Neuropsychologic and Adaptive Functioning in Adolescents and Young Adults Shunted for Congenital Hydrocephalus

Abstract

The major aim of this study was to assess whether the syndrome of nonverbal learning disabilities described in hydrocephalic children is observed in adulthood. Eleven adults shunted for congenital hydrocephalus related to spina bifida and eight adults shunted for hydrocephalus related to aqueductal stenosis were administered an extensive neuropsychologic battery to investigate discrepancies between verbal and visuospatial cognition, verbal and visuospatial long-term memory, and psycho-social adaptive abilities. The results showed no discrepancies between Wechsler Performance IQ or Verbal IQ in either hydrocephalic group. Nevertheless, the subjects with spina bifida appeared more cognitively impaired than the subjects with aqueductal stenosis, who performed normally on the Wechsler Adult Intelligence Scale-Revised. Memory assessment using Signoret's Memory Battery revealed no discrepancy between verbal and visuospatial memory in the hydrocephalic group. Nevertheless, the subjects with spina bifida had poorer verbal and visuospatial memory performance than the subjects with aqueductal stenosis. There were no differences on the Vineland Adaptive Behavioral Scale between subjects with spina bifida and those with aqueductal stenosis in autonomy, socialization, and daily living skills. These results suggest that shunted congenital hydrocephalus is not characterized by nonverbal learning disabilities syndrome in adolescence or in adulthood.

Neuropsychological Assessment of Adult Patients with Shunted Hydrocephalus

“…Eventually, the patients with hydrocephalus had significant impairment on the neurocognitive functions of their frontal, parietal and temporal lobes. On the other hand, the statistical analyses performed on demographic data showed that the aetiology of the hydrocephalus, age, sex and localization of the shunt (frontal or posterior parietal) did not affect the test results, as reported in the literature 12) ; it could therefore be said that these difficulties may be caused by hydrocephalus itself and not the aetiological factors.…”

“…In literature, some authors suggested that although the hydrocephalus is apparently arrested, the disorder may progress and produce neuropsychological disturbances in certain patients. Recent study results have support this thesis that these patients have persistent neuropsychological difficulties affecting visuospatial, language skills and motor functions; and difficulties in other nonverbal domains such as attention, memory, maths, numeracy, and problem solving 3,12,14,22) . Because these problems with memory and concentration reduce intellectual ability and decrease performance in school, these patients have serious adaptive problems in their social, cultural, behavioral and academic life 11,12,14) .…”

“…This stress may develope impaired cerebral metabolism by decreasing of the cerebral blood flow which may cause to reduce the concentration of neurotransmitters and peptide neuromodulators, and to reflect the neuronal dysfunction and neurocognitive disruption/deficits 5,6,12) . Fletcher et al (1992) showed that the hydrocephalic children have low points at their performance tests which measure the functions of the right hemisphere of the brain (known as the non-dominant hemisphere).…”

“…However, little knowledge about the adult outcomes of the neuropsychological difficulties. Some of the cognitive disfunction in hydrocephalic young adult with spina bifida are now being identified; but their adaptive difficulties are poorly explained 11,12,14,22) . In these studies, there are some questions between the aetiological factors and development of the neuropsychological difficulties.…”

Profiles of Neuropsychological Functioning in Children and Adolescents with Spina Bifida: Associations with Biopsychosocial Predictors and Functional Outcomes

“…Additionally, previous studies have typically not included an ethnically diverse participant sample and/or have not reported the ethnicity of their participants (e.g., Barf et al, 2003;Dennis et al, 1981;Hommet et al, 1999;Iddon et al, 2004;Lindquist et al, 2009;Jenkinson et al, 2011;Snow, 1999;Snow et al, 1994). Due to this practice, the phenotype that is described in the literature may not be representative of children with lower intelligence or children of diverse ethnicities.…”