Problematic psychosocial adaptation and executive dysfunction in women and men with myelomeningocele

Abstract

Purpose: Myelomeningocele (MMC) is caused by incomplete neural tube development, affecting physical, cognitive and adaptive functioning. The aim of this study was to characterize women and men with problematic psychosocial adaptation with respect to cognitive functions and psychological symptoms. It was expected that cognitive functions, especially the executive functions, were mostly impaired. In addition, the clinical history, the neurological and the psychological functioning was investigated. Method: Twelve participants (six men, six women; age range 24–41 years) with MMC were recruited from TRS National Resource Centre for Rare Disorders. Inclusion criteria were (1) uncompleted upper secondary school, (2) unemployment and (3) lack of social relationships. The participants underwent a systematic clinical history, a clinical neurological examination, a neuropsychological assessment and questionnaires regarding cognitive and psychological functioning. Results: All participants had major neurological deficits and most of them had hydrocephalus and Chiari-II malformation. Cognitive deficits were present in a range of domains, especially the executive functions. The neuropsychological findings showed no obvious difference between men and women. Symptoms of psychopathology were more pronounced in women. The men were less capable to structure daily living. Conclusions: The neuropsychological findings disclosed that the executive functions were most impaired. Future research should be directed towards cognitive rehabilitation.

Implications for Rehabilitation

• It is conceivable that executive deficits in patients with myelomeningocele are decisive for problematic psychosocial adaptation.

• Cognitive rehabilitation should be considered for neuropsychological impairments to improve psychosocial functioning and quality of life.

• Gender differences in psychological functioning are evident.

Keywords::

• Chiari-II malformation
• cognitive function
• executive function
• hydrocephalus
• myelomeningocele
• psychological symptoms
• psychosocial problems
• spina bifida

Acknowledgements

We thank the nurses Karen Grimsrud, Astri Andersen and Pål-Erik Plaum for assistance in taking care of the participants and contributing to take the clinical history.

Declarations of interest: The authors report no conflict of interest.