Fetal alcohol spectrum disorders (FASDs) comprise a range of effects resulting from prenatal alcohol exposure (PAE) including neurological abnormalities, cognitive and behavioral impairments, growth retardation, and craniofacial anomalies. Very few treatments have been investigated despite FASD?s tremendous public health burden. Neurocognitive deficits are a core feature of FASD, and cognition is a natural target for intervention because deficits contribute to problems with adaptive functioning, social skills, and independent living. One potential intervention for the cognitive impairments in FASD is the essential nutrient choline - which is known to have numerous direct effects on brain development and emerging cognition. Choline impacts neurodevelopment broadly, but especially in the hippocampus; choline contributes to increased dendritic arborization, larger cells, and functional changes. Choline affects the cholinergic system and alters brain structure and function in regions essential for memory functioning, including methylation in the hippocampus and prefrontal cortex. Only a handful of human choline studies for FASD have been undertaken and our group has conducted most of them. Our early double-blind, randomized, controlled trial established safety and tolerability. Our subsequent trial revealed beneficial effects for sequential delayed memory in participants with FASD (greater in younger [ages 2-3] rather than older [ages 3-5] children). Our third (ongoing) study included a long-term follow-up that demonstrated permanent benefits for choline vs. placebo in non-verbal processing, working memory, long-term verbal memory, and ADHD behavior. The proposed studies will capitalize on three existing cohorts for additional longitudinal studies that have the potential to show permanency of the effects of early treatment. A 4-year and 8-year follow-up study will each examine cognitive effects as well as structural and functional brain effects using advance MRI methods. Cognitive measures will include the Stanford-Binet Intelligence Scale, the Elicited Imitation memory test, the NIH Toolbox Flanker test and Picture Sequence Memory Test, and the Minnesota Executive Function Scale. We will examine choline effects on behavior using parent-report (Child Behavior Checklist). Hippocampus in particular will be examined for volumetric alterations following choline, including alterations at the level of sub-structures. Hippocampal connectivity will be examined and is expected to reflect changes from early choline supplementation. Lastly, the proposed studies will include a new clinical trial with a new cohort of 2-5 year old children with FASD. Rather than a placebo-controlled trial, this will be a 3-arm dose finding study in which participants will receive choline for one of three durations (3, 6, or 9 months). Results of the trial will directly inform future clinical implementation of choline as a neurodevelopmental intervention.
We have completed several studies of choline supplementation in children with neurodevelopmental abnormalities resulting from prenatal alcohol exposure (PAE): a feasibility study, a pilot efficacy study, and a long-term follow-up study. The proposed study will continue that work, helping to determine whether choline supplementation during a specific developmental window when the child?s brain remains plastic is able to attenuate the deficits in thinking, memory, processing speed, and behavior that are common in children with PAE and whether these changes are long-lasting. We will also use MRI to measure changes in the trajectory of structures known to be involved in these cognitive functions as well as to examine the development of connectivity in response to choline or placebo.
