Diagnosis, Treatment and Rehabilitation of Intellectual Disorders Ma Bingxiang Department of Pediatrics, The First Affiliated Hospital of Henan College of Traditional Chinese Medicine Hospital of Henan College of Traditional Chinese Medicine The First Affiliated Hospital of Henan College of Traditional Chinese Medicine Ma Bingxiang Children’s Brain Disease Diagnosis and Rehabilitation Center Concept Intellectual disorders are impairments that occur during the developmental stage and include deficits in both intellectual and adaptive functioning, manifested in the conceptual, social and practical domains. (DSM-5) Mental retardation refers to a group of syndromes of incomplete or impaired mental development, characterized by mental retardation and difficulties in social adaptation, with onset before developmental maturity (before age 18). (CCMD-3) Explanation of conceptual content (DSM-5) 1. intellectual deficits Deficits in intellectual functioning, such as reasoning, problem solving, planning, abstract thinking, judgment, academic learning, and learning from experience, as identified by clinical assessment and individualized, standardized intelligence tests. 2. adaptive deficits Failure to meet developmental levels and sociocultural standards for personal independence and social responsibility. Adaptation deficits result in limitations in one or more daily living functions such as communication, social participation, and independent living in multiple settings such as home, school, work, and community without ongoing support. 3. developmental stages Beginning at conception and up to age 18. decreases in intellectual and social adaptation from different causes after age 18 cannot be an intellectual disability. 4. Mental retardation is not an independent disease, but a syndrome. It does not have a single cause or a consistent disease process, but simply indicates the consequence of various factors that cause brain development to be impaired and the individual’s intelligence and adaptive function to be below a certain level. Explanation of related disease names Foolishness, dementia, idiocy Mental retardation, mental retardation, mental disability, mental retardation, mental retardation Intellectual developmental disorder (ICD-11) Intellectual disability (DSM-5) Education, civil affairs, and administration tend to use retardation, intellectual disability, and mental retardation. Epidemiological analysis WHO 1985 data show that the prevalence of mild is about 3% and moderate to severe is about 0.3% to 0.4%. (Since 1930, the prevalence of moderate to severe cases has remained almost unchanged. With the improvement of medical and health care, the incidence of severe has decreased, but the overall prevalence is comparable due to the longer life span of patients.) China: In the 1982 12-region epidemiological survey, the overall prevalence was 3.33%, including 5.27% for 7-14 years old, 2.2% for urban and 4.3% for rural areas; 3.73% for males and 2.92% for females. In 1988, the epidemiological survey of children aged 0-14 years in eight provinces (cities) nationwide, the prevalence rate was 1.2%; 0.7% in urban areas. 1.41% in rural areas. The results of the 2001 National Sample Survey of Children with Disabilities aged 0-6 years showed that the current prevalence of mental retardation in children was 0.931%. The 2nd national sample of people with disabilities in 2006 showed that the overall prevalence of mental retardation in the country was 0.42% Patients with mental retardation are often associated with somatic and neurological disorders; 15%-30% have seizures; 20%-30% have motor disorders; 10%-20% have sensory disorders; the more severe the mental retardation, the higher the percentage of these associated somatic disorders. Analysis of epidemiologically relevant issues 1. There is a difference in the prevalence of men and women, with slightly more male patients than female, with a male to female ratio of approximately 1.5:1. Analysis of the causes: male fetal chromosomal susceptibility, genetic abnormalities, increased susceptibility to prenatal and neonatal damage, and other groups of multiple factors. 2. The prevalence rate in rural areas is significantly higher than that in urban areas. Reason analysis: It may be related to poor health care conditions in rural areas (prematurity, generation, intracranial hemorrhage, neonatal asphyxia, central nervous system infection, malnutrition, nuclear jaundice, etc.), poor health awareness (drugs, poisoning, radiation, underlying maternal diseases such as hypertension, kidney disease, severe anemia, diabetes, etc.), consanguineous marriage, iodine deficiency, and low educational level. 3. The prevalence rate of each age group showed that school-age children had the highest prevalence rate. Analysis of the reasons: Early diagnosis of mild mental retardation is difficult in infancy and early childhood, and mental activities are detected only after schooling when they are significantly behind other children. In contrast, some patients with mild mental retardation are better adapted to society and have certain social adaptation ability, which is difficult to identify in the general population. The epidemiology shows a decreasing trend, which is related to the development of economic and cultural education, the strengthening of preventive measures, and the progress of medical science. Analysis of etiology and pathogenesis Genetic factors + environmental factors The majority of severe mental retardation is caused by biological factors, while mild mental retardation usually develops under the combined effect of genetic and environmental factors. At present, 50% of the causes of mental retardation are not identified (i) before birth 