness of SCMs by pediatricians, educators, and other professionals involved in their child's care may lead to earlier diagnosis and intervention. CONCLUSION This is the largest qualitative study to date examining parent and caregiver experiences with a pediatric diagnosis of SCMs. Increased knowledge and awareness of nonmedical SCM symptoms are needed among medical, education, occupational, and psychology professionals for early testing referral and improved support of children with SCMs.
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Affiliation(s)
| | - Brianna Gross
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Sharron Close
- Nell Hodgson Woodruff School of Nursing, Emory University Atlanta, GA
| | | | - Megan A. Allyse
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN
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8
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Capelli E, Silibello G, Provera A, Dall'Ara F, Ajmone PF, Monti F, Scionti N, Zanchi P, Costantino MA, Vizziello PG, Zampini L. Speech Sound Development in 18-Month-Old Children With Sex Chromosome Trisomies. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:287-297. [PMID: 36603546 DOI: 10.1044/2022_ajslp-22-00118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
PURPOSE This study aimed to describe speech sound development in a group of 18-month-old children with sex chromosome trisomies (SCTs), compared with a group of typically developing (TD) peers. Concurrent and longitudinal relationships between speech sound abilities and lexical development were examined. METHOD A group of 76 children aged 18 months, 38 children prenatally diagnosed with SCTs (12 with XXY, 12 with XYY, and 14 with XXX) and 38 TD children, participated in the study. From video recordings of semistructured naturalistic parent-child play sessions, quantitative and qualitative measures of speech sound development were collected (e.g., the number of consonants, type and place of articulation, and syllable structures used), and group differences were observed. The relationships between the number of consonants produced and vocabulary size at 18 and 24 months were assessed. RESULTS At 18 months, children with SCTs used a significantly lower number of consonants than TD children. Qualitatively, children with SCTs used significantly fewer articulatory complex consonants (fricative/affricates) and a more restricted inventory of syllable structures. The number of consonants used was significantly correlated with lexical development at 18 months. Moreover, in the SCTs group (but not in the TD group), the children with lower speech sound development at 18 months showed a significantly smaller vocabulary growth between 18 and 24 months than those with higher speech-sound development. CONCLUSIONS Toddlers with SCTs showed a significantly delayed speech sound development pattern rather than an atypical one. Children with SCTs with low speech sound development also showed lower vocabulary growth between 18 and 24 months of age. These results can be clinically relevant for follow-up and treatment planning for children with SCTs.
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Affiliation(s)
- Elena Capelli
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Gaia Silibello
- Child and Adolescent Neuropsychiatric Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Francesca Dall'Ara
- Child and Adolescent Neuropsychiatric Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paola Francesca Ajmone
- Child and Adolescent Neuropsychiatric Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Federico Monti
- Child and Adolescent Neuropsychiatric Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Nicoletta Scionti
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Paola Zanchi
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Maria Antonella Costantino
- Child and Adolescent Neuropsychiatric Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paola Giovanna Vizziello
- Child and Adolescent Neuropsychiatric Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Laura Zampini
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
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9
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Serrarens C, Kashyap S, Riveiro-Lago L, Otter M, Campforts BCM, Stumpel CTRM, Jansma H, Linden DEJ, van Amelsvoort TAMJ, Vingerhoets C. Resting-state functional connectivity in adults with 47,XXX: a 7 Tesla MRI study. Cereb Cortex 2022; 33:5210-5217. [PMID: 36255323 PMCID: PMC10151873 DOI: 10.1093/cercor/bhac410] [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: 07/15/2022] [Revised: 09/20/2022] [Accepted: 09/21/2022] [Indexed: 11/13/2022] Open
Abstract
Triple X syndrome is a sex chromosomal aneuploidy characterized by the presence of a supernumerary X chromosome, resulting in a karyotype of 47,XXX in affected females. It has been associated with a variable cognitive, behavioral, and psychiatric phenotype, but little is known about its effects on brain function. We therefore conducted 7 T resting-state functional magnetic resonance imaging and compared data of 19 adult individuals with 47,XXX and 21 age-matched healthy control women using independent component analysis and dual regression. Additionally, we examined potential relationships between social cognition and social functioning scores, and IQ, and mean functional connectivity values. The 47,XXX group showed significantly increased functional connectivity of the fronto-parietal resting-state network with the right postcentral gyrus. Resting-state functional connectivity (rsFC) variability was not associated with IQ and social cognition and social functioning deficits in the participants with 47,XXX. We thus observed an effect of a supernumerary X chromosome in adult women on fronto-parietal rsFC. These findings provide additional insight into the role of the X chromosome on functional connectivity of the brain. Further research is needed to understand the clinical implications of altered rsFC in 47,XXX.
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Affiliation(s)
- Chaira Serrarens
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, 6200 MD, The Netherlands
| | - Sriranga Kashyap
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, 6229 EV, The Netherlands.,Techna Institute, University Health Network, Toronto, M5G 2C4, Canada
| | - Laura Riveiro-Lago
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, 6200 MD, The Netherlands
| | - Maarten Otter
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, 6200 MD, The Netherlands.,Medical Department, SIZA, Arnhem, 6800 AM, The Netherlands.,Department of Community Mental Health in Mild Intellectual Disabilities, Trajectum, Zutphen, 7202 AG, The Netherlands
| | - Bea C M Campforts
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, 6200 MD, The Netherlands
| | - Constance T R M Stumpel
- Department of Clinical Genetics and School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, 6229 ER, The Netherlands
| | - Henk Jansma
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, 6229 EV, The Netherlands
| | - David E J Linden
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, 6200 MD, The Netherlands
| | - Thérèse A M J van Amelsvoort
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, 6200 MD, The Netherlands
| | - Claudia Vingerhoets
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, 6200 MD, The Netherlands.,'s Heeren Loo Zorggroep, Amersfoort, 3818 LA, The Netherlands
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10
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Supporting students with sex chromosome aneuploidies in educational settings: Results of a nationwide survey. J Sch Psychol 2022; 93:28-40. [PMID: 35934449 PMCID: PMC9360991 DOI: 10.1016/j.jsp.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 03/24/2022] [Accepted: 06/13/2022] [Indexed: 11/18/2022]
Abstract
Children with sex chromosome aneuploidies (SCAs) are at an increased risk for neurocognitive and behavioral disorders that may interfere with academic success, including early developmental delays, learning disabilities, executive function problems, and social communication deficits. The present national survey aimed to update and extend our understanding of school supports and educational outcomes for students with these increasingly common genetic diagnoses. Parents of children with a diagnosed SCA, birth to 21 years, living in the United States (N = 248), responded to an electronic survey with questions focused on school support plans, academic accommodations, educational therapies, school completion, and perceptions of educator awareness of SCAs. Results revealed high rates of delayed kindergarten, grade retention in primary years, and educational support plans (IEPs = 71%; Section 504 Plans = 26%). A majority (73%) of respondents with children over age 18 years (N = 41) reported their children successfully completed high school, and nearly half (46%) pursued post-secondary education opportunities. Many parents reported their children's educators had little to no knowledge of SCA conditions, justifying a need to train teachers and policy makers in the unique educational needs of children and adolescents with SCAs. School psychologists should be aware of the frequent need for accommodations and individualized support plans in this population so they can support children and families by advocating for early and comprehensive evaluations and intervention plans.
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11
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Kuiper KC, Swaab H, Tartaglia N, van Buggenhout G, Wouters C, van Rijn S. The developmental impact of sex chromosome trisomies on emerging executive functions in young children: Evidence from neurocognitive tests and daily life skills. GENES, BRAIN, AND BEHAVIOR 2022; 21:e12811. [PMID: 35584398 PMCID: PMC9744538 DOI: 10.1111/gbb.12811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 04/21/2022] [Accepted: 04/21/2022] [Indexed: 11/30/2022]
Abstract
Sex chromosomal trisomies (SCT) are associated with impairments in executive functions in school-aged children, adolescents, and adults. However, knowledge on preschool development of executive functions is limited but greatly needed to guide early intervention. The current study examined emerging executive functions in young children with SCT. Participants were 72 SCT children and 70 population-based controls, aged 3-7 years, who completed a neurocognitive assessment of both global executive function (MEFS) and verbal executive function skills (NEPSY Word Generation). Caregivers completed the Behavior Rating Inventory of Executive Function (BRIEF) questionnaire to capture real-world behavioral manifestations of impairments in executive functions. Results showed that impairments were significantly more prevalent in SCT than in controls and already present from 3 years, specifically verbal executive functions and working memory. Broader more pronounced impairments were found in older children with SCT. Age was significantly related to executive functions, but specific domains showed different relations with age. For example, deficits in planning and organizing remained evident with older age in SCT whereas it declined with age in controls. Impairments in executive functions were present across different levels of intelligence. Already at an early age, impairments across executive functions should be considered part of the neurodevelopmental profile of SCT, which appear more prominent at later age. Future studies should investigate developmental pathways of executive functions in SCT, given its relevance in cognitive, social, and emotional development. Executive functions should be screened and monitored in children with SCT and could be an important target of preventive intervention.
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Affiliation(s)
- Kimberly C. Kuiper
- Clinical Neurodevelopmental SciencesLeiden UniversityLeidenThe Netherlands
- Leiden Institute for Brain and CognitionLeidenThe Netherlands
| | - Hanna Swaab
- Clinical Neurodevelopmental SciencesLeiden UniversityLeidenThe Netherlands
- Leiden Institute for Brain and CognitionLeidenThe Netherlands
| | - Nicole Tartaglia
- eXtraordinarY Kids Clinic, Developmental PediatricsChildren's Hospital ColoradoAuroraColoradoUSA
- Department of PediatricsUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Griet van Buggenhout
- Center for Human GeneticsUniversity Hospital GasthuisbergLeuvenBelgium
- Department of Human GeneticsKU Leuven (University of Leuven)LeuvenBelgium
| | - Caroline Wouters
- Center for Human GeneticsUniversity Hospital GasthuisbergLeuvenBelgium
| | - Sophie van Rijn
- Clinical Neurodevelopmental SciencesLeiden UniversityLeidenThe Netherlands
- Leiden Institute for Brain and CognitionLeidenThe Netherlands
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12
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Franik S, Fleischer K, Kortmann B, Stikkelbroeck NM, D'Hauwers K, Bouvattier C, Slowikowska-Hilczer J, Grunenwald S, van de Grift T, Cartault A, Richter-Unruh A, Reisch N, Thyen U, IntHout J, Claahsen-van der Grinten HL. The impact of Klinefelter syndrome on socioeconomic status: a multicenter study. Endocr Connect 2022; 11:EC-22-0010. [PMID: 35700267 PMCID: PMC9254318 DOI: 10.1530/ec-22-0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 06/13/2022] [Indexed: 11/11/2022]
Abstract
Klinefelter syndrome (KS) is associated with an increased risk of neuropsychological morbidity, such as learning disabilities, which may have a significant impact on socioeconomic status (SES). The objective of this study was to investigate the SES in men with KS and to associate this outcome with social participation, age at diagnosis, testosterone therapy and physical and mental health status. Men with KS were recruited in 14 clinical study centers in six European countries which participated in the European dsd-LIFE study. Two hundred five men with KS were eligible for inclusion. Male normative data from the European Social Surveys (ESS) were used for comparison. Data related to education, occupation, satisfaction with income and householding were collected. Compared to the ESS reference population, fewer men with KS achieved a high level of education (13% vs 25%, P < 0.001). There was a significant difference in having a paid job (55% vs 66%, P < 0.001), and the percentage of absence by sickness or disability was higher among men with KS (10% vs 3%, P < 0.001). Furthermore, satisfaction with current household's income was lower (32% vs 42%, P < 0.01). Lower scores for subjective general health were associated with lower scores for these outcomes. Men with KS achieve on average lower levels of education, occupation and report less satisfaction with income compared to the ESS reference population. The presence of health problems and lower scores of subjective general health was related to lower levels of occupation and lower satisfaction with income in men with KS.
