Al-Mazidi Sarah H
Physiology, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU.
Cureus. 2023 Oct 6;15(10):e46581. doi: 10.7759/cureus.46581. eCollection 2023 Oct.
Cognitive impairment is among the most challenging characteristics of autism spectrum disorder (ASD). Although ASD is one of the common neurodevelopmental disorders, we are still behind in diagnosing and treating cognitive impairment in ASD. Cognitive impairment in ASD varies, meaning it could be at the sensory perception level to cognitive processing, learning, and memory. There are no diagnostic criteria for cognitive impairment that are specific to ASD. The leading causes of cognitive impairment in ASD could be neurological, immune, and gastrointestinal dysfunction. Immune dysfunction might lead to neuroinflammation, affecting neural connectivity, glutamate/gamma-aminobutyric acid (GABA) balance, and plasticity. The gut-brain axes are essential in the developing brain. Special retinal changes have recently been detected in ASD, which need clinical investigation to find their possible role in early diagnosis. Early intervention is crucial for ASD cognitive dysfunction. Due to the heterogeneity of the disease, the clinical manifestation of ASD makes it difficult for clinicians to develop gold-standard diagnostic and therapeutic criteria. We suggest a triad for diagnosis, which includes clinical tests for immune and gastrointestinal dysfunction biomarkers, clinical examination for the retina, and an objective neurocognitive evaluation for ASD, and to develop a treatment strategy involving these three aspects. Developing clear treatment criteria for cognitive impairment for ASD would improve the quality of life of ASD people and their caregivers and would delay or prevent dementia-related disorders in ASD people.
认知障碍是自闭症谱系障碍（ASD）最具挑战性的特征之一。尽管ASD是常见的神经发育障碍之一，但我们在ASD认知障碍的诊断和治疗方面仍较为滞后。ASD中的认知障碍各不相同，这意味着它可能出现在感觉知觉层面，也可能涉及认知加工、学习和记忆。目前尚无针对ASD的特定认知障碍诊断标准。ASD中认知障碍的主要原因可能是神经、免疫和胃肠功能障碍。免疫功能障碍可能导致神经炎症，影响神经连接、谷氨酸/γ-氨基丁酸（GABA）平衡和可塑性。肠脑轴在大脑发育过程中至关重要。最近在ASD中检测到特殊的视网膜变化，这需要临床研究来发现它们在早期诊断中的可能作用。早期干预对ASD认知功能障碍至关重要。由于该疾病的异质性，ASD的临床表现使得临床医生难以制定金标准的诊断和治疗标准。我们建议采用一种三联诊断法，包括对免疫和胃肠功能障碍生物标志物进行临床检测、对视网膜进行临床检查以及对ASD进行客观的神经认知评估，并制定涉及这三个方面的治疗策略。为ASD的认知障碍制定明确的治疗标准将改善ASD患者及其照顾者的生活质量，并延缓或预防ASD患者出现与痴呆相关的疾病。
