IJCRR - 14(18), September, 2022
Pages: 17-20
Date of Publication: 24-Sep-2022
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Role of Allergic Rhinitis in Cognitive Functions and Psychological Condition of Children Aged 8-16 years
Author: Ipsa Kujur, Mamata Panda, Suryakanta Swain, Bishwajit Mishra, Smruti Dash Mohapatro, Manisha Patro
Category: Healthcare
Abstract:Introduction: Allergic rhinitis (AR) is defined as a symptomatic disorder of the nose induced after coming in contact to allergens by an immunoglobulin E(IgE) mediated inflammation. Allergic rhinitis is one of the commonest chronic allergic diseases in school age group. AR is clinically diagnosed and its symptoms are watery nose, nasal obstruction, itching and sneezing.AR is divided into intermittent or persistent disease according to the duration of active symptoms. The severity of AR can be classified as mild, moderate or severe according to the level of disturbance of the daily activities. Around 20-30% of the population suffers from AR and the majority of them show symptoms from 6-7 years of age. Objectives/Aim: To evaluate the role of symptomatic allergic rhinitis in cognitive functioning of a child and the effect of allergic rhinitis on the psychological condition of affected children. Methodology: A prospective observational study was carried out in the OPD/IPD of HI-TECH Medical college and hospital from 1st September 2019-31st October 2021.150 children were evaluated in this period special questionnaire regarding the quality of life in rhinitis patients for psychological well-being and their cognitive ability like verbal memory, memory retrieval, working memory, information processing, color word interference and cognitive flexibility was evaluated with the help of computerized Visual verbal learning test(VVLT) and Stroop colour word test(SCWT). Results: In the study we found out that there was a significant association with age in years with working memory/memory retrieval/colour word interference/cognitive flexibility, with p less than 0.05. The psychological status of children was assessed by the questionaries and was found to be affected due to regular medications leading to inattentive behavior, absence from school, stress on parents due to high burden of disease, shame because of the persistent nature of the disease and feeling drowsy throughout on medications. Conclusion: Allergic rhinitis affects the psychological well-being of a child and decreases cognitive ability but there is no cognitive impairment drastically.
Keywords: Allergic rhinitis, cognitive function, psychological condition, visual verbal learning test, Stroop colour word test, questionaries on allergic rhinitis
Full Text:
INTRODUCTION:
Allergic rhinitis (AR) is a common chronic disease.1. ISAAC phase 1 revealed that in India 12.5% of children in the age group of 6-7 years and18.6%in the age group of 13-14 years had nasal symptoms related to allergic rhinitis.ISAAC phase 3 revealed an elevation in nasal symptoms to 12.9% and 23.6 % in 6-7- and 13-14-year age groups respectively.4ARis often underestimated. Not only physical manifestations but mental problems, reduce the quality of life (QOL).6,9Allergic rhinitis can have a negative impact on scholastic performance and work performance which contributes to the experience of stress and agony in children.3 Children with allergic rhinitis report increased sleep disturbances secondary to allergic symptoms and increased daytime fatigue which affects school performance.5Michael S Blaiss wrote an article on behalf of the allergic rhinitis in school children consensus group in 2004.2The group concluded that allergic rhinitis symptoms can have considerable harmful effects on absenteeism, presenteeism(inattention, distraction, lack of concentration), cognitive impairment(difficulty in the use of speech, visual perception and construction, calculation ability, information processing and execution etc), poor school performance, behaviour and psychosocial problems in school children.10 Symptomatic allergic patients are significantly slower in processing particular data than non-symptomatic patients. 8 Remembering things and making decisions along with basic functions such as speed directly influences most aspects of daily activities. Consequently, slow thinking and motor action may impose difficulty on the child in an attempt to maintain a certain performance. This causes fatigue and increased susceptibility to distraction. This increases stress in a family system like parent-child conflict, parental sleep disruption, increased parenting stress etc. Therefore, it affects both the child and the parents. Now the question arises if cognition and psychosocial well-being is compromised then to what extent
MATERIALS AND METHODS
This study will be done at Hi-Tech Medical college and hospital Bhubaneswar. The study will cover children aged from 8-16 years. Patient particulars like age, sex, and address will be noted. Detailed history including the age of onset of illness, duration of illness (seasonal or perineal), family history of atopy, previous anti-allergy treatment and history of scholastic performance will be recorded. Four aspects of cognitive development will be measured. To assess VERBAL MEMORY, Visual Verbal Learning Test (VVLT) will be carried out.15 words will be shown and the child will be asked to remember the words shown to him/her. This procedure will be repeated 5 times. A number of words recalled immediately shows WORKING MEMORY. Then after 20 minutes, words remembered show long-term memory(MEMORY RETRIEVAL). To test the information processing of the child, the Stroop-Colour-Word Test (SCWT) will be carried out. The test will involve three cards showing colour names(SCWT1), coloured figures (SCWT2) and names of the colour written in different coloured ink from the name of the colour it is suggesting (SCWT 3). On the first and second cards, the colour names and figures showing the same colour, no incongruity have to be read aloud as quickly as possible, which shows the speed of INFORMATION PROCESSING. On the third card, the amount of time required to discard irrelevant but important information (reading of colour name)will be recorded. The difference between SCWT3 and the mean of SCWT1 and SCWT2 will reflect “COLOUR WORD INTERFERENCE”, which shows COGNITIVE FLEXIBILITY. The results from the above test will be represented using appropriate tables, graphs and diagrams. The psychological condition of the patient will be evaluated using a customised questionnaire.
