Introduction

Brain abnormalities in cerebral palsy (CP) are known to relate to motor outcome; however, their association with cognitive functioning is less clear.

Aim of the study

1) To investigate the prognostic value of brain abnormalities for cognitive functioning; 2) To explore the added value of prognostic variables across ICF domains: motor function, epilepsy, gestational age, birthweight and educational level of the parents.

Methods

We retrospectively analyzed brain MRI scans of 75 children with CP (GMFCS level I–V, 36% born preterm), as part of a longitudinal study. MRI classification: qualitative classification of brain abnormality pattern and semi-quantitative grading of the extent of damage. Cognitive functioning, measured as non-verbal intelligent quotient (IQ), was dichotomized into ‘impaired cognition’ (IQ ≤ 70) and ‘normal’ (IQ > 70). Multivariable logistic regression produced odds ratios (OR) with 95% confidence interval (C.I.) of risk factors for impaired cognition.

Results

Overall, 27% of the tested participants had a non-verbal IQ below 70 and 36% of the participants was classified as ‘having impaired cognition’. At a young age, a higher degree of white matter damage (OR 1.6, 95% C.I. 0.97–2.67) and a more severe GMFCS level (OR 3.2, 95% C.I. 1.70–5.98) are risk factors for impaired cognition at school-age (4–7 years of age). This model correctly predicts 89% of the cases. Brain damage alone predicts the presence of impaired cognition in 71% of the cases.

Interpretation

Brain MRI characteristics and GMFCS level at a young age can each help identify children with CP at risk for impaired cognition at school age and together have a strong predictive value.

中文翻译：

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脑异常对脑瘫认知功能的预后价值：一项前瞻性队列研究

介绍

已知脑瘫（CP）中的脑部异常与运动结局有关。然而，它们与认知功能的关系尚不清楚。

研究目的

1）研究脑异常对认知功能的预后价值；2）探索跨ICF域的预后变量的附加价值：运动功能，癫痫，胎龄，出生体重和父母的受教育程度。

方法

作为一项纵向研究的一部分，我们回顾性分析了75名CP患儿（GMFCS I–V级，早产36％）的脑MRI扫描。MRI分类：脑部异常模式的定性分类和损伤程度的半定量分级。以非语言智能商（IQ）衡量的认知功能被分为“受损的认知”（IQ≤70）和“正常”（IQ> 70）。多变量logistic回归产生比值比（OR）和95％的认知障碍危险因素置信区间（CI）。

结果

总体而言，有27％的受测参与者的非语言智商低于70，有36％的参与者被归类为“认知能力受损”。在年轻时，较高的白质损伤程度（OR 1.6，95％CI 0.97–2.67）和更严重的GMFCS水平（OR 3.2，95％CI 1.70–5.98）是学龄儿童认知能力下降的危险因素。 （4-7岁）。该模型可以正确预测89％的情况。仅脑损伤就可以预测71％的病例中认知能力受损。

解释

幼年时的脑部MRI特征和GMFCS水平可以帮助确定CP患儿在学龄时认知能力受损的风险，并且两者均具有很强的预测价值。