A large cross-sectional study in the US has suggested that paediatric atopic dermatitis could be associated with a greater risk of learning and memory difficulties, particularly in children who might have comorbid neurodevelopmental disorders, according to the researchers.
In a weighted sample of more than 69m children, they found that those with atopic dermatitis were more likely to experience learning difficulties compared with their peers without the condition (10.8% vs 5.9%, P<0.001), along with memory difficulties (11.1% vs 5.8%, P<0.001), reported Joy Wan, MD, MSCE, of Johns Hopkins University School of Medicine in Baltimore, and colleagues.
After adjusting for socio-demographic factors, asthma, food allergiesb and seasonal allergies or hay fever, atopic dermatitis was still associated with increased odds of difficulties in learning (adjusted OR 1.77, 95% CI 1.28-2.45) and memory (aOR 1.69, 95% CI 1.19-2.41), the group detailed in JAMA Dermatology.
They said the association was primarily limited to children with neurodevelopmental comorbidities, like attention deficit-hyperactivity disorder (ADHD) or learning disabilities.
Youngsters with atopic dermatitis were more likely to have ADHD (11.3% vs 7.2%), developmental delay (7.8% vs 4.1%), and learning disability (7.5% vs 4.5%).
“These findings may improve the risk stratification of children with AD (atopic dermatitis) for cognitive impairments and suggest that evaluation for cognitive difficulties should be prioritised among children with AD and neurodevelopmental disorders,” the authors added.
Among children with atopic dermatitis, no learning difficulties were reported by 58.7% of those with any neurodevelopmental comorbidity, compared with 96.4% of those with no neurodevelopmental comorbidity, and no memory difficulties were reported by 60.4% of those with any neurodevelopmental comorbidity, compared with 96.3% of those with none.
“Our results also suggest that memory and learning difficulties related to AD may vary by neurodevelopmental condition,” Wan and co-authors noted. After stratification of outcomes by neurodevelopmental condition, memory difficulties were two to three times more likely among children with atopic dermatitis and:
• Any neurodevelopmental disorder (aOR 2.26, 95% CI 1.43-3.57)
• ADHD (aOR 2.90, 95% CI 1.60-5.24)
• Learning disabilities (aOR 2.04, 95% CI 1.04-4.00)
Learning difficulties were also observed among children with atopic dermatitis and neurodevelopmental disorders (aOR 1.52, 95% CI 1.00-2.32), particularly ADHD (aOR 1.78, 95% CI 0.97-3.26), but this finding was not statistically significant.
Adjusted analyses also showed that older children had slightly increased odds of difficulties in learning (aOR 1.07, 95% CI 1.05-1.10) and memory (aOR 1.11, 95% CI 1.08-1.13), while female sex was linked with lower odds of learning difficulties (aOR 0.76, 95% CI 0.60-0.96).
Wan and colleagues suggested several possible explanations for their findings: paediatric patients with atopic dermatitis and concomitant learning disabilities may be more likely to be identified and receive appropriate intervention; or atopic dermatitis may have varying effects on different aspects of cognition, “with perhaps a greater impact on memory than on learning”.
“For example, sleep disturbances from AD may contribute to greater difficulties with memory in this context,” they wrote.
Medpage reports that for the study, the researchers used data on 69 732 807 children from the 2021 National Health Interview Survey (NHIS), 13.2% of whom had atopic dermatitis. Mean age was 8.6 years, 50.3% were boys, and 77% were white. Children with atopic dermatitis were more likely to be of black or non-Hispanic race and ethnicity, have poorer health, and have other atopy.
Participants’ status was based on parent or caregiver reports of atopic dermatitis symptoms, learning and memory problems, and a current or confirmed diagnosis of atopic dermatitis.
Limitations noted by the authors included use of caregiver-perceived cognitive difficulties, and the absence of NHIS data on atopic dermatitis severity, age at diagnosis, and sleep. These studies have relied primarily on neurodevelopmental diagnoses (rather than symptoms) as proxy measures of cognitive function, they added.
“It remains unknown if certain subpopulations of children with AD are at greater risk of cognitive impairment.”
Study details
Symptoms of cognitive impairment among children with atopic dermatitis
Emily Ma, Hannah Chang, Sarah Radtke et al.
Published in JAMA Dermatology on 6 March 2024
Abstract
Importance
Previous studies suggest that atopic dermatitis (AD) is associated with cognitive impairment in children, but these studies have relied primarily on neurodevelopmental diagnoses (rather than symptoms) as proxy measures of cognitive function. It remains unknown if certain subpopulations of children with AD are at greater risk of cognitive impairment.
Objective
To examine the association of AD with symptoms of cognitive impairment (difficulty in learning or memory) among US children and whether this association varies according to the presence or absence of neurodevelopmental comorbidities (attention-deficit/hyperactivity disorder [ADHD], developmental delay, or learning disability).
Design, Setting, and Participants
This cross-sectional study used 2021 data from the US National Health Interview Survey collected on children aged 17 or younger without intellectual disability or autism. The presence of AD was based on a parent or adult caregiver’s report indicating either a current diagnosis of AD or a previous medical confirmation of AD by a health care professional.
Main Outcomes and Measures
Difficulty with learning or memory as reported by the child’s caregiver.
Results
Among the weighted total of 69 732 807 participants, 9 223 013 (13.2%) had AD. Compared with children without AD, children with AD were more likely to experience difficulties with learning (10.8% [95% CI, 7.8%-15.8%] vs 5.9% [95% CI, 5.1%-6.9%]; P < .001) and difficulties with memory (11.1% [95% CI, 8.0%-15.9%] vs 5.8% [95% CI, 4.9%-6.9%]; P < .001). In multivariable logistic regression models adjusted for socio-demographic factors, asthma, food allergies, and seasonal allergies or hay fever, AD was associated with increased odds of difficulties in learning (adjusted odds ratio [AOR], 1.77; 95% CI, 1.28-2.45) and memory (AOR, 1.69; 95% CI, 1.19-2.41). In analyses stratified by neurodevelopmental comorbidities, AD was associated with 2- to 3-fold greater odds of memory difficulties among children with any neurodevelopmental disorder (AOR, 2.26; 95% CI, 1.43-3.57), including ADHD (AOR, 2.90; 95% CI, 1.60-5.24) or learning disabilities (AOR, 2.04; 95% CI, 1.04-4.00). However, AD was not associated with learning or memory difficulties among children without neurodevelopmental conditions.
Conclusions and Relevance
Results of this cross-sectional study suggest that paediatric AD was generally associated with greater odds of reported difficulties in learning and memory. However, this association was primarily limited to children with neurodevelopmental comorbidities, such as ADHD or learning disabilities. These findings may improve the risk stratification of children with AD for cognitive impairments and suggest that evaluation for cognitive difficulties should be prioritised among children with AD and neurodevelopmental disorders.
JAMA Dermatology article – Symptoms of Cognitive Impairment Among Children With Atopic Dermatitis
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