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Affiliation(s)
- Sebastian Franik
- Department of Obstetrics and Gynaecology, Radboudumc, Nijmegen, The Netherlands
| | - Kathrin Fleischer
- Department of Obstetrics and Gynaecology, Radboudumc, Nijmegen, The Netherlands
| | - Barbara Kortmann
- Department of Pediatric Urology, Radboudumc, Nijmegen, The Netherlands
| | | | | | - Claire Bouvattier
- Department of Pediatric Endocrinology, Bicêtre Hospital, Paris Sud University, Paris, France
| | | | - Solange Grunenwald
- Department of Endocrinology and Metabolic Disease, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Tim van de Grift
- Departments of Plastic Surgery and Medical Psychology, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
| | - Audrey Cartault
- Department of Pediatrics, Hospital des Enfants, Toulouse, France
| | - Annette Richter-Unruh
- Kinderendokrinologie und Diabetologie, Universitätsklinikum Ruhr-Universität Bochum, Kinderklinik, Bochum, Germany
| | - Nicole Reisch
- Medizinische Klinik and Poliklinik IV, Department of Endocrinology, University Hospital Munich, Munich, Germany
| | - Ute Thyen
- Klinik fur Kinder- und Jugendmedizin, Universitat zu Lubeck, Lubeck, Germany
| | - Joanna IntHout
- Department for Health Evidence, Radboudumc, Nijmegen, The Netherlands
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13
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Thompson T, Stinnett N, Tartaglia N, Davis S, Janusz J. 'I Wish the School Had a Better Understanding of the Diagnosis': parent perspectives on educational needs of students with sex chromosome aneuploidies. JOURNAL OF RESEARCH IN SPECIAL EDUCATIONAL NEEDS : JORSEN 2022; 22:175-187. [PMID: 35529320 PMCID: PMC9074887 DOI: 10.1111/1471-3802.12558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 12/07/2021] [Indexed: 06/14/2023]
Abstract
Students with sex chromosome aneuploidies (SCAs) are at increased risk for learning disabilities and often require individualized supports in the school setting. Parents of students with rare disorders such as SCAs possess a unique understanding of their child's educational experiences and play a crucial role in the development of successful school support plans. This international survey study aimed to inductively capture parent perspectives on educational needs and supports for students with SCAs. Parents of youth with SCAs ages 5-21 years (n = 305) provided free-text responses to open-ended questions about their child's education. Qualitative content analysis using a bioecological systems framework resulted in three overarching themes. Overall, parents identified multiple factors related to the SCA diagnosis that act as barriers to learning, a strong need for school-based social and emotional supports, and elusive or incomplete educational support plans. Based on these findings, we recommend developing robust family-school partnerships, increased collaboration between the school and the child's medical team, and acknowledgement of the significant role the genetic condition plays in the educational experiences of students with SCAs. Specific suggestions for school support plans for students with SCAs are explored, such as providing school-based behavioral health supports and explicit teaching of executive function strategies.
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Affiliation(s)
- Talia Thompson
- University of Colorado School of Medicine, USA
- Children’s Hospital Colorado, USA
| | | | - Nicole Tartaglia
- University of Colorado School of Medicine, USA
- Children’s Hospital Colorado, USA
| | - Shanlee Davis
- University of Colorado School of Medicine, USA
- Children’s Hospital Colorado, USA
| | - Jennifer Janusz
- University of Colorado School of Medicine, USA
- Children’s Hospital Colorado, USA
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14
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Lorini A, Zampini L, Silibello G, Dall'Ara F, Rigamonti C, Ajmone PF, Monti F, Lalatta F, Costantino MA, Vizziello PG. Children's Behavior and Maternal Parenting Stress in Young Children With Sex Chromosome Trisomies. J Dev Behav Pediatr 2022; 43:e197-e203. [PMID: 34636360 PMCID: PMC10868669 DOI: 10.1097/dbp.0000000000001015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 08/25/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Children and adolescents with sex chromosome trisomies (SCTs) usually show a higher frequency of behavioral problems than typically developing (TD) children. However, little is known about the presence of behavioral issues in toddlers with SCT. This study aimed at investigating their behavioral profile in the second year of life and its impact on maternal stress. METHOD Participants were 87 children ranging in age from 18 to 26 months: 63 children with SCTs (all diagnosed prenatally) and 24 TD children. Their psychomotor and language development and their behavioral profile were assessed. In addition, the level of maternal parenting stress was evaluated. RESULTS Both psychomotor and language development were significantly lower in children with SCTs than in TD children. Conversely, no significantly greater behavioral problems emerged in children with SCTs. However, a significantly higher level of parenting stress related to a dysfunctional interaction with the child emerged in the mothers of children with SCTs. In this population, maternal stress seemed positively related to their children's emotional problems and pervasive disorders and negatively related to their children's psychomotor and linguistic competence. CONCLUSION Although no significant behavioral issues emerged in the second year of life, the relationships found between children's behavioral profiles and maternal parenting stress highlight the importance of prenatal counseling and support groups for parents of children with SCTs. This might help them recognize the first signs of behavioral problems and become aware of their influence on parenting stress.
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Affiliation(s)
- Alessandra Lorini
- Department of Psychology, University of Milano-Bicocca, Milan, Italy;
| | - Laura Zampini
- Department of Psychology, University of Milano-Bicocca, Milan, Italy;
| | - Gaia Silibello
- Child and Adolescent Neuropsychiatric Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy;
| | - Francesca Dall'Ara
- Child and Adolescent Neuropsychiatric Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy;
| | - Claudia Rigamonti
- Child and Adolescent Neuropsychiatric Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy;
| | - Paola Francesca Ajmone
- Child and Adolescent Neuropsychiatric Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy;
| | - Federico Monti
- Child and Adolescent Neuropsychiatric Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy;
| | - Faustina Lalatta
- Clinical Genetics Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Maria Antonella Costantino
- Child and Adolescent Neuropsychiatric Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy;
| | - Paola Giovanna Vizziello
- Child and Adolescent Neuropsychiatric Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy;
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15
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GREEN TAMAR, FLASH SHIRA, SHANKAR GEETA, SHRESTHA SHARONBADE, JO BOOIL, KLABUNDE MEGAN, HONG DAVIDS, REISS ALLANL. Effect of sex chromosome number variation on attention-deficit/hyperactivity disorder symptoms, executive function, and processing speed. Dev Med Child Neurol 2022; 64:331-339. [PMID: 34431088 PMCID: PMC8816867 DOI: 10.1111/dmcn.15020] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 07/15/2021] [Accepted: 07/16/2021] [Indexed: 01/15/2023]
Abstract
AIM To study sex differences in attention-deficit/hyperactivity disorder (ADHD) symptoms, we explored whether X chromosome absence or excess is independently associated with deficits in attention and hyperactivity, executive function, and processing speed. METHOD We assessed 116 children (ages 3y 10mo-11y 11mo, mean 8y 5mo, SD 1y 11mo) with a variable number of sex chromosomes: 36 females with Turner syndrome (45, X0), 20 males with Klinefelter syndrome (47, XXY), 37 typically developing females (XX), and 23 typically developing males (XY). RESULTS X chromosome absence was associated with increased attention problems, hyperactivity, and deficits in inhibitory control, compared with female children with XX (all p<0.003). Conversely, X chromosome excess was associated with weakness in working memory (p=0.018) and approached significance for attention problems (p=0.071) but not with hyperactivity, or weakness in inhibitory control relative to male children with XY. Using non-parametric effect size to quantify the clinical effect revealed that X chromosome absence affected attention, hyperactivity, executive function, and processing speed (all r>0.4), while X excess affected in-laboratory as well as parent-reported working memory (all r>0.4). INTERPRETATION Our observations provide compelling evidence that the absence or excess of an X chromosome distinctly affects cognition and behaviors associated with ADHD.
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Affiliation(s)
- TAMAR GREEN
- Division of Interdisciplinary Brain Sciences, Stanford University School of Medicine, Stanford, CA,Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - SHIRA FLASH
- Division of Interdisciplinary Brain Sciences, Stanford University School of Medicine, Stanford, CA,Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - GEETA SHANKAR
- Division of Interdisciplinary Brain Sciences, Stanford University School of Medicine, Stanford, CA,Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - SHARON BADE SHRESTHA
- Division of Interdisciplinary Brain Sciences, Stanford University School of Medicine, Stanford, CA,Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - BOOIL JO
- Division of Interdisciplinary Brain Sciences, Stanford University School of Medicine, Stanford, CA,Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - MEGAN KLABUNDE
- Department of Psychology, University of Essex, Colchester, UK
| | - DAVID S HONG
- Division of Interdisciplinary Brain Sciences, Stanford University School of Medicine, Stanford, CA,Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - ALLAN L REISS
- Division of Interdisciplinary Brain Sciences, Stanford University School of Medicine, Stanford, CA,Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA,Department of Radiology, Stanford University School of Medicine, Stanford, CA,Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
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16
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Serrarens C, Otter M, Campforts BCM, Stumpel CTRM, Jansma H, van Amelsvoort TAMJ, Vingerhoets C. Altered subcortical and cortical brain morphology in adult women with 47,XXX: a 7-Tesla magnetic resonance imaging study. J Neurodev Disord 2022; 14:14. [PMID: 35196987 PMCID: PMC8903568 DOI: 10.1186/s11689-022-09425-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 02/14/2022] [Indexed: 12/01/2022] Open
Abstract
Background Triple X syndrome (47,XXX) is a relatively common sex chromosomal aneuploidy characterized by the presence of a supernumerary X chromosome in females and has been associated with a variable cognitive, behavioural and psychiatric phenotype. 47,XXX may serve as a suitable model for studying the effect of genetic architecture on brain morphology. Previous studies have shown alterations in brain structure in 47,XXX particularly in childhood and adolescence. In this study, we examined subcortical and cortical brain morphology in adult women with 47,XXX using ultra-high field 7T MRI. Given previous evidence of impaired social functioning and emotion recognition in adults with 47,XXX, we also investigated the relationship of these functions with brain morphology. Methods Twenty-one adult women with 47,XXX and 22 age- and sex-matched healthy controls were included. Structural T1-weighted images were acquired using a 7-Tesla magnetic resonance scanner. Measures of subcortical brain volumes, cortical surface area and thickness, and cortical folding were obtained and compared between the groups using general linear models. Additionally, we examined potential relationships between brain outcome measures and social functioning and social cognition in 47,XXX using correlation analyses. Results Adults with 47,XXX showed lower volumes of the thalamus, caudate, putamen, hippocampus, nucleus accumbens and pallidum, and larger lateral ventricle volumes. Lower surface area was found in the superior frontal gyrus and superior temporal gyrus in 47,XXX participants compared to healthy controls. Altered cortical thickness and cortical folding were not present in 47,XXX. Cortical thickness was associated with social cognition in 47,XXX. Conclusions Results suggest that a supernumerary X chromosome in females affects subcortical and lateral ventricle volumes, and cortical surface area in adulthood. 47,XXX may serve as a suitable model for studying genetic influences on structural brain morphology across developmental stages in order to understand neurobiological mechanisms underlying cognitive and behavioural impairments. Supplementary Information The online version contains supplementary material available at 10.1186/s11689-022-09425-1.
