Bosenbark Danielle D, Krivitzky Lauren, Ichord Rebecca, Jastrzab Laura, Billinghurst Lori
a Department of Psychology , Drexel University , Philadelphia , PA , USA.
b Department of Child and Adolescent Psychiatry and Behavioral Sciences , Children's Hospital of Philadelphia , PA , USA.
Child Neuropsychol. 2018 Jan;24(1):106-123. doi: 10.1080/09297049.2016.1225708. Epub 2016 Sep 7.
Perinatal arterial ischemic stroke (PAIS) is a form of childhood stroke; the majority of those affected experience neurologic sequelae, including motor, language and neurocognitive impairments. This study examines the attention and executive functioning (EF) profiles of children following PAIS, as well as the impact of age and sex. In this single-center cross-sectional study, 40 children aged 3 to 16 years (median age 7.2 years; 58% male) who have suffered a PAIS underwent a comprehensive neuropsychological battery to assess attention and EF. Parents completed behavioral questionnaires regarding real-world functioning. Composite scores were calculated for seven attention and EF domains (Attention, Working Memory, Verbal Retrieval, Inhibitory Control, Flexibility/Shifting, Planning/Organization, and Processing Speed). The results for all measured domains of attention and EF are significantly lower in the participants compared to the normative samples (p < .001), with the exception of Working Memory. However, increasing difficulty with Working Memory is associated with developing age. Older age at time of testing is also associated with a higher incidence of clinically-elevated attention deficit hyperactivity disorder (ADHD) symptoms. Sex is not associated with performance measures or parental report of functioning. The participants demonstrate mild-to-moderate attention and EF impairment compared to the normative population. Clinicians, families, and educators should be informed about the neurocognitive sequelae of PAIS and the need for close developmental surveillance in this population to identify vulnerable children and initiate appropriate therapeutic interventions in a timely fashion.
围产期动脉缺血性卒中（PAIS）是儿童卒中的一种形式；大多数患者会出现神经后遗症，包括运动、语言和神经认知障碍。本研究考察了PAIS患儿的注意力和执行功能（EF）概况，以及年龄和性别的影响。在这项单中心横断面研究中，40名年龄在3至16岁（中位年龄7.2岁；58%为男性）的PAIS患儿接受了一套全面的神经心理测试，以评估注意力和EF。家长完成了关于现实世界功能的行为问卷。计算了七个注意力和EF领域（注意力、工作记忆、言语检索、抑制控制、灵活性/转换、计划/组织和处理速度）的综合得分。与正常样本相比，参与者在所有测量的注意力和EF领域的结果均显著更低（p <.001），工作记忆除外。然而，工作记忆难度的增加与年龄增长有关。测试时年龄较大也与临床注意力缺陷多动障碍（ADHD）症状发生率较高有关。性别与表现指标或家长对功能的报告无关。与正常人群相比，参与者表现出轻度至中度的注意力和EF损害。临床医生、家庭和教育工作者应了解PAIS的神经认知后遗症，以及对该人群进行密切发育监测的必要性，以便识别易受影响的儿童并及时启动适当的治疗干预措施。
