Intellectual disability in cerebral palsy: a population‐based retrospective study

• Published in: Developmental medicine and child neurology 2018-07, Vol.60 (7), p.687-694
• Main Authors: Reid, Susan M, Meehan, Elaine M, Arnup, Sarah J, Reddihough, Dinah S
• Format: Article
• Language: English
• ISSN: 0012-1622; 1469-8749
• DOI: 10.1111/dmcn.13773

Aim A population‐based observational study design was used to describe the epidemiology of intellectual disability in cerebral palsy (CP) in terms of clinical and neuroimaging associations, and to report the impact of intellectual disability on utilization of health services and length of survival. Method Population CP registry data were used to retrospectively assess the frequency of intellectual disability and strength of associations between intellectual disability and mobility, epilepsy, vision, hearing, communication, and neuroimaging patterns (n=1141). Data linkage was undertaken to assess usage of hospital inpatient and emergency department services. Survival analysis was performed in a 30‐year birth cohort (n=3248). Results Intellectual disability, present in 45% of the cohort, was associated with non‐ambulation (47% vs 8%), later walking (mean 2y 7mo vs 1y 9mo), hypotonic (8% vs 1%) or dyskinetic (9% vs 5%) CP, a quadriplegic pattern of motor impairment (42% vs 5%), epilepsy (52% vs 12%), more emergency and multi‐day hospital admissions, and reduced 35‐year survival (96% vs 71%). Grey matter injuries (13% vs 6%), malformations (18% vs 6%), and miscellaneous neuroimaging patterns (12% vs 4%) were more common in people with intellectual disability. Interpretation Intellectual disability adds substantially to the overall medical complexity in CP and may increase health and mortality disparities. What this study adds Cerebral maldevelopments and grey matter injuries are associated with higher intellectual disability rates. Health care is more ‘crisis‐driven’ and ‘reactive’ in children with co‐occurring intellectual disability. Length of survival is reduced in individuals with CP and co‐occurring intellectual disability. Resumen Discapacidad intelectual en parálisis cerebral: un estudio poblacional retrospectivo Objetivo se utilizó un estudio con diseño poblacional de observación para describir la epidemiologia de la discapacidad intelectual en parálisis cerebral (PC) en términos de asociaciones clínicas y con neuroimágenes, y para reportar el impacto de la discapacidad intelectual en la utilización de los servicios de salud y tiempo de sobrevida. Metodos Los datos de los registros de la población con PC se utilizaron para evaluar de forma retrospectiva la frecuencia de discapacidad intelectual y la fuerza de asociación entre la discapacidad intelectual y movilidad, epilepsia, visión, audición, comunicación y patrones en neuroimágenes (n=1141). Se real