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Affiliation(s)
- Chaira Serrarens
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands.
| | - Maarten Otter
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands.,Medical Department, SIZA, Arnhem, The Netherlands.,Department of Community Mental Health in Mild Intellectual Disabilities, Trajectum, Zutphen, The Netherlands
| | - Bea C M Campforts
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Constance T R M Stumpel
- Department of Clinical Genetics and School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Henk Jansma
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Thérèse A M J van Amelsvoort
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Claudia Vingerhoets
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands.,Heeren Loo Zorggroep, Amersfoort, The Netherlands.,Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centre, Amsterdam, The Netherlands
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17
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Kuiper K, Swaab H, Tartaglia N, van Rijn S. Early developmental impact of sex chromosome trisomies on attention deficit-hyperactivity disorder symptomology in young children. Am J Med Genet A 2021; 185:3664-3674. [PMID: 34240550 PMCID: PMC9292447 DOI: 10.1002/ajmg.a.62418] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 05/14/2021] [Accepted: 06/18/2021] [Indexed: 01/16/2023]
Abstract
Individuals with sex chromosome trisomies ([SCT], XXX, XXY, and XYY)) are at increased risk for neurodevelopmental problems, given that a significant portion of the sex chromosome genes impact brain functioning. An elevated risk for psychopathology has also been described, including attention deficit-hyperactivity disorder (ADHD). The present study aimed at identifying early markers of ADHD, providing the first investigation of ADHD symptomology in very young children with SCT. The variety, type, and severity of ADHD symptomology in 1-6-year-old children with SCT (n = 104) were compared with population-based controls (n = 101) using the strengths and weaknesses of ADHD symptoms and normal-behavior (SWAN) parent-report questionnaire. ADHD symptomology was significantly more prevalent in SCT and already present from toddlerhood on, compared to controls. ADHD inattention symptoms were significantly increased in all karyotypes (XXX, XXY, and XYY), boys with XYY also showed significantly more hyperactivity/impulsivity symptoms than controls. Inattentiveness was more pronounced with increasing age for SCT, in contrast to controls. Within the SCT group, 24% of the children had significantly elevated ADHD symptoms at a clinical level. Already from an early age on, SCT is associated with a risk for ADHD, suggesting that its neurodevelopmental risk lies anchored in early brain maturation. Studying this genetically vulnerable population allows for the prospective study of risk markers to facilitate early and preventive interventions.
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Affiliation(s)
- Kimberly Kuiper
- Clinical Neurodevelopmental SciencesLeiden UniversityLeidenThe Netherlands
- Leiden Institute for Brain and CognitionLeidenThe Netherlands
| | - Hanna Swaab
- Clinical Neurodevelopmental SciencesLeiden UniversityLeidenThe Netherlands
- Leiden Institute for Brain and CognitionLeidenThe Netherlands
| | - Nicole Tartaglia
- eXtraordinarY Kids Clinic, Developmental PediatricsChildren's Hospital ColoradoAuroraColoradoUSA
- Department of PediatricsUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Sophie van Rijn
- Clinical Neurodevelopmental SciencesLeiden UniversityLeidenThe Netherlands
- Leiden Institute for Brain and CognitionLeidenThe Netherlands
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18
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Sumien N, Cunningham JT, Davis DL, Engelland R, Fadeyibi O, Farmer GE, Mabry S, Mensah-Kane P, Trinh OTP, Vann PH, Wilson EN, Cunningham RL. Neurodegenerative Disease: Roles for Sex, Hormones, and Oxidative Stress. Endocrinology 2021; 162:6360925. [PMID: 34467976 PMCID: PMC8462383 DOI: 10.1210/endocr/bqab185] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Indexed: 02/08/2023]
Abstract
Neurodegenerative diseases cause severe impairments in cognitive and motor function. With an increasing aging population and the onset of these diseases between 50 and 70 years, the consequences are bound to be devastating. While age and longevity are the main risk factors for neurodegenerative diseases, sex is also an important risk factor. The characteristic of sex is multifaceted, encompassing sex chromosome complement, sex hormones (estrogens and androgens), and sex hormone receptors. Sex hormone receptors can induce various signaling cascades, ranging from genomic transcription to intracellular signaling pathways that are dependent on the health of the cell. Oxidative stress, associated with aging, can impact the health of the cell. Sex hormones can be neuroprotective under low oxidative stress conditions but not in high oxidative stress conditions. An understudied sex hormone receptor that can induce activation of oxidative stress signaling is the membrane androgen receptor (mAR). mAR can mediate nicotinamide adenine dinucleotide-phosphate (NADPH) oxidase (NOX)-generated oxidative stress that is associated with several neurodegenerative diseases, such as Alzheimer disease. Further complicating this is that aging can alter sex hormone signaling. Prior to menopause, women experience more estrogens than androgens. During menopause, this sex hormone profile switches in women due to the dramatic ovarian loss of 17β-estradiol with maintained ovarian androgen (testosterone, androstenedione) production. Indeed, aging men have higher estrogens than aging women due to aromatization of androgens to estrogens. Therefore, higher activation of mAR-NOX signaling could occur in menopausal women compared with aged men, mediating the observed sex differences. Understanding of these signaling cascades could provide therapeutic targets for neurodegenerative diseases.
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Affiliation(s)
- Nathalie Sumien
- Department of Pharmacology & Neuroscience, Center for Healthy Aging, University of North Texas Health Science Center, Fort Worth, TX 76107, USA
| | - J Thomas Cunningham
- Department of Physiology & Anatomy, University of North Texas Health Science Center, Fort Worth, TX 76107, USA
| | - Delaney L Davis
- Department of Pharmacology & Neuroscience, Center for Healthy Aging, University of North Texas Health Science Center, Fort Worth, TX 76107, USA
| | - Rachel Engelland
- Department of Pharmaceutical Sciences, School of Pharmacy, University of North Texas Health Science Center, Fort Worth, TX 76107, USA
| | - Oluwadarasimi Fadeyibi
- Department of Pharmaceutical Sciences, School of Pharmacy, University of North Texas Health Science Center, Fort Worth, TX 76107, USA
| | - George E Farmer
- Department of Physiology & Anatomy, University of North Texas Health Science Center, Fort Worth, TX 76107, USA
| | - Steve Mabry
- Department of Pharmaceutical Sciences, School of Pharmacy, University of North Texas Health Science Center, Fort Worth, TX 76107, USA
| | - Paapa Mensah-Kane
- Department of Pharmacology & Neuroscience, Center for Healthy Aging, University of North Texas Health Science Center, Fort Worth, TX 76107, USA
| | - Oanh T P Trinh
- Department of Pharmacology & Neuroscience, Center for Healthy Aging, University of North Texas Health Science Center, Fort Worth, TX 76107, USA
| | - Philip H Vann
- Department of Pharmacology & Neuroscience, Center for Healthy Aging, University of North Texas Health Science Center, Fort Worth, TX 76107, USA
| | - E Nicole Wilson
- Department of Pharmaceutical Sciences, School of Pharmacy, University of North Texas Health Science Center, Fort Worth, TX 76107, USA
| | - Rebecca L Cunningham
- Department of Pharmaceutical Sciences, School of Pharmacy, University of North Texas Health Science Center, Fort Worth, TX 76107, USA
- Correspondence: Rebecca L. Cunningham, PhD, Department of Pharmaceutical Sciences, University of North Texas Health Science Center, 3400 Camp Bowie Boulevard, Fort Worth, TX, USA, 76107-2699.
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19
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Martin F, van Rijn S, Bierman M, Swaab H. Social Management Training in Males With 47,XXY (Klinefelter Syndrome): A Pilot Study of a Neurocognitive-Behavioral Treatment Targeting Social, Emotional, and Behavioral Problems. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2021; 126:1-13. [PMID: 33370785 DOI: 10.1352/1944-7558-126.1.1] [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: 04/10/2017] [Accepted: 08/05/2020] [Indexed: 06/12/2023]
Abstract
Klinefelter syndrome (47,XXY) is associated with problems in social interaction and behavioral adaptation. Sixteen adolescents and adult men with 47,XXY enrolled in a pilot-study evaluating the effectiveness of Social Management Training (SMT), a novel neurocognitive-behavioral treatment program targeted at improving social, emotional, and behavioral functioning. Participants reported improved emotional stability from pre- to post-test (5 months). Informants reported reductions in internalizing and externalizing symptoms, including improvement in self-regulation. Although informants did not report changes in autism-like symptoms, increased awareness of social challenges was found. SMT may improve emotional stability, self-regulation, and self-reflection in people males with Klinefelter syndrome. This potentially efficacious treatment approach may prove to be a promising psychosocial therapeutic intervention for this population.
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Affiliation(s)
| | | | - Marit Bierman
- Marit Bierman, GGZ Centraal Fornhese, Clinical Child and Adolescent Psychiatric Care Centre
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20
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Skakkebæk A, Wallentin M, Gravholt CH. Klinefelter syndrome or testicular dysgenesis: Genetics, endocrinology, and neuropsychology. HANDBOOK OF CLINICAL NEUROLOGY 2021; 181:445-462. [PMID: 34238477 DOI: 10.1016/b978-0-12-820683-6.00032-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Klinefelter syndrome (47,XXY) is a frequent chromosomal disorder among males, often presenting with hypergonadotropic hypogonadism, small firm testicles, metabolic disorders, neurocognitive challenges, and increased height. Neurologic disorders such as epilepsy, seizures, and tremor as well as psychiatric disorders are also seen more frequently. The neurocognitive deficits seen are present in many areas of cognition, typically affecting general cognitive abilities, language, and executive functioning. Also, social dysfunction is frequent. Dyslexia is present in more than half of all males. Brain imaging studies generally show a typical pattern, with many nuclei and brain areas being smaller than among controls. However, it has not been possible to link the brain alterations found in imaging studies with the neurocognitive profile. The genetics underlying the phenotypic traits found among males with Klinefelter syndrome still remains to be elucidated; however, recent studies have described pervasive changes in the methylome and transcriptome and new and interesting candidate genes have been pinpointed, but their involvement in the phenotype of Klinefelter syndrome has not been proven.
