Study Finds Associations Between Memory Difficulties and History of Asthma in Children

Asthma is a common chronic respiratory disease that affects nearly 5 million US children. In early studies evaluating rodent models, asthma history had indicated possible memory deficits, though there is little known about whether these influences are present in human children. Authors of a study published in JAMA Network Open evaluated data from the Adolescent Brain and Cognitive Development (ABCD) study to determine whether children who have asthma show lower memory performance.

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This cohort study utilized data from the ABCD study, a nationwide longitudinal study of brain development and child health from 21 sites within the US. At baseline, the study enrolled about 11,800 children aged 9 to 10 years. The current study authors extracted baseline, 1-year follow-up, and 2-year follow-up data from ABCD. Additionally, race and ethnicity demographics (eg, American Indian, Asian, Black, Hispanic or Latino, White, or other race) were gathered from the children’s parents or guardians, and these were described to assess the variability in the distribution of racial and ethnic groups across asthma status within the ABCD study.

Inclusion data was based on parent reports of asthma attacks or asthma-related medical treatment, which were combined in 2 ways to generate the longitudinal sample and cross-sectional sample. For the longitudinal sample, the investigators focused on time points for which indicators of both asthma and cognitive performance were available, and children were distinguished based on whether parents reported asthma indicators at baseline and at the 2-year follow-up point (earlier childhood onset group), and those who reported asthma indicators only at the 2-year follow-up (later childhood onset group). Additionally, children in the cross-sectional sample were placed in the asthma group if their parents reported indicators of asthma at any time point, whether it was at baseline, 1-year follow-up, or 2-year follow-up.

Asthma indicators were derived from parent report of their child’s experienced asthma attacks (ranging from 0 to 40) and medical treatment for asthma (yes or no). The use of these indicators was previously validated and shown to be highly associated with polygenic risk score of asthma. Additionally, an examination of reported medications confirmed higher frequency of use of asthma-related medications—including bronchodilators, corticosteroids, or other anti-inflammatories—among children with asthma compared with the comparison group in both the longitudinal and cross-sectional samples. Memory performance was assessed using the Picture Sequence Memory Test, Pattern Comparison Processing Speed Test, and the Flanker Inhibitory Control and Attention Test.

According to the findings, a total of 237 children with asthma with a mean age of 9.90 years were identified and included in the study. Most of the children were male (n = 76; 56%), White, (n = 91; 48%) and had asthma onset earlier in childhood (n = 135). A comparison group of children without asthma (n = 237) with matching covariates at baseline was also created.

The data presented that, overall, episodic memory improved over time (change in age: β = 0.28; 95% CI, 0.21 to 0.35; P < .001), but those with earlier childhood asthma onset showed lower rates of improvements within episodic memory activities relative to the comparison group (change in age × earlier onset: β = −0.17; 95% CI, −0.28 to −0.05; P = .01). This difference was not observed 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).

Longitudinal models were also tested for processing speed as well as inhibition and attention. Similarly to episodic memory, the investigators observed improvements over time in both processing speed (change in age: β = 0.39; 95% CI, 0.32-0.45; P < .001) as well as inhibition and attention (change in age: β = 0.29; 95% CI, 0.21-0.36; P < .001); however, no significant group differences were observed.

According to the investigators, these findings were unaffected by the inclusion and exclusion of the outlined covariates and the use of alternative asthma indicators, such as asthma attacks. Further, the results were replicated with models that utilized the entirety of the ABCD sample comparison group candidates (eg, children without any asthma indicators at any visit; 8414 in sample at baseline) without implementing any matching procedure.

Additionally, the authors also found that a cross-sectional analysis showed that children with a history of asthma 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 those without a history of asthma. These results, noted the study authors, were not affected by the inclusion and exclusion of the outlines covariates.

Limitations of the study include the study’s inability to precisely assess the severity of asthma or its exact onset and duration as well as the interactions between prescription corticosteroids and neurocognitive development or asthma. Additionally, the authors suggested that future research should prospectively recruit patients based on key factors such as severity of asthma, medication regimen, and exposure to environmental pollutants.

REFERENCE

Christopher-Hayes NJ, Haynes SC, Kenyon NJ, Merchant VD, Schweitzer JB, Ghetti S. Asthma and Memory Function in Children. JAMA Netw Open. 2024;7(11):e2442803. doi:10.1001/jamanetworkopen.2024.42803