Neuropsychologic Impairment in Bilateral Cerebral Palsy Roser Pueyo, PhD *, Carme Junque ´, PhD * † , Pere Vendrell, PhD * † , Ana Narberhaus, PhD *, and Dolors Segarra, PhD * The lower-than-average cognitive performance of indi- viduals with bilateral cerebral palsy found in previous studies does not always refer to an abnormal perfor- mance or clinically significant impairment. We aimed to establish the percentage of persons with bilateral cerebralpalsy who present neuropsychologic impair- ment, and its relationship to perinatal data and motor signs.Forty children, adolescents, and adults (age range, 6-38 years; 15 females and 25 males) with bilat- eral cerebral palsy were neuropsychologically assessed. Vocabulary was impaired in 85% of participants, lan- guage comprehension in 13-48%, visuoperceptual abil- ities in 60%,visuospatial abilities in 90%, short-term memory in 21-58%, declarative memory in 47-67%, and praxis comprehension in 20%, with executive defi- cits in 58-74%. Perinatal data (intrauterine growth and birth weight) contributedto explaining memory impairment. Among cerebral palsy subtypes (spastic, mixed,and dyskinetic), forms of impairment differed only in short-term verbal memory.No persons with dyskinetic cerebral palsy experienced impairment in immediate memory or working visual memory.We conclude that visuospatial deficit is the most frequent impairmentin people with bilateralcerebralpalsy. Moreover, short-term memory impairment seems sen- sitive to perinatal complications, and differsamong bilateral cerebral palsy subtypes. Ó 2009 by Elsevier Inc. All rights reserved. Pueyo R, Junque´ C, Vendrell P, Narberhaus A, Segarra D. Neuropsychologic impairment in bilateral cerebral palsy. Pediatr Neurol 2009;40:19-26. Introduction The first definition of cerebral palsy, published by Little in the nineteenth century, did not include certain manifes tions such as cognitive disorders [1]. Today, it is acknowl- edged that cognitive disturbances often accompany the motor disorders of cerebral palsy, and they are now tenta tively included in the definition of the condition [2]. Indee cognitive performance and its clinical significance repre- sent a key area in the cerebral palsy literature. Given the heterogeneity of cerebral palsy, it is essentia that cognitive research into this entity should use an accu rate categorization system. The differentiation of unilater and bilateral motor involvement in cerebral palsy is cur- rently used by the Surveillance of Cerebral Palsy in Europ Network, and is a promising categorization approach with proven reliability [3,4].So far,mostcognitive studies in cerebralpalsy havefocusedon the unilateral form. However, brain reorganization in unilateral lesions differs from that in bilateral lesions [5], so that cognitive finding in persons with hemiplegia cannot be generalized to pers with bilateral cerebral palsy. Most studies of bilateral cerebral palsy were conducted children with diplegia, the mildest form of motor impair- ment. This group presents a low performance intelligence quotient; impairments in visuoperceptual, visuospatial, and visuoconstructional abilitieswere also suggested [6-11]. In addition, children with spastic diplegia performe poorly on a visual orienting task [12]. All these studies reported differences in mean performances, butnotall of them specified whether the lowest scores should be class fied as abnormal. Fedrizziet al. [8] found that 63% of childrenwith spasticdiplegiaexhibitedan impaired From the *Department of Psychiatry and Clinical Psychobiology, Uni- versity of Barcelona, Barcelona, Spain; and † Biomedical Research Institute August Pi i Sunyer, Barcelona, Spain. Communications should be addressed to: Dr. Pueyo; Departament de Psiquiatria i Psicobiologia Clı ´nica, Facultat de Psicologia; Universitat de Barcelona; Passeig de la Vall d’Hebron 171; 08035 Barcelona, Spain. E-mail: rpueyo@ub.edu Received December 28, 2007; accepted August 22, 2008. Ó 2009 by Elsevier Inc. All rights reserved. doi:10.1016/j.pediatrneurol.2008.08.003 0887-8994/09/$—see front matter Pueyo et al: Neuropsychology of Cerebral Palsy 19