La cerebral palsy is a condition that encompasses a diverse set of permanent disorders related to muscle function, movement, and posture. These are attributed to non-progressive injuries to the developing brain. As a result, cerebral palsy causes significant limitations in daily activities and social participation. It should be added that these alterations are associated with disorders of intellectual and cognitive development, of perception and communication, as well as sensory, medical-orthopedic and mental health disorders.
Cerebral palsy is estimated to affect approx 2 out of every 1.000 births, being the main one cause of physical disability in childhood. Although the diagnosis is usually made at an early stage, and special attention is given during childhood and adolescence, it is important to remember that cerebral palsy is an affectation that lasts throughout life, and the needs of affected people change significantly at each evolutionary stage.
As the people with cerebral palsy grow old, it has been observed that their quality of life tends to decrease. This is related to the appearance of health problems such as pain, fatigue, myelopathies, epilepsy and loss of mobility. Furthermore, these health problems have been shown to have a significant impact on the life expectancy of these people.
In any case, one of the relevant aspects that is often overlooked is cognitive function. However, the cognition encompasses memory, reasoning and other mental functions, and is a crucial predictive factor for the evolution of the individual. The neuropsychological profile of people with cerebral palsy is highly variable depending on etiology, degree of involvement, extent of injury and clinical presentation.
around the 40-60% have a diagnosis of intellectual disability, and this is more common and severe in those with greater motor impairment, and other disorders such as epilepsy. Despite this relationship, even mildly affected individuals may experience cognitive difficulties that may go unnoticed. Similarly, some people with severe motor impairment can maintain their cognitive abilities, which has important implications for their care and support. That's why, neuropsychological assessment is positioned as an essential tool to know the person's functioning, and to adapt the treatment and their environment.
Despite the inherent variability in individual differences and clinical histories, one has been observed general pattern in which verbal skills tend to be relatively better than visuo-perceptual skills, attention, and executive functions. However, there are still many questions to be answered in the field of cerebral palsy. Most research studies focus on mildly affected children and young adults. Expanding research to include more severely affected individuals is crucial, which will require adapting current neuropsychological assessment tools.
We have little information about the evolution of these people as they age. Just as individuals with normative development, people with cerebral palsy can have an impairment, and this can also be cognitive.
A recent study found a significantly higher incidence of dementia diagnosis in people with cerebral palsy, compared to people without cerebral palsy. However, diagnosing cognitive impairment in people with disabilities poses challenges, as it can manifest through behavioral, medical or health problems. It is important to note that similar difficulties have been identified in other conditions, such as intellectual disability associated with syndromes such as Down's, and protocols and best practice guides have been developed to address these challenges.
From the Aspace Catalonia Foundation, the importance of evaluating and adapting to the individual neuropsychological profile is kept in mind, from a multidisciplinary approach. It is essential to continue to advance in this direction and to pool and expand existing knowledge in this field. This will require enable assessment tools, review diagnostic criteria, and develop continuous assessment protocols and action guides. Only in this way, we will be able to adequately address such a relevant need in adulthood. Aware of these new realities that emerge in adulthood, of the people we serve. We will continue to work to deal with it.
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