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The Fragile X mental retardation protein.

The clinical features of the Fragile X mental retardation syndrome are linked to the absence of the set of protein isoforms, derived from alternative splicing of the Fragile X mental retardation gene 1 (FMR1), and collectively termed FMRP. FMRP is an RNA binding protein that is part of a ribonucleoprotein particle associated to actively translating polyribosomes, and which can shuttle between nucleus and cytoplasm. Two highly homologous human proteins, FXR1P and FXR2P, share the same domain structure as FMRP, and probably similar functions. The properties of FMRP suggested that it is involved in nuclear export, cytoplasmic transport, and/or translational control of target mRNAs. In particular, it may play a role in regulation of protein synthesis at postsynaptic sites of dendrites, and in maturation of dendritic spines. Efforts are underway to identify the putative specific mRNA targets of FMRP, and study the effect of FMRP absence on the corresponding proteins. Other approaches have led to the identification of proteins that interact with FMRP. Some of them discriminate between FMRP and the homologous FXR1/2P proteins, and may thus be important for defining unique functions of FMRP that are deficient in Fragile X patients. The physiological functions of FMRP are notably approached through the study of a FMR1 knock-out mouse model. The recent identification in Drosophila melanogaster of genes encoding homologs of FMRP/FXRP and of their interacting proteins, open the way to use of Drosophila genetics to study FMRP function.

Animals↗

Cognitive rigidity in the aged and the mentally retarded.

Three groups, one of elderly, one of young mentally retarded, and one of non-retarded young persons were compared on a visual recognition task which involved changing from one category of identification to another. The mentally retarded participants had greater difficulty in changing categories than did the non-retarded participants. Results for the elderly were similar but may have been partly due to the choice of stimulus material. In a second task, the same elderly and non-retarded young participants named as many objects as possible in one minute. The elderly group produced fewer responses on average than the young group and fewer categories of such responses. Results suggested that older persons find it more difficult to change between different categories of identification.

Adult↗

Antibody to hepatitis A antigen in institutionalized mentally retarded patients.

Institutionalized patients with Down syndrome and matched controls with other causes of mental retardation were tested by immune adherence hemagglutination for the presence of antibody to hepatitis A antigen (anti-HA). Altogether 75.1% (175 of 233) exhibited presence of anti-HA, with no differences by sex or age. Patients reactive for hepatitis B surface antigen (HBsAg) or its antibody (anti-HBs) were reactive for anti-HA significantly more frequently than those with a negative reaction for these markers. In contrast to serologic markers of hepatitis type B, prevalence of anti-HA does not depend on the cause of mental retardation or on the age at primary infection. The rate of anti-HA positivity was found to be closely correlated with duration of institutionalization. The study confirmed that many closed institutions for the mentally retarded are hyperendemic for hepatitis type A and that formation of anti-HA is not greatly affected by either immune deficiency or immune immaturity.

Adolescent↗

Are children with Down syndrome less careful in performing a tray-carrying task than children with other types of mental retardation?

To investigate whether children with Down syndrome are less careful in performing motor tasks than children with other types of mental retardation, a tray-carrying task was devised in which subjects carried a tray bearing a glass filled with water which they tried not to spill. This task was given to children with Down syndrome (6 boys and 4 girls, n = 10) and those with other types of mental retardation (9 boys and 9 girls, n = 18; most of them diagnosed as undifferentiated). Mean chronological ages in the groups were 15.4 yr. for the Down group, and 16.3 yr. for the Mental retardation group. Mental ages were the same in both groups: 4.8 yr. The performance of children with Down syndrome was not significantly different from that of other children as measured by the amount of water spilled. Children with Down syndrome required more time and took more steps than the other children, although the time taken for each step was the same in both groups. The strategy of children with Down syndrome appeared to be to make each unit of movement smaller to carry out the given motor task.

Adolescent↗

Basic money-counting skills of children with mental retardation.

The thought processes involved in counting and comparing small amounts of money among children and adolescents with Down syndrome (n = 17), other children and adolescents with mental retardation of unknown etiologies (n = 17), and normally developing first graders (n = 15) were examined. Three different tasks that progressively reduced the cognitive demands placed on the children were used. Although not generally different from each other, the two groups of children with mental retardation had far greater difficulties with the tasks than normals. Also, as the complexity of the counting task increased, the number of comparison errors made by the children with mental retardation increased. Based on the findings, a program for teaching money principles to children with mental retardation was proposed.

Achievement↗

Pharmacological outcomes in people with mental retardation and epilepsy.

