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      Cognitive development in children with chronic protein energy malnutrition

      research-article
      Author(s): 1 , , 2 , 3
      Publication date (Electronic):
      Journal: Behavioral and Brain Functions : BBF
      Publisher: BioMed Central

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          Abstract

          Background

          Malnutrition is associated with both structural and functional pathology of the brain. A wide range of cognitive deficits has been reported in malnourished children. Effect of chronic protein energy malnutrition (PEM) causing stunting and wasting in children could also affect the ongoing development of higher cognitive processes during childhood (>5 years of age). The present study examined the effect of stunted growth on the rate of development of cognitive processes using neuropsychological measures.

          Methods

          Twenty children identified as malnourished and twenty as adequately nourished in the age groups of 5–7 years and 8–10 years were examined. NIMHANS neuropsychological battery for children sensitive to the effects of brain dysfunction and age related improvement was employed. The battery consisted of tests of motor speed, attention, visuospatial ability, executive functions, comprehension and learning and memory

          Results

          Development of cognitive processes appeared to be governed by both age and nutritional status. Malnourished children performed poor on tests of attention, working memory, learning and memory and visuospatial ability except on the test of motor speed and coordination. Age related improvement was not observed on tests of design fluency, working memory, visual construction, learning and memory in malnourished children. However, age related improvement was observed on tests of attention, visual perception, and verbal comprehension in malnourished children even though the performance was deficient as compared to the performance level of adequately nourished children.

          Conclusion

          Chronic protein energy malnutrition (stunting) affects the ongoing development of higher cognitive processes during childhood years rather than merely showing a generalized cognitive impairment. Stunting could result in slowing in the age related improvement in certain and not all higher order cognitive processes and may also result in long lasting cognitive impairments.

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          Most cited references40

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          Localization of cognitive operations in the human brain.

          M Posner, S. Petersen, Marcus E. Raichle … (1988)
          The human brain localizes mental operations of the kind posited by cognitive theories. These local computations are integrated in the performance of cognitive tasks such as reading. To support this general hypothesis, new data from neural imaging studies of word reading are related to results of studies on normal subjects and patients with lesions. Further support comes from studies in mental imagery, timing, and memory.
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            Severity and timing of stunting in the first two years of life affect performance on cognitive tests in late childhood.

            Linda S Adair, M. Méndez (1999)
            Undernutrition in infancy and early childhood is thought to adversely affect cognitive development, although evidence of lasting effects is not well established. With the use of data from the Cebu Longitudinal Health and Nutrition Study, we assesshere the relationship between stunting in the first 2 y of life and later cognitive development, focusing on the significance of severity, timing and persistence of early stunting. The sample included > 2000 Filipino children administered a cognitive ability test at ages 8 and 11 y. Stunting status was determined on the basis of anthropometric data collected prospectively between birth and age 2 y. Children stunted between birth and age 2 y had significantly lower test scores than nonstunted children, especially when stunting was severe. The shortfall in test scores among children stunted in the first 2 y was strongly related to reduced schooling, which was the result of a substantial delay in initial enrollment as well as higher absenteeism and repetition of school years among stunted children. Interactions between stunting and schooling were not significant, indicating that stunted and nonstunted children benefitted similarly from additional schooling. After multivariate adjustment, severe stunting at age 2 y remained significantly associated with later deficits in cognitive ability. The timing of stunting was also related to test performance, largely because children stunted very early also tended to be severely stunted (chi(2) P = 0.000). Deficits in children's scores were smaller at age 11 y than at age 8 y, suggesting that adverse effects may decline over time. Results emphasize the need to prevent early stunting and to provide adequate schooling to disadvantaged children.
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              Neural basis of protracted developmental changes in visuo-spatial working memory.

              H. Kwon, A Reiss, V Menon (2002)
              Developmental studies have shown that visuo-spatial working memory (VSWM) performance improves throughout childhood and adolescence into young adulthood. The neural basis of this protracted development is poorly understood. In this study, we used functional MRI (fMRI) to examine VSWM function in children, adolescents, and young adults, ages 7-22. Subjects performed a 2-back VSWM experiment that required dynamic storage and manipulation of spatial information. Accuracy and response latency on the VSWM task improved gradually, extending into young adulthood. Age-related increases in brain activation were observed in focal regions of the left and right dorsolateral prefrontal cortex, left ventrolateral prefrontal cortex (including Broca's area), left premotor cortex, and left and right posterior parietal cortex. Multiple regression analysis was used to examine the relative contributions of age, accuracy, and response latency on activation. Our analysis showed that age was the most significant predictor of activation in these brain regions. These findings provide strong evidence for a process of protracted functional maturation of bilateral fronto-parietal neural networks involved in VSWM development. At least two neural systems involved in VSWM mature together: (i) a right hemisphere visuo-spatial attentional system, and (ii) a left hemisphere phonological storage and rehearsal system. These observations suggest that visually and verbally mediated mnemonic processes, and their neural representations, develop concurrently during childhood and adolescence and into young adulthood.
              Article 0 comments Cited 80 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Behav Brain Funct
                Title: Behavioral and Brain Functions : BBF
                Publisher: BioMed Central
                ISSN (Electronic): 1744-9081
                Publication date Collection: 2008
                Publication date (Electronic): 24 July 2008
                Volume: 4
                Page: 31
                Affiliations
                [1 ]Centre for Behavioural and Cognitive Sciences, Psychology Building, University of Allahabad, Allahabad, 211001, U.P., India
                [2 ]Department of Clinical Psychology, National Institute of Mental Health and Neurosciences, PB No.: 2900, Hosur Road, Bangalore, 560029, Karnataka, India
                [3 ]Department of Neurosurgery, National Institute of Mental Health and Neurosciences, PB No.: 2900, Hosur Road, Bangalore, 560029, Karnataka, India
                Article
                Publisher ID: 1744-9081-4-31
                DOI: 10.1186/1744-9081-4-31
                PMC ID: 2519065
                PubMed ID: 18652660
                SO-VID: f32ef0d2-76e0-46d1-b672-8cb7f067c18c
                Copyright © Copyright © 2008 Kar et al; licensee BioMed Central Ltd.
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 23 October 2007
                Date accepted : 24 July 2008
                Categories
                Subject: Research

                ScienceOpen disciplines: Neurology
                Data availability:
                ScienceOpen disciplines: Neurology

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