Abstract
Cohen syndrome is a rare autosomal recessive syndrome with a distinctive clinical phenotype that includes mental retardation and a characteristic sociable disposition. Variability in the level of learning disability and the behavioural phenotype is seen in the published literature. In a cohort of Finnish Cohen syndrome patients, severe mental retardation and non-maladaptive behaviour were described. Outside of Finland, autistic-spectrum behaviour has been reported in a few isolated Cohen syndrome patients but in a recent UK study was found to be highly prevalent. We report the results of neuropsychological studies in a group of 16 genetically heterogeneous patients, all with the characteristic clinical features of Cohen syndrome. Of the 9 patients who underwent formal neuropsychological testing, all but one was functioning in the severely mentally impaired range. Of the remaining patients, 3 were below the age of formal testing and 4 had such profound learning and behavioural problems that they were deemed unable to participate in testing. Mild maladaptive behaviour was observed in 13 patients and 3 were documented as having significant maladaptive behaviour. In contrast to the Finnish group of Cohen syndrome patients, this UK study identifies significant neuropsychological impairment combined with maladaptive behaviour as a characteristic of Cohen syndrome. Although autistic-type behaviour was observed, an increased prevalence of autism in Cohen syndrome was not confirmed.
Key words
Cohen syndrome - mental retardation - maladaptive behaviour - autism - neuropsychology
References
-
1 American Psychiatric Association .Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington DC; American Psychiatric Association 1994
-
2
Carey J C, Hall B D.
Confirmation of the Cohen syndrome.
J Pediatr.
1978;
93
239-244
-
3 Chandler K E, Kidd A, Al-Gazali L, Kolehmainen J, Lehesjoki A-E, Black G CM, Clayton-Smith J. Diagnostic criteria, clinical characteristics and natural history of Cohen syndrome. Submitted to J Med Genet (In press).
-
4
Cohen M M, Hall B D, Smith D W, Graham C B, Lampert K J.
A new syndrome with hypotonia, obesity, mental deficiency and facial, oral, ocular and limb anomalies.
J Pediatr.
1973;
83
280-284
-
5
Deb S, Prasad K.
B. The prevalence of autistic disorder among children with learning disability.
Br J Psychiatry.
1994;
165
395-399
-
6
Fryns J P, Legius E, Devriendt K, Meire F, Standaert L, Baten E. et al .
Cohen syndrome: the clinical symptoms and stigmata at a young age.
Clin Genet.
1996;
49
237-241
-
7
Horn D, Krebsova A, Kunze J, Reis A.
Homozygosity mapping in a family with microcephaly, mental retardation, and short stature to a Cohen syndrome region on 8 q21. 3 - 8 q22. 1: redefining a clinical entity.
Am J Med Genet.
2000;
92
285-292
-
8
Howlin P.
Autistic features in Cohen syndrome: a preliminary report.
Dev Med Child Neurol.
2001;
43
692-696
-
9
Kivitie-Kallio S, Rajantie J, Juvonen E, Norio R.
Granulocytopenia in Cohen syndrome.
Brit J Haemat.
1997;
98
308-311
-
10
Kivitie-Kallio S, Autti T, Salonen O, Norio R.
MRI of the brain in the Cohen syndrome: a relatively large corpus callosum in patients with mental retardation and microcephaly.
Neuropediatrics.
1998;
29
298-301
-
11
Kivitie-Kallio S, Eronen M, Lipsanen-Nyman M, Marttinen E, Norio R.
Cohen syndrome: evaluation of its cardiac, endocrine and radiological features.
Clin Genet.
1999;
56
41-50
-
12
Kivitie-Kallio S, Larsen A, Kajasto K, Norio R.
Neurological and psychological findings in patients with Cohen syndrome: A study of 18 patients aged 11 months to 57 years.
Neuropediatrics.
1999;
30
181-189
-
13
Kivitie-Kallio S, Summanen P, Raitta C, Norio R.
Opthalmologic findings in Cohen syndrome - A long term follow up.
Ophthalmology.
2000;
107
1737-1745
-
14
Kivitie-Kallio S, Norio R.
Cohen syndrome: Essential features, natural history, and heterogeneity.
Am J Med Gen.
2001;
102
125-135
-
15
Kolehmainen J, Norio R, Kivitie-Kallio S, Tahvanainen E, de la Chapelle A, Lehesjoki A-E.
Refined mapping of the Cohen Syndrome gene by linkage disequilibrium.
Eur J Hum Genet.
1997;
5
206-213
-
16
Kondo I, Nagataki S, Miyagi N.
The Cohen syndrome: Does a mottled retina separate a Finnish and a Jewish type?.
Am J Med Genet.
1990;
37
109-13
-
17
Nordin V, Gillberg C.
Autistic spectrum disorders in children with physical or mental disability or both. I: Clinical and epidemiological aspects.
Dev Med Child Neurol.
1996;
38
297-313
-
18
Norio R, Raitta C, Lindahl E.
Further delineation of the Cohen syndrome; Report on chorioretinal dystrophy, leukopenia and consanguinity.
Clin Genet.
1984;
25
1-14
-
19
North C, Patton M A, Baraitser M, Winter R.
The clinical features of the Cohen syndrome: further case reports.
J Med Genet.
1985;
22
131-134
-
20
North K N, Fulton A B, Whiteman D AH.
Identical twins with Cohen syndrome.
Am J Med Genet.
1995;
58
54-58
-
21
Okamoto N, Hatsukawa Y, Arai H, Goto M.
Cohen syndrome with high urinary excretion of hyaluronic acid.
Am J Med Genet.
1998;
76
387-388
-
22
Partington M, Anderson D.
Mild growth retardation and developmental delay, microcephaly, and a distinctive facial appearance.
Am J Med Genet.
1994;
49
247-250
-
23
Sack J, Friedman E.
The Cohen syndrome in Israel.
Israel J Med Sci.
1986;
22
766-770
-
24 Sparrow S S, Balla D A, Cicchetti D V. Vineland Behaviour Scales: Interview Edition, Survey Form Manual. Minnesota; American Guidance Service 1984
-
25
Steinlein O, Tariverdien G, Boll H U, Vogel F.
Tapetoretinal degeneration in brothers with apparent Cohen syndrome: Nosology with Mirhosseini-Holmes-Walton syndrome.
Am J Med Genet.
1991;
41
196-200
-
26
Tahvanainen E, Norio R, Karila E, Ranta S, Weissenbach J, Sistonen P. et al .
Cohen syndrome gene assigned to the long arm of chromosome 8 by linkage analysis.
Nat Genet.
1994;
7
201-204
-
27
Thomaidis L, Fryssira H, Katsrou E, Metaxotou C.
Cohen syndrome: two new cases in siblings.
Eur J Pediatr.
1999;
158
838-841
-
28 Wechsler D. Wechsler Abbreviated Scale of Intelligence. San Antonio; The Psychological Corporation 1999
-
29 Wilson B, Cockburn J, Baddeley A. The Rivermead Behavioural Memory Test. 2nd ed. Bury, St. Edmunds; Thames Valley Test Company 1991
-
30
Young I D, Moore J R.
Intrafamilial variation in Cohen syndrome.
J Med Genet.
1987;
24
488-492
Dr. K. E. Chandler
Academic Unit of Medical Genetics and Regional Genetics Service · St Mary's Hospital
Hathersage Road
Manchester M13 OJH
U.K.
eMail: kate.chandler@cmmc.nhs.uk