The aim of this study was to examine prospective outcomes in mentally retarded people with epilepsy seen for the first time during 1998 until the end of 2001. Two hundred and fourteen patients (120 men, 94 women, aged 11-70 years [median 34 years]) were referred over this 4-year period. Median duration of follow-up was 18 months (range, 13-36 months). Seventeen (8%) had nonepileptic attacks only, 10 of whom were being treated with antiepileptic drugs (AEDs). The remaining 197 (92%) patients had epilepsy, the majority (n=151, 77%) presenting with focal seizures. A total of 22 patients were started on AED treatment, with seizure freedom for at least a year being achieved in 10 (45%). AED manipulation was undertaken in a further 136 patients, resulting in 59 (43%) becoming seizure-free. No relationship was found between extent of mental retardation and seizure control. There was no deterioration in mean caregiver scores rating sleep, appetite, alertness, and behavior. These findings suggest that AED therapy can result in seizure freedom in more than 40% of mentally retarded people with epilepsy without producing unacceptable toxicity.

Adolescent↗

Anthropometric asymmetry in normal and mentally retarded males.

Anthropometric asymmetry was considered in a sample of 202 normal and about 200 mentally retarded males. In addition to height, 11 bilateral measurements of bone, soft tissue and strength were taken. Differences between bilateral measurements were analysed in terms of absolute and signed differences, and in terms of the differences corrected for height. Mentally retarded individuals show greater anthropometric asymmetry than normal individuals in both absolute measurements and those corrected for height. The distributions of the differences, both absolute and signed, are also broader in the retarded, and variances of the left-right differences are greater than variances associated with measurement. Left-right differences between the normal and retarded males occur primarily in the upper extremity; in contrast, side differences in the lower extremity are not great. Within the mentally retarded sample, there are no significant left-right differences among different I.Q. groups. However, there are significant differences among aetiological categories, and those with neurological impairment are more structurally asymmetrical.

Adolescent↗

Hemizygosity of delta-catenin (CTNND2) is associated with severe mental retardation in cri-du-chat syndrome.

Delta-catenin is an adherens junction protein involved in cell motility and expressed early in neuronal development. It was discovered as an interactor with presenilin-1. The genomic structure of the human delta-catenin gene (Human Gene Nomenclature Committee-approved symbol CTNND2) was determined and mapped to 5p15.2. A deletion of this chromosomal region has been associated with the cri-du-chat syndrome (CDCS), a segmental aneusomy syndrome of 5p that is associated with an unusual high-pitched cry at birth, facial dysmorphology, poor growth, and severe mental retardation. delta-catenin maps to a specific region in 5p15.2 that has been implicated in the mental retardation phenotype. The breakpoints in patients with 5p terminal deletions were characterized with respect to the severity of mental retardation and the physical location of the delta-catenin gene. A strong correlation was found between the hemizygous loss of delta-catenin and severe mental retardation. These findings and the properties of delta-catenin as a neuronal-specific protein, expressed early in development and involved in cell motility, support its role in the mental retardation of CDCS when present in only one copy.

Armadillo Domain Proteins↗

Gilles de la Tourette disorder among individuals with severe or profound mental retardation.

There have been limited reports on the incidence of Gilles de la Tourette disorder among individuals with mental retardation. Only three cases have been reported in people with severe or profound mental retardation. In this paper three additional case reports of people with severe or profound mental retardation and Tourette disorder were presented. Issues related to the diagnosis of Tourette disorder in this population were discussed.

Adult↗

[About the sexual hygiene of mental retarded boys, an exercise of the sexual pedagogic (author's transl)].

The sexual hygiene of mental retarded boys is examinated. In comparison with normal school boys is pointed out the necessity of sexual pedagogic education. The striking more numerous quote of balanitis in mental retarded boys is discussed with a critical review of Literature about the cleanness of the hands while miction of man, about the cleanness of the inferior abdomen, the cleanness of the pants and the hygiene of the toilet. The conclusion is drawn, that the cleaning of the foreskin has also to be observed by the mental retarded men, boys once a week and youths day by day.

Adolescent↗

Chromosomal abnormalities in mentally retarded children in the Konya region--Turkey.

Etiology of mental retardation is diverse. 120 Students from 11 special training, education, and rehabilitation subclasses were investigated cytogenetically for determining the contribution of chromosomal abnormalities to mild mental retardation. 23 of the 120 children (19%) had chromosomal abnormalities: thirteen cases a classical trisomy 21 (the male:female ratio was 9:4), three a balanced autosomal reciprocal translocation, one a pericentric inversion of chromosome 9, and six fragile-X syndrome (The male:female ratio was 5:1).

Adolescent↗

Mapping to distal Xq28 of nonspecific X-linked mental retardation MRX72: linkage analysis and clinical findings in a three-generation Sardinian family.

