Cerebral Palsy and Dementia
To aid in a dialogue regarding the risk for dementia linked to cerebral palsy, we have included these relevant research articles:
Commonalities in biomarkers and phenotypes between mild cognitive impairment and cerebral palsy: a pilot exploratory study
Ng,T.K.S., Tagawa, A., Ho, R.C., Larbi, A., Kua, E.H., Mahendran, R., Carollo, J.J., & Heyn, P.C.
Aging (Albany NY), 2021, 13. [Epub ahead of print]
Abstract: Clinically, individuals with cerebral palsy (CP) experience symptoms of accelerated biological aging. Accumulative deficits in both molecular underpinnings and functions in young adults with CP can lead to premature aging, such as heart disease and mild cognitive impairment (MCI). MCI is an intermediate stage between healthy aging and dementia that normally develops at old age. Owing to their intriguingly parallel yet “inverted” disease trajectories, CP might share similar pathology and phenotypes with MCI, conferring increased risk for developing dementia at a much younger age. Thus, we examined this hypothesis by evaluating these two distinct populations (MCI= 55, CP = 72). A total of nine measures (e.g., blood biomarkers, neurocognition, Framingham Heart Study Score (FHSS) were compared between the groups. Compared to MCI, upon controlling for covariates, delta FHSS, brain-derived neurotrophic factor (BDNF) levels, and systolic blood pressure were significantly lower in CP. Intriguingly, high-sensitivity CRP, several metabolic outcomes, and neurocognitive function were similar between the two groups. This study supports a shared biological underpinning and key phenotypes between CP and MCI. Thus, we proposed a double-hit model for the development of premature aging outcomes in CP through shared biomarkers. Future longitudinal follow-up studies are warranted to examine accelerated biological aging.
Incidence of dementia in adults with cerebral palsy: A UK cohort study
Smith,K. Peterson, M., Victor,C, & Ryan, J.
Innovations in Aging, 2018 Nov; 2(Suppl 1), 980.
Published online 2018 Nov 16. doi: 10.1093/geroni/igy031.3628
Abstract: Researchers have previously hypothesized that aging with cerebral palsy (CP) may be associated with an increased risk of developing dementia. However no study has yet formally investigated this proposition while accounting for important morbidities such as intellectual disability (ID) or epilepsy. We used a United Kingdom primary care database as our data source (CPRD Gold). Data for 1,705 adults with CP (age range 18–89) and 5,115 age, sex and general practice matched controls without CP was extracted from the database. Dementia was defined by read codes. We used stratified Cox Proportional Hazards Regression analyses to determine incidence of dementia. In total there were 51 cases of incident dementia over follow-up. There was no significant difference in the risk of developing dementia between people with CP and those without CP (HR 1.40, 95% CI 0.58–3.40). We then repeated our analysis comparing those with CP and either ID or epilepsy with adults without CP. Those with ID co-morbidity had a higher risk of developing dementia than people with no CP (HR 7.11, 95% CI 1.38–36.75) as did those with CP and epilepsy (HR 12.0, 95% CI 1.34–107.36). Results suggest that only those people with CP and ID or epilepsy are more likely to develop dementia. This suggests that the previously speculated link between CP and dementia may be due to other neurologic or intellectual co-morbidities rather than as a direct effect of CP; however, more work is needed to confirm this link and the mechanisms underlying it.
"Results suggest that only those people with CP and ID or epilepsy are more likely to develop dementia."
Risk of dementia in adults with cerebral palsy: a matched cohort study using general practice data
Smith, K.J.,Peterson, M.D.,Victor, C., & Ryan, J.M.
BMJ Open, 2021;11:e042652. doi:10.1136/ bmjopen-2020-042652
Abstract: Determine the risk of incident dementia in adults with cerebral palsy (CP) compared with age, sex and general practice (GP) matched controls. A retrospective cohort study designed was used. The setting was the UK using GPs linked into the Clinical Practice Research Datalink (CPRD). CPRD data were used to identify adults aged 18 or older with a diagnosis of CP. Each adult with CP was matched to three controls who were matched for age, sex and GP. In total, 1703 adults with CP and 5109 matched controls were included in the analysis. The mean baseline age of participants was 33.30 years (SD: 15.48 years) and 46.8% of the sample were female. The primary outcome included a new diagnosis of dementia during the follow-up period (earliest date of 1987 to latest date of 2015). The results showed that during the follow- up, 72 people were identified with a new diagnosis of dementia. The overall proportion of people with and without CP who developed dementia was similar (CP: n=19, 1.1%; matched controls n=54, 10.0%). The unadjusted HR suggested that people with CP had an increased hazard of being diagnosed with dementia when compared with matched controls (HR 2.69, 95% CI 1.44 to 5.00). This association was attenuated when CP comorbidities (sensory impairment, intellectual disability and epilepsy) were accounted for (HR 1.92, 95% CI 0.92 to 4.02).There was no difference in the proportion of people with CP and matched controls who were diagnosed with dementia during the follow-up. Furthermore, while there was evidence for an increased hazard of dementia among people with CP, the fact that this association was attenuated after controlling for comorbidities indicates that this association may be explained by comorbidities rather than being a direct result of CP. Findings should be interpreted with caution due to the low number of incident cases of dementia.
"There was no difference in the proportion of people with CP and matched controls who were diagnosed with dementia."