Cognitive Evaluation Necessary Among Children with Eczema, Comorbid Neurodevelopmental Disorders

A cognitive evaluation looking into potential impairment among children with atopic dermatitis (AD) may be necessary for such patients with comorbid neurodevelopmental disorders such as attention-deficit/hyperactivity disorder (ADHD), according to new findings.¹

This new research was conducted to look into AD’s link with cognitive impairment symptoms such as learning or memory issues, specifically looking at US children. The team of investigators also sought to examine whether such an association shows any variation with neurodevelopmental comorbidity presence.

This study was led by Emily Z. Ma, BA, from the University of Maryland School of Medicine in Baltimore. Ma and colleagues. Prior research had already been conducted regarding cognitive dysfunction and eczema patients, though specifics about subgroups and their susceptibility were not yet apparent.²

“Thus, we investigated the association between AD and learning or memory difficulties and whether this association varies according to the presence or absence of comorbid neurodevelopmental conditions (ie, ADHD, developmental delay, or learning disability),” Ma and colleagues wrote.

Background and Methods

The investigators used a cross-sectional study design and looked at data which had been sourced from the 2021 National Health Interview Survey (NHIS). The NHIS provided a comprehensive representation of American households, and the research team selected a single child from each surveyed household.

The information on the child necessary for the study was provided by their parents or adult caregivers. The Johns Hopkins Institutional Review Board granted approval for this research, as it involved the implementation of publicly accessible and de-identified information.

The investigators assessed children in the age range of 17 years or younger who did not exhibit autism or an intellectual disability. The team looked at atopic dermatitis and based their data on affirmative responses to either of the following inquiries:

• “Does the child get an itchy rash due to eczema or atopic dermatitis?”
• “Have you ever been told by a doctor or other health professional that the child had eczema or atopic dermatitis?”

Furthermore, the research team evaluated learning disability, developmental delays, and ADHD through direct questions in their surveys. An evaluation of the child’s learning and memory issues was carried out through the following inquiry:

• "Does the child encounter difficulty learning [or remembering] things compared to other children of the same age?"

The team later assessed their learning and memory issues as dichotomous outcomes, looking at whether they reported any difficulties compared to no difficulties. A logistic regression was also done by the team to compare odds of such difficulties between subjects with and without eczema.

Findings

The investigators ended up with a cohort of 69,732,807 subjects, with 13.2% having been diagnosed with atopic dermatitis. Those impacted by the skin disease were shown by the research team to have exhibited an increased likelihood of challenges experienced in learning (10.8% [95% CI, 7.8%-15.8%] versus 5.9% [95% CI, 5.1%-6.9%]; P < .001) and in memory (11.1% [95% CI, 8.0%-15.9%] versus 5.8% [95% CI, 4.9%-6.9%]; P < .001) in comparison to individuals shown not to have the condition.

Once the investigators adjusted for asthma, sociodemographic elements, allergies to different foods, and seasonal allergies or hay fever in their multivariable logistic regression models, they reported that eczema was linked with difficulties in learning odds increases (adjusted odds ratio [AOR], 1.77; 95% CI, 1.28-2.45) and memory (AOR, 1.69; 95% CI, 1.19-2.41).

Additionally, the research team found that children with the skin disease were shown to have a 2- to 3-fold greater likelihood of memory difficulty experiences provided that they had any neurodevelopmental disorders (AOR, 2.26; 95% CI, 1.43-3.57), with learning disabilities (AOR, 2.04; 95% CI, 1.04-4.00) and ADHD being examples (AOR, 2.90; 95% CI, 1.60-5.24).

Despite such findings, the investigators also found that among children that were reported as not having neurodevelopmental issues, no link was shown to exist between eczema and learning or memory issues.

“These findings may improve the risk stratification of children with AD for cognitive impairment and suggest that evaluation for cognitive impairment should be prioritized among children with AD and comorbid ADHD or learning disability,” they wrote.

References

1. ^{Ma EZ, Chang HR, Radtke S, Wan J. Symptoms of Cognitive Impairment Among Children With Atopic Dermatitis. JAMA Dermatol. Published online March 06, 2024. doi:10.1001/jamadermatol.2024.0015.}
2. ^{Jackson-Cowan L, Cole EF, Silverberg JI, Lawley LP. Childhood atopic dermatitis is associated with cognitive dysfunction: a National Health Interview Survey study from 2008 to 2018. Ann Allergy Asthma Immunol. 2021;126(6):661-665. doi:10.1016/j.anai.2020.11.008.}