Early Asthma Onset Associated With Memory and Executive Function Difficulties in Children

Asthma was associated with memory and executive function difficulties in children and could be more severe if asthma onset is earlier in children, according to the results of a recent cohort study published in the Journal of the American Medical Association.¹

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It is largely unknown whether asthma is associated with memory difficulties in children. However, the large prevalence of the condition in children in the United States and the inflammatory process associated with asthma has made it a potential concern, especially as inflammation could extend to the brain as neuroinflammation.¹

The issue has been investigated within the context of corticosteroid treatment. Bender et al demonstrated that children with asthma who are treated with higher doses of corticosteroids exhibited reduced verbal memory compared to those receiving lower doses. Yet the absence of a comparison group in this trial precludes any conclusions regarding asthma and memory abilities.²

Other trials, including one conducted by Jiang et al utilizing functional magnetic resonance imaging, have reported difficulties in executive function, attention, and visual and working memory. However, these trials did not account for confounding effects of socioeconomic factors that could affect the probability of developing asthma and cognitive difficulties. This reality makes it difficult to understand the full picture of the potential association.^1,3

In the current trial, the investigators used data from the Adolescent Brain and Cognitive Development Study to assess whether asthmatic children demonstrate lower memory performance. A set of cognitive measures, including a picture sequence memory test and pattern comparison processing speed test, were used to measure cognitive ability.¹

In total, 237 children with asthma were analyzed based on inclusion and exclusion criteria, with 135 children having earlier childhood onset. Overall, episodic memory improved over time (change in age: β = 0.28; 95% CI, 0.21 to 0.35; P < .001). Notably, though, the earlier childhood onset group demonstrated lower rates of improvements in episodic memory abilities relative to the comparison group (change in age × earlier onset: β = −0.17; 95% CI, −0.28 to −0.05; P = .01).¹

No such difference was observed by the investigators between the later childhood onset group and the comparison group (change in age × later onset: β = −0.02; 95% CI, −0.15 to 0.10; P = .75).¹

Findings like those regarding episodic memory abilities were found after testing longitudinal models for processing speed and inhibition/attention. Improvements over time were observed in processing speed (change in age: β = 0.39; 95% CI, 0.32-0.45; P < .001) and inhibition and attention (change in age: β = 0.29; 95% CI, 0.21-0.36; P < .001), with no major differences found between the groups.¹

Next, the investigators conducted cross-sectional analyses between children with a history of asthma (1031 children) and a comparison group of children without asthma (1031 children). The analyses showed that children with an asthma history performed worse on episodic memory (β = −0.09; 95% CI, −0.18 to −0.01; P = .04), processing speed (β = −0.13; 95% CI, −0.22 to −0.03; P = .01), and inhibition and attention measures (β = −0.11; 95% CI, −0.21 to −0.02; P = .02) relative to the comparison group, according to the study authors.¹

This data provides initial evidence that children who experience asthma are more likely to perform poorly on memory tasks, the study authors discussed. This is the case especially for children who develop asthma earlier, as the condition may be particularly likely to disturb neurodevelopment.¹

One possible explanation for this association could be that the link between asthma and developmental trajectories emerge earlier for memory, perhaps due to its sensitivity to subtle hippocampal injury, the study authors wrote. To address this question, future studies should seek to include additional time points of data.¹

“These results accentuate the need to examine this population more closely to understand the full extent to which asthma influences neurodevelopment,” the investigators concluded.¹

REFERENCES

1. Christopher-Hayes NJ, Haynes SC, Kenyon NJ, et al. Asthma and memory function in children. JAMA Netw Open. 2024;7(11):e2442803. doi:10.1001/jamanetworkopen.2024.42803

2. Bender BG, Lerner JA, Kollasch PA, et al. Mood and memory changes in asthmatic children receiving corticosteroids. Amer Acad Child Asolescent Psychiatry. 1988;27(6):720-725. doi:10.1097/00004583-198811000-00010

3. Kaihua Jiang, Lin Zhu, Yawen Ge, et al. Brain network study of attentional cognitive impairment in children with bronchial asthma. 2021. PREPRINT (Version 1) available at Research Square. doi:10.21203/rs.3.rs-969991/v1]