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Affiliation(s)
- Anne Skakkebæk
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Genetics, Aarhus University Hospital, Aarhus, Denmark
| | - Mikkel Wallentin
- Center of Functionally Integrative Neuroscience, Aarhus University Hospital, Aarhus, Denmark; Center for Semiotics, Aarhus University, Aarhus, Denmark
| | - Claus Højbjerg Gravholt
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark; Department of Endocrinology and Internal Medicine and Medical Research Laboratories, Aarhus University Hospital, Aarhus, Denmark.
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21
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van Elst PC, Otter M, Wijnen F, Junge C. Evaluating the Scope of Language Impairments in a Patient with Triple X Syndrome: A Brief Report. Dev Neurorehabil 2020; 23:402-406. [PMID: 32419557 DOI: 10.1080/17518423.2020.1764652] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The phenotype of triple X syndrome comprises a variety of physical, psychiatric, and cognitive features. Recent evidence suggests that patients are prone to severe language impairments. However, it remains unclear whether verbal impairments are pervasive at all levels of language, or whether one domain is relatively more spared than others. Here we document the language profile of one patient with triple X, using standardized language tests and reports. Results concur in showing that impairments are noticeable both in expressive and receptive language skills, and in vocabulary as well as in structural components of language. Although receptive ability in some tests appears relatively spared, even here A's performance is clearly below average. This single case study further underscores that language and communication at all levels can be severely compromised in patients with triple X. Practitioners should be aware of the limited language abilities that possibly exist in patients with triple X.
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Affiliation(s)
| | - Maarten Otter
- Forensic Psychiatric Department, STEVIG , Oostrum, The Netherlands.,Department of Community Mental Health for People with Learning Disabilities, Trajectum, Zutphen, The Netherlands
| | - Frank Wijnen
- Utrecht Institute of Linguistics OTS, Utrecht University , Utrecht, The Netherlands
| | - Caroline Junge
- Departments of Experimental and Developmental Psychology, Utrecht University , Utrecht, The Netherlands
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22
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Martin KA, Samango-Sprouse CA, Kantor V, Dhamankar R, Valenti E, Trefogli MT, Balosbalos I, Lagrave D, Lyons D, Kao C, Hakonarson H, Billings PR. Detection of maternal X chromosome abnormalities using single nucleotide polymorphism-based noninvasive prenatal testing. Am J Obstet Gynecol MFM 2020; 2:100152. [PMID: 33345882 DOI: 10.1016/j.ajogmf.2020.100152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 06/03/2020] [Accepted: 06/07/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Maternal X chromosome abnormalities may cause discordant results between noninvasive prenatal screening tests and diagnostic evaluation of the fetus/newborn, leading to unnecessary invasive testing. Women with X chromosome abnormalities are at increased risk for reproductive, pregnancy, or other health complications, which may be reduced or ameliorated by early diagnosis, monitoring, and intervention. OBJECTIVE This study aimed to validate a single nucleotide polymorphism-based noninvasive prenatal test to identify X chromosome abnormalities of maternal origin. STUDY DESIGN All tests unable to evaluate fetal risk for aneuploidy because of uninformative algorithm results were eligible for inclusion. Two groups of cases were prospectively identified: Group A (n=106) where a maternal X chromosome abnormality was suspected and Group B (control group, n=107) where a fetal chromosome abnormality involving chromosome 13, 18, 21, or X was suspected but did not meet criteria for reporting. Maternal DNA was isolated from the plasma-depleted cellular pellet and sent to a reference laboratory for blinded analysis using chromosomal microarray. A chromosome abnormality involving chromosomes 13, 18, 21, or X was reported by the reference laboratory if ≥5 Mb in size and present in ≥20% of the DNA. RESULTS A maternal X chromosome abnormality was suspected in 1/1305 tests (149/194,385; 0.08%). In Group A, a maternal X chromosome abnormality was confirmed in 100/106 cases (94.3% positive predictive value, 1-sided 97.5% confidence interval, 88.1%-100.0%). Turner syndrome was the most commonly suspected maternal abnormality (58/106, 54.7%), with confirmation of mosaic or nonmosaic 45,X by microarray in 38/58 (65.5%) cases. Noninvasive prenatal screening tests suspected the presence of maternal 47,XXX with or without mosaicism in 40/106 (37.7%) cases, confirmed by microarray in 38/40 (95.0%). In Group B (n=107), no maternal microarray abnormalities were reported, providing a negative predictive value of 100% (1-sided 97.5% confidence interval, 96.6%-100.0%). CONCLUSION When noninvasive prenatal testing suspected a maternal X chromosome abnormality, maternal microarray confirmed an X chromosome abnormality with 94.3% positive predictive value. Of the maternal X chromosome abnormalities detected by array, >50% were 45,X. When fetal chromosome abnormalities involving chromosomes 13, 18, 21, or X were suspected, no maternal chromosome abnormalities were reported, yielding a negative predictive value of 100%. Women with maternal X abnormalities suspected with noninvasive prenatal testing may be at increased risk for reproductive and health complications; early evaluation and treatment may prevent long-term consequences or disability.
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Affiliation(s)
| | - Carole A Samango-Sprouse
- Department of Pediatrics, George Washington University of Health Sciences, Washington, DC; The Focus Foundation, Davidsonville, MD; Department of Human and Molecular Genetics, Florida International University, Miami, FL
| | | | | | | | | | | | | | | | - Charlly Kao
- Center for Advanced Genomics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Hakon Hakonarson
- Center for Advanced Genomics, Children's Hospital of Philadelphia, Philadelphia, PA
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23
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Wigby K, Cordeiro L, Wilson R, Angkustsiri K, Simon TJ, Tartaglia N. Adaptive functioning in children and adolescents with Trisomy X: An exploratory analysis. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2020; 184:456-468. [PMID: 32548885 DOI: 10.1002/ajmg.c.31803] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 04/29/2020] [Accepted: 05/11/2020] [Indexed: 01/30/2023]
Abstract
Identifying the factors related to adaptive functioning will improve the information available to families and providers of females with Trisomy X. Cognitive and behavioral features were assessed in 50 females ages 12.2 ± 3.6 years using the Behavior Assessment System for Children Second Edition (BASC-2) and Wechsler Scales of Intelligence. Executive functioning, social skills, and autistic traits were evaluated in a subset. Adaptive functioning was assessed using the BASC-2 adaptive skills composite score (ASC). Participants were classified as average adaptive skills (ASC T-score > 40) or deficits (ASC T-score < 40). Group comparisons were conducted. Multiple linear regression examined which factors contributed to ASC score. Twenty-eight females (55.6%) had adaptive skills deficits with functional communication being the most commonly affected adaptive domain. The group with ASC in the average range had higher verbal IQ (VIQ) and lower rates of numerous behavioral concerns. Internalizing behavior composite, DSM-IV inattentive symptoms score, and VIQ were significant predictors of ASC. Prenatally diagnosed females comprised over 70% of those with average adaptive skills. In this study, internalizing behaviors, inattentive ADHD symptoms, and VIQ were associated with poorer adaptive functioning. Early interventions targeting internalizing behaviors, attention/executive functioning, and communication skills may improve adaptive skills and deserve further study.
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Affiliation(s)
- Kristen Wigby
- Department of Pediatrics, Division of Genetics, University of California, San Diego and Rady Children's Hospital-San Diego, San Diego, California, USA.,Rady Children's Institute for Genomic Medicine, San Diego, California, USA
| | - Lisa Cordeiro
- Department of Pediatrics, Section of Developmental Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA.,eXtraordinarY Kids Clinic, Developmental Pediatrics, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Rebecca Wilson
- Department of Pediatrics, Section of Developmental Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA.,eXtraordinarY Kids Clinic, Developmental Pediatrics, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Kathleen Angkustsiri
- Department of Pediatrics, Division of Developmental-Behavioral Pediatrics, University of California, Davis, California, USA.,MIND Institute, University of California, Davis, California, USA
| | - Tony J Simon
- MIND Institute, University of California, Davis, California, USA.,Department of Psychiatry and Behavioral Sciences, University of California, Davis, California, USA
| | - Nicole Tartaglia
- Department of Pediatrics, Section of Developmental Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA.,eXtraordinarY Kids Clinic, Developmental Pediatrics, Children's Hospital Colorado, Aurora, Colorado, USA
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24
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Janusz J, Harrison C, Boada C, Cordeiro L, Howell S, Tartaglia N, Boada R. Executive function in XXY: Comparison of performance-based measures and rating scales. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2020; 184:469-481. [PMID: 32519473 DOI: 10.1002/ajmg.c.31804] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 04/28/2020] [Accepted: 05/11/2020] [Indexed: 11/07/2022]
Abstract
Few studies have systematically assessed executive functioning (EF) skills in boys with XXY, and these are limited by small samples and restricted EF assessment. This study used a broader battery of performance-based measures as well as parent-rating scales of EF in 77 boys and adolescents with XXY (mean age = 12.5 years), recruited from a clinical trial and an outpatient clinic. Exploratory factor analyses were used to create EF domains from performance-based measures, and similar domains were measured using the Behavior Rating Inventory of Executive Function and Conners Parent-Rating Scales. The boys with XXY showed a distinct EF profile, with the greatest deficit in attention and more moderate deficits in working memory, switching, and planning/problem solving. Parent ratings showed similar challenges, as well as impaired inhibition. Independent sample t-tests showed no difference on performance measures between boys diagnosed or not diagnosed with attention-deficit/hyperactivity disorder (ADHD), although parents of boys diagnosed with ADHD reported more difficulties. There were no differences on performance-based tests between those diagnosed pre- and postnatally, although parents of postnatally diagnosed boys reported more metacognitive problems. Language deficits, cognition, and socio-economic status did not account for EF deficits.
