Mental Retardation: please explain its neurology, prognosis

Perhaps one of the more heartbreaking conditions is, IMO, mental retardation. As pervasive as mental retardation is, I understand little about it.

When someone is MR/developmentally handicapped, what is wrong with that person’s brain? Is the problem one of depressed neural activity, such as misfiring synapses, damaged synapses/neurons, or what? Does the neurology vary according to the etiology of the retardation? Is the brain damage generally localized?

I understand that cerebral palsy is usually traced to inadequate oxygen flow just prior to or during delivery. Does this lack of oxygen destroy neurons?

Last, is there anything on the horizon–even distant and speculative, such as stem cell therapy–that might suggest an eventual treatment for MR persons?

Mental Retardation is mostly a legal term. It means that a person scores below a particular level on a particular test agreed upon by a specific state’s legislature, or the federal government’s subsidiaries which provide funding, such as Medicare, SSI, and other such bodies.

What causes the developmental delay, and behavioral deficits that are grouped together as Mental Retardation by the lay population is much more complex than you might think.

There are over a thousand named syndromes which are often associated with mental retardation, the most common of which is Down’s Syndrome. In addition, whether or not it is correct, many people with other syndromes are grouped with mental retardation, because they are unable for physical reasons to perform the mandatory behaviors of normal daily living.

Just being unable to hear makes it harder to learn to speak. It doesn’t mean you have an impaired intellect, but it does mean that your stimulatory environment will be less diverse unless deliberate actions by other make up for the deficit of deafness. If that doesn’t happen, thousands of other variables will tend to make it harder for a person to learn. Cerebral Palsy is another example. The delay in learning might not be caused by CP, but rather by the barrier that CP causes in the process of learning. Blindness is another. All of these things make normal development more difficult. Without well managed intervention, they can result in a cumulative delay in learning, and physical growth.

Anoxia associated with birth, neural damage during, or shortly after gestation, fever during illness that interferes with neural development, heart malformations during development that impair circulation, or oxygenation of the blood, drugs, many specific diseases, and a fairly large number of micronutritional deficiencies are all possible causes. Severe epilepsy during childhood can prevent, or drastically slow down normal cognitive development. Neglect or abuse can do it as well. Hundreds of identified genetic factors, and many unidentified ones as well cause impairments that can result in mental retardation. Macronutritional deficits, (big word for chronic hunger) will almost always limit neural development in children.

What can be done? Huge steps could be taken. Micronutrition alone could entirely eliminate five or six percent of mental retardation, world wide, at a cost of less than a billion dollars for three or four years, and less than a million a year thereafter. Raise the average IQ of the entire human race by five points, mostly at the bottom ten percent. The only things preventing that are ignorance, and politics. Well baby care and prenatal nutrition could double or triple that effect, although that would cost much more.

The cold facts of life in the industrialized world are counterintuitive. We don’t let as many folks just die in childhood as in the third world. We save babies at any cost. And there are strong political forces, which impel, or even compel us to continue to do that, even when individual choices are not enough. That means we will have progressively more and more mentally retarded people. Yet the same forces which encourage that growth do not combine to provide social infrastructure to meet the increasing demand for services.

It is a problem that is much more complex than your question anticipates.

Tris

Triskadecamus covered a lot of this. In essense, there isn’t a single cause. Sometimes, the brain just doesn’t develop properly, or the cells fail to organize themselves properly. Certain infections in a pregnant woman can cause brain damage. Sometimes there’s no clear cause - the person’s brain does not function like that of others, and we can’t locate a reason why. Environment also plays a role. In addition to general health and the importance of proper nutrition, locking a physically normal child in a room 24 hours a day with no mental stimulation - no toys, no conversation, nothing to do - will also result in mental retardation and stunted growth.

Although there is a category of lawyer that would have you believe this, recent research suggests the origins of CP may be much more complex, and may occur far in advance of labor and delivery. After all, not every baby temporarially deprieved of oxygen has CP, and some children with textbook perfect deliveries are born with CP. It is possible that in some cases, again, a part of the brain fails to develop. Prenatal strokes are also a possibility. Yes, neurons are destroyed, but how, exactly, that occurs is not known with certainty.

We already have treatment for the “MR” - environmental enrichment, for lack of a better term. We can’t repair the brain, but we can help the person make the best use possible of the brain they have. It can make the difference between being unable to dress or feed oneself and being able to take care of personal care, work at a job, and otherwise having a meaningful, interesting life.

But I get where you’re going - you’d like to repair the brain. Well, no, there’s nothing “on the horizon”. Some limited stem cell work has been done in Parkinson’s disease, but it didn’t work out at all well, and that’s largely a matter of replacing just one cell type in a very specific location in the brain. What you’re suggesting is a much more complex thing, involving repairing/rewiring large portions of the brain. No, we’re nowhere near anything like that.