Families with mentally retarded males found to be negative for FRAXA and FRAXE mutations are useful in understanding the genetic basis of X-linked mental retardation. According to the most recent data (updated to 1999), 69 MRX loci have been mapped and 6 genes cloned. Here we report on a linkage study performed on 20 subjects from a 4-generation Sardinian family segregating a non-specific X-linked recessive mental retardation (XLMR)(MRX72) associated with global delay of all psychomotor development. Five of 8 affected males have been tested for mental age, verbal and performance skills and behavioral anomalies; mental impairment ranged from mild to severe. Only minor anomalies were present in the affected subjects. Two-point linkage analysis based on 28 informative microsatellites spanning the whole X chromosome demonstrated linkage between the disorder and markers DXS1073 and F8c in Xq28 (maximum Lod score of 2. 71 at straight theta = 0.00). Multipoint linkage analysis confirmed the linkage with a Z(max) of 3.0 at straight theta = 0.00 at DXS1073 and F8c. Recombination in an affected male at DXS1073 and F8c allowed us to delimit centromerically and telomerically the region containing the putative candidate gene. The region, where MRX72 maps, overlaps that of another MRX families previously mapped to Xq28, two of which harbored mutations in GDI. Involvement of this gene was excluded in our family, suggesting another MRX might reside in Xq28.

Adolescent↗

Job interview training for the mentally retarded: issues and applications.

Vocational training has long been a major part of habilitation programs for mentally retarded adults. However, even after retarded persons develop work habits and skills, they may be unable to convince potential employers of their vocational competence. The present article discusses the rationale for systematically teaching mentally retarded persons job interview and other job finding skills, and reviews applied job interview training research with mentally retarded clients and other low functioning populations. Implementation of training techniques is also discussed.

Employment↗

Gold Award: Reducing the admissions of high-risk chronic patients to state institutions. Gulf Coast Regional Mental Health-Mental Retardation Center, Galveston, Texas.

A regional mental health-mental retardation center has reduced admissions to state institutions for the citizens of the Gulf Coast in Texas by 74 per cent over the past ten years. The center serves first those most in need, based on risk of institutionalization. Because it focuses on the clients' level of functioning rather than on diagnosis, retardation services are not separated from mental health services. There are outpatient programs, day treatment programs, and residential services. Treatment stress clients' acquisition of practical living skills. The center's innovative measures include the use of law enforcement officers who are trained to recognize and deal with mentally and emotionally disturbed clients and thus divert them from the criminal to the mental health system, a liaison team that assesses programs and support systems needed to bring institutionalized clients back to the community, and a local inpatient unit for clients in crisis that precludes commitment to state hospitals.

Chronic Disease↗

Recurrence risks in mental retardation.

Despite improvements in diagnostic techniques and progress made in mapping genes associated with syndromal mental handicap, the estimation of recurrence risks in non-syndromal mental retardation is still dependent on empirical data. Unfortunately, few studies are available to guide the clinician and their results differ significantly. For example, recurrence risks to all sibs of a male index patient with severe mental retardation vary between 3.5% and 14% in commonly quoted series. The present review highlights the problems involved in interpreting the previous work in this area and discusses the definition of mental retardation according to the degree of severity, phenotype, and its pattern of inheritance. In planning future studies, an appreciation of these issues should allow us to derive accurate and comparable risk figures for use in counselling affected subjects and their families.

Female↗

A patient with mental retardation and possible panic disorder.

The limited communication skills and varying behavior patterns of people with mental retardation make the diagnosis of psychiatric disorders a challenging task. The authors present the case of a patient with mild mental retardation and possible panic disorder whose panic symptoms were missed by clinicians until a structured questionnaire to screen for those symptoms was administered. In assessing people with mental retardation for psychiatric disorder, clinicians should be alert to the possibility of panic disorder if patients show avoidant behaviors and report vague somatic complaints. A simplified structured format for assessment may lead to more accurate diagnosis.

Communication Barriers↗

[The complex relation between obesity and mental retardation in children].

In a group of 27 obese mentally retarded children compared with an equal-sized group of children with normal weight the author demonstrates the adverse influence of obesity on the development of mental retardation. The latter is reinforced by other factors. To resolve this problem it would be useful to adhere to preventive measures against the development of obesity, to compensate complications of the basic diagnosis, and in particular a greater activity of health workers.

Child↗

Medical evaluation of persons with mental retardation referred for psychiatric assessment.

Many people with developmental disabilities and "challenging behaviors" present to primary care physicians, internists, or general psychiatrists for assessment and treatment. These clinicians seek to provide the comprehensive biopsychosocial assessment necessary for successful treatment, but may encounter interference from funding agencies. Epidemiologic data on medical comorbidity in persons with developmental disabilities with a primarily "behavioral" presentation may assist in facilitating these assessments. A total of 1135 people with mental retardation referred for mental health assessment were medically evaluated according to a two-step protocol which included a screening evaluation of all persons and expanded testing, depending on clinical status. The workup was considered complete when the person with either improving clinically or had a specific terminal diagnosis and was as comfortable as possible. Medical comorbidity was about double that of people referred for mental health assessment who do not have mental retardation. Common conditions presented in unusual ways, and less frequent conditions presented more often. The cost of the medical assessments was promptly recovered in a variety of savings to systems. Comprehensive medical assessment discloses increased medical comorbidity in persons with mental retardation referred for psychiatric evaluation. Comprehensive treatment based on the assessment findings appears to be associated with better clinical outcomes and cost savings to systems.

Adult↗