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Affiliation(s)
- Jennifer Janusz
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA.,Division of Neurology, Children's Hospital Colorado, Aurora, Colorado, USA.,eXtraordinarY Kids Program, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Caroline Harrison
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Cristina Boada
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Lisa Cordeiro
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Susan Howell
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA.,eXtraordinarY Kids Program, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Nicole Tartaglia
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA.,eXtraordinarY Kids Program, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Richard Boada
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA.,Division of Neurology, Children's Hospital Colorado, Aurora, Colorado, USA.,eXtraordinarY Kids Program, Children's Hospital Colorado, Aurora, Colorado, USA
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25
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Nielsen MM, Trolle C, Vang S, Hornshøj H, Skakkebaek A, Hedegaard J, Nordentoft I, Pedersen JS, Gravholt CH. Epigenetic and transcriptomic consequences of excess X-chromosome material in 47,XXX syndrome-A comparison with Turner syndrome and 46,XX females. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2020; 184:279-293. [PMID: 32489015 DOI: 10.1002/ajmg.c.31799] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 04/30/2020] [Accepted: 05/01/2020] [Indexed: 01/21/2023]
Abstract
47,XXX (triple X) and Turner syndrome (45,X) are sex chromosomal abnormalities with detrimental effects on health with increased mortality and morbidity. In karyotypical normal females, X-chromosome inactivation balances gene expression between sexes and upregulation of the X chromosome in both sexes maintain stoichiometry with the autosomes. In 47,XXX and Turner syndrome a gene dosage imbalance may ensue from increased or decreased expression from the genes that escape X inactivation, as well as from incomplete X chromosome inactivation in 47,XXX. We aim to study genome-wide DNA-methylation and RNA-expression changes can explain phenotypic traits in 47,XXX syndrome. We compare DNA-methylation and RNA-expression data derived from white blood cells of seven women with 47,XXX syndrome, with data from seven female controls, as well as with seven women with Turner syndrome (45,X). To address these questions, we explored genome-wide DNA-methylation and transcriptome data in blood from seven females with 47,XXX syndrome, seven females with Turner syndrome, and seven karyotypically normal females (46,XX). Based on promoter methylation, we describe a demethylation of six X-chromosomal genes (AMOT, HTR2C, IL1RAPL2, STAG2, TCEANC, ZNF673), increased methylation for GEMIN8, and four differentially methylated autosomal regions related to four genes (SPEG, MUC4, SP6, and ZNF492). We illustrate how these changes seem compensated at the transcriptome level although several genes show differential exon usage. In conclusion, our results suggest an impact of the supernumerary X chromosome in 47,XXX syndrome on the methylation status of selected genes despite an overall comparable expression profile.
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Affiliation(s)
| | - Christian Trolle
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark.,Department of Endocrinology and Internal Medicine and Medical Research Laboratories, Aarhus University Hospital, Aarhus, Denmark
| | - Søren Vang
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik Hornshøj
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Anne Skakkebaek
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Genetics, Aarhus University Hospital, Aarhus, Denmark
| | - Jakob Hedegaard
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Iver Nordentoft
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Jakob Skou Pedersen
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark.,Bioinformatics Research Centre, Aarhus University, Aarhus, Denmark
| | - Claus Højbjerg Gravholt
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark.,Department of Endocrinology and Internal Medicine and Medical Research Laboratories, Aarhus University Hospital, Aarhus, Denmark
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26
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Skakkebæk A, Gravholt CH, Chang S, Moore PJ, Wallentin M. Psychological functioning, brain morphology, and functional neuroimaging in Klinefelter syndrome. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2020; 184:506-517. [DOI: 10.1002/ajmg.c.31806] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/11/2020] [Accepted: 05/12/2020] [Indexed: 01/16/2023]
Affiliation(s)
- Anne Skakkebæk
- Department of Clinical GeneticsAarhus University Hospital Aarhus Denmark
- Department of Endocrinology and Internal MedicineAarhus University Hospital Aarhus Denmark
| | - Claus H. Gravholt
- Department of Endocrinology and Internal MedicineAarhus University Hospital Aarhus Denmark
- Department of Molecular MedicineAarhus University Hospital Aarhus Denmark
| | - Simon Chang
- Department of Endocrinology and Internal MedicineAarhus University Hospital Aarhus Denmark
- Department of Internal MedicineLillebaelt Hospital Kolding Denmark
| | - Philip J. Moore
- Department of Psychological and Brain SciencesThe George Washington University Washington DC USA
| | - Mikkel Wallentin
- Department of Linguistics, Cognitive Science, and SemioticsAarhus University Aarhus Denmark
- Center of Functionally Integrative NeuroscienceAarhus University Hospital Aarhus Denmark
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27
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Karipidis II, Hong DS. Specific learning disorders in sex chromosome aneuploidies: Neural circuits of literacy and mathematics. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2020; 184:518-530. [DOI: 10.1002/ajmg.c.31801] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 05/02/2020] [Accepted: 05/07/2020] [Indexed: 01/25/2023]
Affiliation(s)
- Iliana I. Karipidis
- Center for Interdisciplinary Brain Sciences Research, Department of Psychiatry and Behavioral SciencesSchool of Medicine, Stanford University Stanford California USA
| | - David S. Hong
- Center for Interdisciplinary Brain Sciences Research, Department of Psychiatry and Behavioral SciencesSchool of Medicine, Stanford University Stanford California USA
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28
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Thompson T, Howell S, Davis S, Wilson R, Janusz J, Boada R, Pyle L, Tartaglia N. Current survey of early childhood intervention services in infants and young children with sex chromosome aneuploidies. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2020; 184:414-427. [PMID: 32449585 DOI: 10.1002/ajmg.c.31785] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 04/15/2020] [Accepted: 04/16/2020] [Indexed: 01/23/2023]
Abstract
Sex chromosome aneuploidies (SCAs) are the most commonly occurring aneuploidies in children with a collective prevalence rate of 1 in 500 live births. Prior research has documented SCAs are associated with an increased risk for early expressive language and gross motor delays, learning disorders, ADHD, autism spectrum disorder, anxiety, and executive function problems. Although SCAs have been historically underdiagnosed in young children, recent advances in noninvasive prenatal testing have resulted in an increasing nationwide cohort of infants with confirmed diagnoses. Consequently, early childhood support systems must prepare for an influx of children with known risks for associated developmental delays and potential school problems. This national survey aimed to update our understanding of current early childhood intervention services for young children with SCA in the United States and to describe parent perspectives and priorities. Descriptive statistics, chi-square tests, and logistic regression models controlling for parent education revealed a majority of respondents reported receiving public early childhood intervention services with speech therapy as the most common service. There were significant differences in early childhood intervention services by timing of diagnosis (prenatal vs. postnatal), number of sex chromosomes (trisomy vs. tetra/pentasomy), and geographic location. Parents described interventions as desirable and effective yet also difficult to obtain due to issues with the SCA phenotype, lack of provider knowledge, and challenges navigating the intervention systems. Results support the need for enhanced provider training in SCAs, policy change for early childhood intervention qualification criteria for SCA conditions, and collaboration between medical and early childhood settings.
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Affiliation(s)
- Talia Thompson
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA.,eXtraordinarY Kids Program, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Susan Howell
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA.,eXtraordinarY Kids Program, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Shanlee Davis
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA.,eXtraordinarY Kids Program, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Rebecca Wilson
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA.,eXtraordinarY Kids Program, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Jennifer Janusz
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA.,eXtraordinarY Kids Program, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Richard Boada
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA.,eXtraordinarY Kids Program, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Laura Pyle
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA.,Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Colorado, USA
| | - Nicole Tartaglia
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA.,eXtraordinarY Kids Program, Children's Hospital Colorado, Aurora, Colorado, USA
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29
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Urbanus E, Swaab H, Tartaglia N, Cordeiro L, van Rijn S. The behavioral profile of children aged 1-5 years with sex chromosome trisomy (47,XXX, 47,XXY, 47,XYY). AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2020; 184:444-455. [PMID: 32432413 PMCID: PMC7384033 DOI: 10.1002/ajmg.c.31788] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 03/27/2020] [Accepted: 04/09/2020] [Indexed: 12/18/2022]
Abstract
Children with SCT have an increased risk of suboptimal neurodevelopment. Previous studies have shown an elevated risk for neurobehavioral problems in individuals with SCT. However, not much is known about neurobehavioral problems in very young children; knowledge that could help with early identification of children at risk for suboptimal development, and that could help establish targets for early intervention. This study addressed the question of what the behavioral profile of children with SCT aged 1–5 years looks like. In total, 182 children aged 1–5 years participated in this study (NSCT=87, Nnonclinical controls = 95). Recruitment and assessment took place in the Netherlands and the United States. The SCT group was recruited through prospective follow‐up (50%), information seeking parents (31%), and clinical referral (18%). Behavioral profiles were assessed with the child behavior checklist and the ages‐and‐stages social–emotional questionnaire. Levels of parent‐rated problem behavior were higher in children with SCT. Difficulties with overall social–emotional functioning were already present in 1‐year‐olds, and elevated scores were persistent across the full age range. Affective and pervasive developmental behaviors were seen in late toddlerhood and prominent at preschool age. Anxiety, attention deficit, and oppositional defiant behaviors were seen in preschool‐aged children. Within this cross‐sectional study, the developmental trajectory of affective, pervasive developmental, and oppositional defiant behaviors seemed to be different for SCT children than nonclinical controls. Collectively, these results demonstrate the importance of behavioral screening for behavioral problems in routine clinical care for children with SCT from a young age. Social–emotional problems may require special attention, as these problems seem most prominent, showing increased risk across the full age range, and with these problems occurring regardless of the timing of diagnosis, and across all three SCT karyotypes.
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Affiliation(s)
- Evelien Urbanus
- Clinical Neurodevelopmental Sciences, Leiden University, Leiden, The Netherlands.,Leiden Institute for Brain and Cognition, Leiden, The Netherlands
| | - Hanna Swaab
- Clinical Neurodevelopmental Sciences, Leiden University, Leiden, The Netherlands.,Leiden Institute for Brain and Cognition, Leiden, The Netherlands
| | - Nicole Tartaglia
- eXtraordinarY Kids Clinic, Developmental Pediatrics, Children's Hospital Colorado, Aurora, Colorado, USA.,Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Lisa Cordeiro
- eXtraordinarY Kids Clinic, Developmental Pediatrics, Children's Hospital Colorado, Aurora, Colorado, USA.,Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Sophie van Rijn
- Clinical Neurodevelopmental Sciences, Leiden University, Leiden, The Netherlands.,Leiden Institute for Brain and Cognition, Leiden, The Netherlands
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30
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Fjermestad KW, Huster R, Thunberg C, Stokke S, Gravholt CH, Solbakk A. Neuropsychological functions, sleep, and mental health in adults with Klinefelter syndrome. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2020; 184:482-492. [DOI: 10.1002/ajmg.c.31797] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 04/28/2020] [Accepted: 04/29/2020] [Indexed: 12/20/2022]
Affiliation(s)
- Krister W. Fjermestad
- Department of PsychologyUniversity of Oslo Oslo Norway
- Frambu Resource Centre for Rare Disorders Siggerud Norway
| | - Rene Huster
- Department of PsychologyUniversity of Oslo Oslo Norway
| | | | - Simen Stokke
- Frambu Resource Centre for Rare Disorders Siggerud Norway
| | | | - Anne‐Kristin Solbakk
- Department of PsychologyUniversity of Oslo Oslo Norway
- Department of NeurosurgeryOslo University Hospital Oslo Norway
- Department of NeuropsychologyHelgeland Hospital Mosjøen Norway
- RITMO Centre for Interdisciplinary Studies in Rhythm, Time and MotionUniversity of Oslo Oslo Norway
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31
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Abstract
PURPOSE This case study provides information regarding the motor development and health-related fitness level of a female with 47,XXX. The Movement Assessment Battery for Children-Second Edition (MABC-2) and the Test of Gross Motor Development-Second Edition (TGMD-2) batteries were used to assess motor competence and gross motor development, respectively. Cardiorespiratory, muscular fitness, and flexibility were assessed by means of field-based tests. Two groups of children developing typically were used for comparison purposes. SUMMARY OF KEY POINTS Results from the MABC-2 indicated that the participant was placed in the 37th percentile, whereas the comparison group was placed in the 68th percentile. The participant scored above the 50th percentile in the TGMD-2 and showed lower fitness values than those in the comparison group. RECOMMENDATIONS FOR CLINICAL PRACTICE Contrary to what is generally expected, supernumerary 47,XXX does not have to negatively impact motor competence, although a low health-related physical fitness can be present.
