Problemi speciali
Il ritardo mentale: cause, genetica, intervento
MENTAL RETARDATION: CAUSES, GENETICS AND INTERVENTION
Franco Panizon
Professore Emerito, Dipartimento di Scienze della Riproduzione e dello Sviluppo, Università di Trieste
Ottobre 2011 - pagg. 520 -525
Abstract
Mental retardation (MR) consists of: a) a defect of IQ higher than 2 SD (<70), b) a defect in the capacity of adaptation and c) an onset during puberty (18 years). In order to answer to the most mandatory of these three conditions, MR should represent 3% of the population (< 3rd centile). Actually, its prevalence is much higher than 3% in poor countries and sufficiently lower than 3% in rich countries. Because of the marginal rate, many acquired causes, from bad nutrition during pregnancy and afterwards, to infections and neglect, certainly play a marginal role especially for mild mental retardation. In order to understand these cases, the limit of IQ has been moved to 75. MR finds its raison d’être in: A) an unfavourable summation of QTL genes, namely of genes with a quantitative effect that pushes the unlucky possessors in the disadvantage corner of the bell curve that covers ALL the kinds of intelligence (non-syndromic, non-familial MR); B) the presence of a single mutated, destructive gene that not only alters the development of the brain but also the other organs and systems (syndromic MR, more than 1,290 “items”); C) the presence of
single mutation, that affects only one function of the brain (familial, non-syndromic MR). In the cases of familial, non-syndromic MR studied up to now, only X-associated genes, which exert their specific function on the cytoskeleton or on the formation and transportation of the synaptic vesicles, have been recognized as the cause. Non-syndromic MR generally falls within the framework of mild mental retardation (IQ 50-75). By nature, the prevalence of mild MR and in particular of marginal MR (IQ 70-75) is very high in the paediatric population and each family paediatrician should take charge of more than one child affected by MR.
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Suggerite dall'AI
Classificazione MeSH
Bibliografia
1. Spreat S, Conroy J, Fullerton A. A cost-benefit
analysis of community and institutional
placements for persons with mental retardation
in Oklahoma. Res Dev Disabil 2005;26:17-31.
2. Accardo PJ, Capute AJ. Mental retardations.
Mental Retardation Develop Disabilities Res
Rev 1998;4:2-5.
3. Accardo PJ. Overview: Mental retardation.
Mental Retardation and Developmental Disabilities
Research Reviews 1998;4:1.
4. Luckasson R, Reeve A. Naming, defining,
and classifying in mental retardation. Ment
Retard 2001;39:47-52.
5. Lin JD. Intellectual disability: definition, diagnosis
and classification. J Med Sci 2003;23: 83-9.
6. American Association on Mental Retarda-
tion. Mental retardation: definition, classification
and systems of supports (9th edition).
Washington, DC: American Association of
Mental Retardation, 1992.
7. AAMR, American Academy of Mental Retardation.
Mental Retardation Definition, Classification,
and Systems of Supports, 10th Edition
2002.
8. World Health Organization (WHO). International
Classification of Diseases 10th release.
Geneva, 1992.
9. American Psychiatric Association. Diagnostic
and Statistical Manual of mental disorders
(DSM-IV). Washington, DC: American
Psychiatric Association, 1995.
10. World Health Organization (WHO). International
Classification of Impairment, Disability
and Handicap. Geneva, 1980.
11. World Health Organization (WHO). International
Classification of Diseases - Clinical
Modification 9th release. Geneva, 1979.
12. APA, American Psychiatry Association.
Diagnostic and Statistical Manual of Mental
Disorders. The Author, Washington DC,
1994.
13. Moog U. The outcome of diagnostic studies
on the etiology of mental retardation: considerations
on the classification of causes. Am
J Med Genet 2005;137:228-31.
14. Wilska ML, Kaski MK. Why and how to
assess the aetiological diagnosis of children
with intellectual disability/mental retardation
and other neurodevelopmental disorders: description
of the Finnish approach. Eur J Paediatr
Neurol 2001;5:7-13.
15. Perez-Arjona E, Dujovny M, DelProposto
Z, et al. Late outcome following central nervous
system injury in child abuse. Child Nerv
Syst 2003;19:69-81.
16. Hildyard KL, Wolfe DA. Child neglect: developmental
issues and outcomes. Child
Abuse Negl 2002;26:679-95.
17. Guerrini R, Masi G, Toniolo D. Ritardo
mentale non sindromico. In: Cao A, Dallapiccola
B, Notarangelo LD (Eds). Malattie genetiche.
Molecole e geni. Diagnosi, prevenzione
e terapia. Padova: Piccin, 2004:651-62.
18. Martin J, Bell J. A pedigree of mental defect
showing sex-linkage. J Neurol Psychiatry
1943;6:154-7.
19. Richards BW, Sylvester PE, Brooker C.
Fragile X-linked mental retardation: the Martin-
Bell syndrome. J Ment Defic Res 1981;25:
253-6.
20. Knight SJ, Flint J. Perfect endings: a review
of subtelomeric probes and their use in
clinical diagnosis. J Med Genet 2000;37:401-9.
21. Demelas L, Serra G, Conti M, et al. Incomplete
penetrance with normal MRI in a
woman with germline mutation of the DCX
gene. Neurology 2001;57:327-30.
22. Penrose L. A clinical and genetic study of
1280 cases of mental defects. London: Her
Majesty Stationey Office, 1938.
23. Chelly J, Mandel JL. Monogenic causes of
X-linked mental retardation. Nat Rev Genet
2001;2:669-80.
24. Lehrke R. Theory of X-linkage of major intellectual
traits. Am J Mental Defic 1972;76: 611-9.
25. Morton NE, Rao DC, Lang-Brown H,
Maclean CJ, Bart RD, Lew R. Colchester revisited:
a genetic study of mental defect. J Med
Genet 1977;14:1-9.
26. Toniolo D. In search of MRX genes. Am J
Med Gen 2000;97:221-7.
27. Stevenson R, Schwartz C, Schoer P. Xlinked
mental retardation. Oxford: Oxford
University Press, 2000.
28. Nichols PL. Familial mental retardation.
Behav Genet 1984;14:161-70.
29. Reed EW, Reed SC. Mental retardation. A
Family study. Philadelphia: Saunders, 1965.
30. Petrill SA. Molarity versus modularity of
cognitive functioning? A behavioral genetic
perspective. Curr Dir Psychol Sci 1997;6:96-9.
31. Petrill SA, Saudino KJ, Cherny SS, et al.
Exploring the genetic etiology of low general
cognitive ability from 14 to 36 months. Dev
Psychol 1997;33:544-8.
32. Saudino KJ, Plomin R, Pedersen NL, Mc-
Clearn GE. The etiology of high and low cognitive
ability during the second half of the life
span. Intelligence 1994;19:359-71.
33. Dubnau J, Tully T. Gene discovery in
Drosophila: new insights for learning and
memory. Annu Rev Neurosci 1998;21:407-44.
34. Mayford M, Kandel ER. Genetic approaches
to memory storage. Trends Genet
1999;15:463-70.
35. Plomin R, De Fries JC, Mc Clearn GE,
McGuffin P. Genetica del comportamento. Milano:
Raffaello Cortina Editore, 2001.
Corrispondenza: franco@panizon.it