RESULTS:
The below graphs and tables give us the interpretation that allergic rhinitis patients have a slower working memory, memory retrieval is poor and cognitive flexibility is affected in comparison with normal kids. The significant p-value is set as 0.05. But there isn’t a major change seen in the children in comparison to non-allergic kids. The effect in the psychological domain is far more than in the cognitive domain due to various reasons.
DISCUSSION:
Cognitive impairment (also known as intellectual disability) is a term used when an individual has some kind of shortcomings in mental function and in domains such as communication, self-help and social interaction. These shortcomings will cause a hindrance in the learning and development of a child. The affected child will be slower than a typical child. It is diagnosed with the help of standardized tests of intelligence and adaptive behaviour. Children going through cognitive problems such as low attention, poor memory or lack of inhibition may later suffer mental health issues as teenagers and young adults.7 Allergic rhinitis is one of the major reasons because of why children miss school in childhood days. Due to rhinorrhoea, headache, sleepless nights, difficulty in concentrating, sleeping pattern problems and lethargy, short-term memory problems are seen in children. The consequences of symptomatic allergic rhinitis can extend to adult life affecting the quality of life in all its aspects. Allergic rhinitis causes emotional problems in children causing them to be depressed and ashamed of themselves, hence decreasing their performance in school.
CONCLUSION
Symptomatic allergic rhinitis disturbs day-to-day life due to signs and symptoms experienced and due to grave impact on mental health. Some investigations and tests have been run to gauge the effect on cognitive functions objectively. But still remains uncertain if it leads to an objective reduction in cognitive functions of the affected child. The psychological condition of the affected patients was significantly impaired.
ACKNOWLEDGEMENT-DR PANDA MAMATA, ASSOCIATE PROFESSOR, DEPT.OF PAEDIATRICS
DR MISHRA BISHWAJIT, ASSOCIATE PROFESSOR, DEPT.OF PAEDIATRICS
DR SWAIN SURYAKANTA, PROFESSOR AND HOD, DEPT.OF PAEDIATRICS
DR DASH MOHAPATRA SMRUTI, MBBS,3rd YEAR POSTGRADUATE, DEPT.OF PAEDIATRICS
DR PATRO MANISHA, MBBS,3rd YEAR POSTGRADUATE, DEPT.OF PAEDIATRICS
SOURCE OF FUNDING-NONE
CONFLICT OF INTEREST-NONE
AUTHORS CONTRIBUTIONS- DR IPSA KUJUR: Integrity of the data and accuracy of the data analysis; study of concept and design; critical revision of the manuscript for important intellectual content; study supervision.
DR. MAMATAPANDA: Study concept and design; acquisition, analysis or interpretation of the data; study supervision
DR BISHWAJIT MISHRA AND DR SURYAKANTA SWAIN: Acquisition, analysis or interpretation of the data; study supervision
DR SMRUTI DASH MOHAPATRA: critical revision of the manuscript for important intellectual content
DR MANISHA PATRO: Drafting of the first manuscript
ETHICAL CLEARANCE: INSTITUTIONAL ETHICS COMMITTEE,HI TECH MEDICAL COLLEGE AND HOSPITAL; No.HMCH/IEC/2021/124, dated 6 10 2021
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