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32
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A review of the intriguing interaction between testosterone and neurocognitive development in males with 47,XXY. Curr Opin Obstet Gynecol 2020; 32:140-146. [PMID: 32004174 DOI: 10.1097/gco.0000000000000612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Although 47,XXY (Klinefelter syndrome) was first discovered more than 50 years ago, there have been limited comprehensive studies on this disorder. The present review explains the study of neurodevelopmental dysfunction and the impact of testosterone replacement at specific junctions in the life of males with 47,XXY. The intricate relationship between testosterone, neurodevelopment, health, and well being warrants an in-depth investigation in order to achieve optimal outcomes. RECENT FINDINGS Current literature suggests that the implementation of biological treatment has a positive impact on numerous areas of neurodevelopment. Further research is needed to determine ideal dosage, timing, and frequency of biological treatment for efficacy and safety of the child with 47,XXY. SUMMARY As noninvasive prenatal screening has detected increasing numbers of fetuses with 47,XXY, parents may benefit from both prenatal and postnatal counseling, including the latest innovative biological treatment, that may further optimize the child's outcome, especially when coupled with targeted early intervention services.
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Samango-Sprouse CA, Counts DR, Tran SL, Lasutschinkow PC, Porter GF, Gropman AL. Update On The Clinical Perspectives And Care Of The Child With 47,XXY (Klinefelter Syndrome). Appl Clin Genet 2019; 12:191-202. [PMID: 31695472 PMCID: PMC6815760 DOI: 10.2147/tacg.s180450] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Accepted: 09/20/2019] [Indexed: 12/13/2022] Open
Abstract
47,XXY (Klinefelter syndrome [KS]) is the most common sex chromosomal aneuploidy (1:660), yet, despite this, only 25% of the males are ever diagnosed. Males with 47,XXY present with characteristic symptoms throughout their lifetime with typical physical and neurodevelopmental manifestations focused in growth, cognitive development, endocrine function, and reproduction. Studies have demonstrated that optimal outcomes are dependent on early detection combined with consistent and targeted neurodevelopmental treatment throughout the lifespan. During infancy and into the preschool years, individuals with 47,XXY commonly face deficits in growth and development in the areas of early hormonal, motor, speech, and behavioral development. As they transition into school, the primary neurodevelopmental concerns include language difficulty, executive dysfunction, behavior, and learning and reading deficits. Adults with 47,XXY often present with taller than average height, low levels of fertility, azoospermia, and elevated gonadotropin levels. These presentations may persist from early childhood through adulthood but can be mitigated by appropriate interventions. Early neurodevelopmental and hormonal treatment has been shown to have a minimizing effect on the physical and neurodevelopmental manifestations in individuals with 47,XXY. With innovative and current research studies, the features common to the neurodevelopmental profile of 47,XXY have been further expanded and defined. Further research is necessary to elucidate and understand the relationship between the brain, behavior, and the phenotypic profile of 47,XXY.
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Affiliation(s)
- Carole A Samango-Sprouse
- Department of Pediatrics, George Washington University, Washington, DC, USA
- Department of Human and Molecular Genetics, Florida International University, Miami, FL, USA
- The Focus Foundation, Davidsonville, MD, USA
| | - Debra R Counts
- Pediatric Endocrinology, Sinai Hospital, Baltimore, MD, USA
| | | | | | | | - Andrea L Gropman
- Department of Neurology, George Washington University, Washington, DC, USA
- Division of Neurogenetics and Developmental Pediatrics, Children’s National Medical Center, Washington, DC, USA
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van Rijn S, Swaab H. Emotion regulation in adults with Klinefelter syndrome (47,XXY): Neurocognitive underpinnings and associations with mental health problems. J Clin Psychol 2019; 76:228-238. [PMID: 31593332 PMCID: PMC6916332 DOI: 10.1002/jclp.22871] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVES The aim of this study is to evaluate if language and executive functioning deficits in individuals with the 47,XXY chromosomal pattern contribute to emotion regulation problems and related symptoms of psychopathology. METHODS A group of 26 adult men with 47,XXY completed measures of cognitive emotion regulation strategies, neurocognitive functioning, and symptoms of psychopathology. RESULTS Atypical emotion regulation strategies were found in the XXY group, with increased expression of emotions (69%), avoiding (65%), distraction seeking (54%), and passive coping (54%). More difficulties in mental flexibility and attention regulation, and speeded responding were associated with more pronounced emotion expression (emotional outbursts). Emotion regulation problems were associated with symptoms of anxiety, depression, thought problems, and hostility. CONCLUSION This study has identified emotion regulation as a potential target for treatment and intervention, with a specific focus on executive functions in the management of emotions in individuals with 47,XXY.
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Affiliation(s)
- Sophie van Rijn
- Clinical Neurodevelopmental Sciences, Leiden University, Leiden, The Netherlands.,Leiden Institute for Brain and Cognition, Leiden, The Netherlands
| | - Hanna Swaab
- Clinical Neurodevelopmental Sciences, Leiden University, Leiden, The Netherlands.,Leiden Institute for Brain and Cognition, Leiden, The Netherlands
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Tran SL, Samango‐Sprouse CA, Sadeghin T, Powell S, Gropman AL. Hormonal replacement therapy and its potential influence on working memory and competency/adaptive functioning in 47,XXY (Klinefelter syndrome). Am J Med Genet A 2019; 179:2374-2381. [DOI: 10.1002/ajmg.a.61360] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 08/12/2019] [Accepted: 09/05/2019] [Indexed: 11/08/2022]
Affiliation(s)
| | - Carole A. Samango‐Sprouse
- The Focus Foundation Davidsonville Maryland
- Department of Human and Molecular Genetics Florida International University Miami Florida
- Department of Pediatrics George Washington University Washington District of Columbia
| | | | - Sherida Powell
- Department of Economics George Washington University Washington District of Columbia
| | - Andrea L. Gropman
- Department of Neurology George Washington University Washington District of Columbia
- Division of Neurogenetics and Developmental Pediatrics Children's National Health System Washington District of Columbia
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Abstract
OBJECTIVE The aim of the study was to evaluate psychiatric symptoms among 1022 persons with various disorders of sex development (DSDs). METHODS The study was a European multicenter cross-sectional clinical evaluation in six countries. The mean (SD) age of participants was 32.1 (13.4) years. The cohort consisted of 325 individuals with Turner syndrome, 219 individuals with Klinefelter syndrome (KS), female individuals with various XY-DSD conditions (107 with and 67 without androgenization), 87 male individuals with XY-DSD conditions, and 221 female individuals with congenital adrenal hyperplasia. The Hospital Anxiety and Depression Scale, the Short Autism Spectrum Quotient, the Adult Attention-Deficit/Hyperactivity Disorder Self-Report Scale, and self-reported mental health history were used to assess psychiatric symptoms. RESULTS Across the six DSD diagnostic groups, clinical cutoff symptom scores were reached in 19.5% of participants for anxiety, in 7.1% for depression, in 4.1% for attention-deficit/hyperactivity disorder, and in 9.1% for autism. The mean depression and anxiety scores were higher compared with population norms in men with KS and men with XY-DSD. Compared with participants with other DSD conditions, men with KS reported significantly more mental health symptoms. Self-esteem, satisfaction with care, body dissatisfaction, and experiences of shame were associated with psychiatric symptoms in many DSD conditions. CONCLUSIONS A substantial minority of adults with DSD, with KS in particular, experience psychiatric morbidity. Across DSD conditions, adults may share feelings of shame. Developing a positive self-esteem and body image may be challenging. Multidisciplinary DSD care that involves specialized mental health support can be of important value. TRIAL REGISTRATION German Clinical Trials Register DRKS00006072.
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Urbanus E, van Rijn S, Swaab H. A review of neurocognitive functioning of children with sex chromosome trisomies: Identifying targets for early intervention. Clin Genet 2019; 97:156-167. [PMID: 31267526 PMCID: PMC6973121 DOI: 10.1111/cge.13586] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 05/22/2019] [Accepted: 06/04/2019] [Indexed: 02/03/2023]
Abstract
Sex chromosome trisomies (SCT) are among the most common chromosomal duplications in humans. Due to recent technological advances in non‐invasive screening, SCT can already be detected during pregnancy. This calls for more knowledge about the development of (young) children with SCT. This review focused on neurocognitive functioning of children with SCT between 0 and 18 years, on domains of global intellectual functioning, language, executive functioning, and social cognition, in order to identify targets that could benefit from early treatment. Online databases were used to identify peer‐reviewed scientific articles using specific search terms. In total 18 studies were included. When applicable, effect sizes were calculated to indicate clinical significance. Results of the reviewed studies show that although traditionally, the focus has been on language and intelligence (IQ) in this population, recent studies suggest that executive functioning and social cognition may also be significantly affected already in childhood. These findings suggest that neuropsychological screening of children diagnosed with SCT should be extended, to also include executive functioning and social cognition. Knowledge about these neurocognitive risks is important to improve clinical care and help identify targets for early support and intervention programs to accommodate for the needs of individuals with SCT.
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Affiliation(s)
- Evelien Urbanus
- Clinical Child and Adolescent Studies, Leiden University, Leiden, the Netherlands.,Leiden Institute for Brain and Cognition, Leiden, the Netherlands
| | - Sophie van Rijn
- Clinical Child and Adolescent Studies, Leiden University, Leiden, the Netherlands.,Leiden Institute for Brain and Cognition, Leiden, the Netherlands
| | - Hanna Swaab
- Clinical Child and Adolescent Studies, Leiden University, Leiden, the Netherlands.,Leiden Institute for Brain and Cognition, Leiden, the Netherlands
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Melogno S, Pinto MA, Scalisi TG, Orsolini M, Tarani L, Di Filippo G. Reasoning on Figurative Language: A Preliminary Study on Children with Autism Spectrum Disorder and Klinefelter Syndrome. Brain Sci 2019; 9:E58. [PMID: 30861991 PMCID: PMC6468593 DOI: 10.3390/brainsci9030058] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 03/02/2019] [Accepted: 03/07/2019] [Indexed: 12/27/2022] Open
Abstract
In this study we explored metaphor and idiom competencies in two clinical populations, children with autistic spectrum disorder (ASD) and children with Klinefelter syndrome (KS), (age range: 9⁻12), compared to typically developing (TD) children of the same age. These three groups were tested with two multiple-choice tests assessing idiom comprehension through iconic and verbal alternatives and a metaphor comprehension test composed of novel, physical-psychological metaphors, requesting verbal explanations. To these instruments, another test was added, assessing basic sentence comprehension. Performances on the different linguistic tasks were examined by means of discriminant analysis which showed that idiom comprehension had a very small weight in distinguishing children with ASD from TD controls, whereas metaphor explanation did distinguish them. This study suggests that figurative language comprehension is not a "core deficit" per se in individuals with ASD. Only when the task requires to explicitly construct and explain a semantic mapping between the two terms of a metaphor does the performance of children with ASD significantly deviate from the typical population. These results are interpreted in terms of a difficulty in children with ASD and KS with complex cognitive and linguistic processes and also in relation with clinical assessment.
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Affiliation(s)
- Sergio Melogno
- Department of Psychology of Development and Socialization Processes, "Sapienza", University of Rome, 00185 Rome, Italy.
- Department of Pediatrics, "Sapienza", University of Rome, 00185 Rome, Italy.
- Faculty of Psychology, University "Niccolò Cusano", Telematica, 00166 Rome, Italy.
| | - Maria Antonietta Pinto
- Department of Psychology of Development and Socialization Processes, "Sapienza", University of Rome, 00185 Rome, Italy.
| | - Teresa Gloria Scalisi
- Department of Psychology of Development and Socialization Processes, "Sapienza", University of Rome, 00185 Rome, Italy.
| | - Margherita Orsolini
- Department of Psychology of Development and Socialization Processes, "Sapienza", University of Rome, 00185 Rome, Italy.
| | - Luigi Tarani
- Department of Pediatrics, "Sapienza", University of Rome, 00185 Rome, Italy.
| | - Gloria Di Filippo
- Faculty of Psychology, University "Niccolò Cusano", Telematica, 00166 Rome, Italy.
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A review of neurocognitive functioning and risk for psychopathology in sex chromosome trisomy (47,XXY, 47,XXX, 47, XYY). Curr Opin Psychiatry 2019; 32:79-84. [PMID: 30689602 PMCID: PMC6687415 DOI: 10.1097/yco.0000000000000471] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE OF REVIEW About one in 650-1000 children is born with an extra X or Y chromosome, referred to as sex chromosome trisomies (SCTs). Studying SCTs may uncover unique insights in neurodevelopmental pathways underlying the risk for neurobehavioral problems and psychopathology. There is also a clinical need for more knowledge about the phenotype of SCT with the recent introduction of noninvasive prenatal screening. RECENT FINDINGS The reviewed studies illustrate an increased vulnerability for psychopathology such as (symptoms of) autism spectrum disorder, attention-deficit/hyperactivity disorder, anxiety, depression and, to a lesser degree, psychotic disorders. Although traditionally the primary focus has been on language and learning problems, recent research suggests that impairments in executive functioning, social cognition and emotion regulation may also be key factors underlying the risk for neurobehavioral problems. SUMMARY The research field of SCT is in need of a more longitudinal perspective to identify early markers of 'at risk' development, and to assess the effectiveness of early interventions. Neurocognitive markers that signal compromised neurodevelopment may prove to be helpful in this. Variability in the SCT phenotype provides a unique opportunity to identify not only genetic but also environmental factors that shape neurodevelopmental outcome, calling for studies focused on understanding individual differences.
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Editorial: Behavioral phenotypes in developmental neuropsychiatric disorders: disrupted epigenetics, microdeletions, sex chromosome aneuploidies, and gestational alcohol toxicity. Curr Opin Psychiatry 2019; 32:51-54. [PMID: 30601170 DOI: 10.1097/yco.0000000000000483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Samango-Sprouse C, Lasutschinkow P, Powell S, Sadeghin T, Gropman A. The incidence of anxiety symptoms in boys with 47,XXY (Klinefelter syndrome) and the possible impact of timing of diagnosis and hormonal replacement therapy. Am J Med Genet A 2019; 179:423-428. [PMID: 30637954 DOI: 10.1002/ajmg.a.61038] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 12/10/2018] [Accepted: 12/14/2018] [Indexed: 12/12/2022]
Abstract
47,XXY (Klinefelter syndrome) is the most common X and Y chromosomal variation (1:660 males). The incidence of anxiety disorders and the impact of hormonal replacement therapy (HRT) is not well understood. Child Behavior Checklist and Screen for Childhood Anxiety Related Emotional Disorders were completed by parents of 80 boys with 47,XXY. Forty received HRT prior to 10 years of age while 40 did not. HRT (22.5%) received early hormonal treatment prior to 18 months. About 32.5% received hormone booster treatment between 5 and 10 years. The remaining 42.5% received both. There were fewer reported social (p = .015), thought (p = .012), and affective problems (p = .048) in treated boys when compared to untreated. Boys with both treatments demonstrated fewer symptoms on anxious/depressed scale (p = .001) compared to those with early treatment only. Within the treated group, prenatally diagnosed showed fewer indications of anxiety problems (p = .02) than their postnatal counterparts. This comparative, cross-sectional study expands previous findings on the possible positive effect of HRT in boys with 47,XXY. Anxiety disorders appear to be a penetrant aspect of the 47,XXY phenotype. Further investigation is warranted to explore the relationship between biological treatment and individual responses to HRT to develop more personalized and precise medicine.
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Affiliation(s)
- Carole Samango-Sprouse
- George Washington University, Department of Pediatrics, Washington, DC.,Children's National Health System, Neurodevelopmental Pediatrics and Neurogenetics, Washington, DC.,Florida International University, Department of Human and Molecular Genetics, Miami, Florida.,The Focus Foundation, Davidsonville, Maryland
| | | | - Sherida Powell
- George Washington University, Department of Pediatrics, Washington, DC
| | | | - Andrea Gropman
- George Washington University, Department of Pediatrics, Washington, DC.,Children's National Health System, Neurodevelopmental Pediatrics and Neurogenetics, Washington, DC
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Melogno S, Pinto MA, Badolato F, Sist E, Esposito A, Orsolini M, Tarani L. High‐level language competencies and Theory of Mind in a group of children with Klinefelter syndrome. Am J Med Genet A 2019; 179:183-189. [DOI: 10.1002/ajmg.a.12] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 10/31/2018] [Accepted: 11/01/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Sergio Melogno
- Department of Developmental and Socialization PsychologySapienza University of Rome Rome Italy
- Faculty of Psychology“Niccolá Cusano” Telematic University, Rome, Via Don Carlo Gnocchi, 3 Rome Italy
| | - M. Antonietta Pinto
- Department of Developmental and Socialization PsychologySapienza University of Rome Rome Italy
| | - Fausto Badolato
- Department of Pediatrics, Sapienza University of Rome Rome Italy
| | - Eleonora Sist
- Department of Developmental and Socialization PsychologySapienza University of Rome Rome Italy
| | | | - Margherita Orsolini
- Department of Developmental and Socialization PsychologySapienza University of Rome Rome Italy
| | - Luigi Tarani
- Department of Pediatrics, Sapienza University of Rome Rome Italy
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Phonemic and Semantic Verbal Fluency in Sex Chromosome Aneuploidy: Contrasting the Effects of Supernumerary X versus Y Chromosomes on Performance. J Int Neuropsychol Soc 2018; 24:917-927. [PMID: 30375320 DOI: 10.1017/s1355617718000723] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Past research suggests that youth with sex chromosome aneuploidies (SCAs) present with verbal fluency deficits. However, most studies have focused on sex chromosome trisomies. Far less is known about sex chromosome tetrasomies and pentasomies. Thus, the current research sought to characterize verbal fluency performance among youth with sex chromosome trisomies, tetrasomies, and pentasomies by contrasting how performance varies as a function of extra X number and X versus Y status. METHODS Participants included 79 youth with SCAs and 42 typically developing controls matched on age, maternal education, and racial/ethnic background. Participants completed the phonemic and semantic conditions of a verbal fluency task and an abbreviated intelligence test. RESULTS Both supernumerary X and Y chromosomes were associated with verbal fluency deficits relative to controls. These impairments increased as a function of the number of extra X chromosomes, and the pattern of impairments on phonemic and semantic fluency differed for those with a supernumerary X versus Y chromosome. Whereas one supernumerary Y chromosome was associated with similar performance across fluency conditions, one supernumerary X chromosome was associated with relatively stronger semantic than phonemic fluency skills. CONCLUSIONS Verbal fluency skills in youth with supernumerary X and Y chromosomes are impaired relative to controls. However, the degree of impairment varies across groups and task condition. Further research into the cognitive underpinnings of verbal fluency in youth with SCAs may provide insights into their verbal fluency deficits and help guide future treatments. (JINS, 2018, 24, 917-927).
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Kanakis GA, Nieschlag E. Klinefelter syndrome: more than hypogonadism. Metabolism 2018; 86:135-144. [PMID: 29382506 DOI: 10.1016/j.metabol.2017.09.017] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Revised: 09/24/2017] [Accepted: 09/26/2017] [Indexed: 10/18/2022]
Abstract
Klinefelter syndrome (KS) is the most frequent chromosome disorder in males (1:650 newborn males), defined by 47,XXY karyotype. The classical phenotype is that of a tall male with relatively long legs, small, firm testes and gynecomastia. Azoospermia and infertility are almost inevitably present, but may be overcome by TESE and ICSI. Nevertheless, a broad spectrum of phenotypes has been described and more than 70% of the actually existing KS men may remain undiagnosed throughout their lifespan. Accordingly, hypogonadism is usually not evident until early adulthood and progresses with ageing. KS patients present a series of comorbidities that increase morbidity and mortality by 40%. Such disturbances are the impaired metabolic profile (obesity, dyslipidemia, insulin resistance) and a tendency to thrombosis, which all favor cardiovascular disease. They also present susceptibility for specific neoplasias (breast cancer, extragonadal germ cell tumors), autoimmune diseases as well as osteoporosis and bone fractures. Moreover, KS has been associated with verbal processing and attention deficits as well as social skill impairments, leading KS individuals to academic and professional achievements inferior to those of their peers of comparable socio-economic status. Nevertheless, the majority fall within the average range regarding their intellectual abilities and adaptive functioning. Testosterone replacement therapy (TRT) is the mainstay of treatment in hypogonadal KS patients; however, randomized trials are needed to determine optimal therapeutic regimens and follow-up schedules.
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Affiliation(s)
- George A Kanakis
- Department of Endocrinology, Athens Naval & VA Hospital, Athens, Greece.
| | - Eberhard Nieschlag
- University Hospital of Muenster, Center of Reproductive Medicine and Andrology, Domagkstraße 11, D-48149, Muenster, Germany
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Pinares-Garcia P, Stratikopoulos M, Zagato A, Loke H, Lee J. Sex: A Significant Risk Factor for Neurodevelopmental and Neurodegenerative Disorders. Brain Sci 2018; 8:E154. [PMID: 30104506 PMCID: PMC6120011 DOI: 10.3390/brainsci8080154] [Citation(s) in RCA: 108] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 08/08/2018] [Accepted: 08/10/2018] [Indexed: 12/11/2022] Open
Abstract
Males and females sometimes significantly differ in their propensity to develop neurological disorders. Females suffer more from mood disorders such as depression and anxiety, whereas males are more susceptible to deficits in the dopamine system including Parkinson's disease (PD), attention-deficit hyperactivity disorder (ADHD) and autism. Despite this, biological sex is rarely considered when making treatment decisions in neurological disorders. A better understanding of the molecular mechanism(s) underlying sex differences in the healthy and diseased brain will help to devise diagnostic and therapeutic strategies optimal for each sex. Thus, the aim of this review is to discuss the available evidence on sex differences in neuropsychiatric and neurodegenerative disorders regarding prevalence, progression, symptoms and response to therapy. We also discuss the sex-related factors such as gonadal sex hormones and sex chromosome genes and how these might help to explain some of the clinically observed sex differences in these disorders. In particular, we highlight the emerging role of the Y-chromosome gene, SRY, in the male brain and its potential role as a male-specific risk factor for disorders such as PD, autism, and ADHD in many individuals.
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Affiliation(s)
- Paulo Pinares-Garcia
- Brain and Gender laboratory, Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Victoria 3168, Australia.
- Department of Anatomy and Developmental Biology, Monash University, Clayton, Victoria 3168, Australia.
| | - Marielle Stratikopoulos
- Brain and Gender laboratory, Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Victoria 3168, Australia.
- Department of Anatomy and Developmental Biology, Monash University, Clayton, Victoria 3168, Australia.
| | - Alice Zagato
- Brain and Gender laboratory, Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Victoria 3168, Australia.
- School of Life and Environmental Sciences, Deakin University, Burwood, Victoria 3125, Australia.
| | - Hannah Loke
- Brain and Gender laboratory, Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Victoria 3168, Australia.
| | - Joohyung Lee
- Brain and Gender laboratory, Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Victoria 3168, Australia.
- Department of Anatomy and Developmental Biology, Monash University, Clayton, Victoria 3168, Australia.
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Freilinger P, Kliegel D, Hänig S, Oehl-Jaschkowitz B, Henn W, Meyer J. Behavioral and psychological features in girls and women with triple-X syndrome. Am J Med Genet A 2018; 176:2284-2291. [PMID: 30070765 DOI: 10.1002/ajmg.a.40477] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 03/29/2018] [Accepted: 06/25/2018] [Indexed: 11/06/2022]
Abstract
Triple-X syndrome is a common sex chromosome aneuploidy, which appears in 1 out of 1,000 females. The aim of our study was to describe the behavioral features of a large group of girls and women with triple-X in comparison to a control group. A total of 72 subjects with triple-X and 69 subjects of an age-matched control group were included. Psychological and behavioral questionnaires were allocated to three age groups, representing a range of ages from young childhood to adulthood. Regarding the females between 4 and 7 years of age, we found significant differences for social problems, attention problems, and school performance. For the age group 8-17 years, we found larger significant differences for the majority of the scales listed in the child behavior checklist. The most significant differences (p < .001) were from total behavior problems, internalizing problems, and four other scales. Young females with triple-X have significantly lower general self-esteem, especially concerning school and family. In the adults, there were significant differences concerning psychological symptoms and distress, with higher scores in the triple-X subjects. Regardless, their mean scores were still in the normal range. We did not find clinical evidence for more than 50% of the triple-X females in any age group, indicating that approximately half of them do not have behavioral problems, and that more than 60% do not differ in their competence from the control group. However, our findings suggest that triple-X influences mental health and the overall well-being of the individuals across their whole life spans.
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Affiliation(s)
- Petra Freilinger
- Genetikum, Neu-Ulm, Germany.,Department of Neurobehavioral Genetics, Trier University, Trier, Germany
| | - David Kliegel
- Department of Biological and Clinical Psychology, Trier University, Trier, Germany
| | - Susann Hänig
- Department of Child and Adolescent Psychiatry and Psychotherapy, Homburg, Saar, Germany
| | | | - Wolfram Henn
- Institute of Human Genetics, Homburg, Saar, Germany
| | - Jobst Meyer
- Department of Neurobehavioral Genetics, Trier University, Trier, Germany
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47
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Gravholt CH, Chang S, Wallentin M, Fedder J, Moore P, Skakkebæk A. Klinefelter Syndrome: Integrating Genetics, Neuropsychology, and Endocrinology. Endocr Rev 2018; 39:389-423. [PMID: 29438472 DOI: 10.1210/er.2017-00212] [Citation(s) in RCA: 133] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 02/05/2018] [Indexed: 01/15/2023]
Abstract
Although first identified over 70 years ago, Klinefelter syndrome (KS) continues to pose substantial diagnostic challenges, as many patients are still misdiagnosed, or remain undiagnosed. In fact, as few as 25% of patients with KS are accurately diagnosed and most of these diagnoses are not made until adulthood. Classic characteristics of KS include small testes, infertility, hypergonadothropic hypogonadism, and cognitive impairment. However, the pathophysiology behind KS is not well understood, although genetic effects are also thought to play a role. For example, recent developments in genetics and genomics point to a fundamental change in our understanding of KS, with global epigenetic and RNA expression changes playing a central role for the phenotype. KS is also associated with more general health markers, including higher morbidity and mortality rates and lower socioeconomic status (which likely affect both morbidity and mortality). In addition, hypogonadism is associated with greater risk of metabolic syndrome, type 2 diabetes, cardiovascular disease, breast cancer, and extragonadal germ cell tumors. Medical treatment typically focuses on testosterone replacement therapy (TRT), although the effects of this therapy have not been studied rigorously, and future studies need to evaluate the effects of TRT on metabolic risk and neurocognitive outcomes. This review presents a comprehensive interdisciplinary examination of recent developments in genetic, endocrine, and neurocognitive science, including the study of animal models. It provides a number of recommendations for improving the effectiveness of research and clinical practice, including neonatal KS screening programs, and a multidisciplinary approach to KS treatment from childhood until senescence.
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Affiliation(s)
- Claus H Gravholt
- Department of Endocrinology and Internal Medicine (MEA), Aarhus University Hospital, Aarhus C, Denmark.,Department of Molecular Medicine, Aarhus University Hospital, Aarhus N, Denmark
| | - Simon Chang
- Department of Endocrinology and Internal Medicine (MEA), Aarhus University Hospital, Aarhus C, Denmark.,Department of Clinical Biochemistry, Esbjerg Sygehus, Esbjerg, Denmark
| | - Mikkel Wallentin
- Department of Linguistics, Cognitive Science, and Semiotics, Aarhus University, Aarhus C, Denmark.,Center of Functionally Integrative Neuroscience, Aarhus University Hospital, Aarhus C, Denmark
| | - Jens Fedder
- Centre of Andrology and Fertility Clinic, Department of Gynaecology and Obstetrics, Odense University Hospital, Odense C, Denmark
| | - Philip Moore
- Department of Psychology, The George Washington University, Washington DC
| | - Anne Skakkebæk
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus N, Denmark.,Department of Clinical Genetics, Aarhus University Hospital, Aarhus N, Denmark
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48
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van Rijn S. Salivary testosterone in relation to social cognition and social anxiety in children and adolescents with 47,XXY (Klinefelter syndrome). PLoS One 2018; 13:e0200882. [PMID: 30036387 PMCID: PMC6056033 DOI: 10.1371/journal.pone.0200882] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 07/05/2018] [Indexed: 11/30/2022] Open
Abstract
Background Approximately 1 in 650 boys are born with an extra X chromosome. Boys and men with 47,XXY (Klinefelter syndrome) are at risk for neurodevelopmental disorders and specific cognitive impairments. This study was focused on social anxiety and social cognition. The aim was to assess if these aspects of the phenotype are related to testosterone deficiency, which is typically seen in 47,XXY from puberty onwards. Methods In the study 20 boys with 47,XXY and 25 non-clinical controls between 8 and 19 years participated. None had ever used testosterone supplements. Cognitive tests measuring the labeling of facial expressions and perspective taking (Theory of Mind) were administered. Self-report questionnaires were used to assess social anxiety. Testosterone was measured in saliva. Results Within the 47,XXY group lower levels of salivary testosterone were significantly associated with higher levels of social anxiety. The correlation was strong, andindependent of age and pubertal development. However, salivary levels of testosterone were uncorrelated to social cognitive skills. Discussion These findings point out that lower testosterone levels might contribute to high social anxiety in 47,XXY, suggesting that anxiety should be monitored in pubertal boys with XXY presenting with testosterone deficiency. This should be done in addition to exploring cognitive behavioral therapy or psychopharmacologic treatments targeting anxiety, which are more evidence based. In contrast, testosterone levels were not associated with social cognitive functioning, suggesting that other mechanisms are driving vulnerabilities in this domain.
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Affiliation(s)
- Sophie van Rijn
- Leiden University, Clinical Child and Adolescent Studies, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition, Leiden, The Netherlands
- * E-mail:
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49
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Zhang X, Yang J, Li Y, Ma X, Li R. Sex chromosome abnormalities and psychiatric diseases. Oncotarget 2018; 8:3969-3979. [PMID: 27992373 PMCID: PMC5354807 DOI: 10.18632/oncotarget.13962] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 12/07/2016] [Indexed: 12/02/2022] Open
Abstract
Excesses of sex chromosome abnormalities in patients with psychiatric diseases have recently been observed. It remains unclear whether sex chromosome abnormalities are related to sex differences in some psychiatric diseases. While studies showed evidence of susceptibility loci over many sex chromosomal regions related to various mental diseases, others demonstrated that the sex chromosome aneuploidies may be the key to exploring the pathogenesis of psychiatric disease. In this review, we will outline the current evidence on the interaction of sex chromosome abnormalities with schizophrenia, autism, ADHD and mood disorders.
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Affiliation(s)
- Xinzhu Zhang
- Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China
| | - Jian Yang
- Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Beijing, China
| | - Yuhong Li
- Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Beijing, China
| | - Xin Ma
- Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Beijing, China
| | - Rena Li
- Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Beijing, China.,Center for Hormone Advanced Science and Education, Roskamp Institute, Sarasota, FL, USA
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50
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Samango-Sprouse C, Stapleton E, Chea S, Lawson P, Sadeghin T, Cappello C, de Sonneville L, van Rijn S. International investigation of neurocognitive and behavioral phenotype in 47,XXY (Klinefelter syndrome): Predicting individual differences. Am J Med Genet A 2018; 176:877-885. [DOI: 10.1002/ajmg.a.38621] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 10/27/2017] [Accepted: 01/04/2018] [Indexed: 11/08/2022]
Affiliation(s)
- Carole Samango-Sprouse
- The Focus Foundation; Davidsonville Maryland
- George Washington University; Washington District of Columbia
- Florida International University; Miami Florida
| | | | - Selena Chea
- The Focus Foundation; Davidsonville Maryland
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