1. Genetic factors (1) chromosomal abnormalities (different classification methods) ①Chromosomal number and structure alterations: number alterations such as haploidy, polyploidy, etc.; structural alterations such as chromosome breaks, deletions, duplications, inversions and translocations. For example, Down syndrome (trisomy 21 of chromosome group G), G/D translocation and G/G translocation, and many other karyotypes. Autosomal aberrations and sex chromosome aberrations; autosomal aberrations such as trisomy 21, trisomy 18, partial deletion of broken arm 5 (cat call syndrome), etc.; sex chromosome aberrations such as congenital testicular hypoplasia (Klinefelter syndrome, with an extra X on the sex chromosome), congenital ovarian hypoplasia (Turner syndrome, with the loss of an X on the sex chromosome) hyperfemales (XXX or X0/XXX chimeric sex chromosomes), and the higher the number of sex chromosome X aberrations, the higher the incidence and degree of mental retardation. (3) Chromosomal fragile sites: Studies have shown a relationship between fragile sites of chromosomes and X-linked mental retardation, such as fragile X chromosome syndrome with fragile seat at Xq27.3. A survey found that 54.3% of children carry fragile sites in the form of cleft and ellipsoidal alterations, which can be distributed on all groups of chromosomes. (2) Inherited metabolic abnormalities Genetic defects in the biosynthesis of certain enzymes, receptors, carriers and membrane pumps composed of polypeptides and/or proteins necessary for the maintenance of normal metabolism in the body, i.e. diseases caused by mutations in the genes encoding such polypeptides (proteins), are a class of genetic diseases with defects in metabolic function, mostly monogenic. These include metabolic macromolecular diseases: lysosomal storage disorders (more than thirty diseases), mitochondrial diseases, etc.; metabolic small molecule diseases: amino acids, organic acids, fatty acids, etc. Inherited metabolic diseases are partly caused by genetic inheritance, and partly by acquired genetic mutations. When genetic metabolic diseases affect the development of the central nervous system, they may manifest mental retardation and other mental abnormalities. Congenital lysosomal enzyme deficiency: allows certain substances to accumulate in the lysosomes, impairing the function of the cells. Mucopolysaccharidoses, lipid deposition disorders, mucolipid deposition disorders, and other lipid deposition disorders. Carbohydrate metabolism disorder: the deficiency of certain enzymes or multiple enzymes causes galactose, glycogen, etc. to be unable to be converted or broken down, resulting in the accumulation of some substances and causing disease; in addition, hypoglycemia due to various causes can also cause brain damage and produce mental retardation. Galactosemia (the process of converting galactose 1-phosphate into glucose 1-phosphate is blocked, and galactose accumulates in blood tissues, causing damage to liver, kidney, brain and other organs); glycogen accumulation disease. Amino acid metabolism disorders: dozens of amino acid metabolism disorders have been found to cause mental retardation, which are autosomal recessive disorders in which a gene mutation causes a deficiency of the relevant enzyme to accumulate certain amino acids in brain tissue. For example, phenylketonuria (deficiency of phenylalanine hydroxylase, which cannot convert phenylalanine to complexine, allows phenyl pyruvate to accumulate in the body and affects the central nervous system). Homocystinuria. Copper metabolism disorder: hepatomegaly, or Wilson’s disease, in which copper is deposited in large amounts in the liver and basal ganglia of the brain, causing liver and neurological symptoms. (3) Polygenic inheritance The result of two or more pairs of genetic lesions and interactions with environmental factors. Many unexplained mental retardation may be associated with polygenic inheritance. 2. Acquired factors during fetal life (1) Infections: Viral infections are most common, such as rubella virus (first trimester), cytomegalovirus (second trimester), herpes simplex virus, influenza virus, bacteria, syphilis. It causes inhibition of cellular value-added and differentiation, resulting in poorly developed or involved fetal central nervous system. In addition the infection produces hypoxia, hyperthermia, shock, toxemia can also involve the fetal central nervous system. Exposure to animals infected with protozoa and toxoplasma can also lead to impaired fetal brain development. (2) Drugs: antithyroid drugs, glucocorticoids, salicylates, antiepileptics, antineoplastics, antipsychotics, and overdose of iodide and sex hormones. It is generally believed that the first 3 months have the greatest impact, and in principle, drugs should not be taken in early pregnancy. 4 months later is relatively safe, but still has some impact. (3) Poisoning: mercury, lead, organic phosphorus, carbon monoxide, toxic gases. Smoking, excessive alcohol consumption (fetal alcohol syndrome) ⑷radiation: Radiation can break DNA and endanger the embryo. Among them, fertilized egg to oogenesis is the most sensitive period of embryo to radiation, therefore, the first 3 months of pregnancy direct irradiation of pelvic cavity is the most harmful. (5) Maternal health status during pregnancy: women suffer from heart disease, kidney disease, hypertension, diabetes, severe anemia, which makes the fetus ischemic and hypoxic during development; poor nutrition, which affects the number of brain cells in early pregnancy and the size of brain cells in late pregnancy, and also easily leads to low weight; the age of pregnant mothers, a study shows that the incidence of Down syndrome in pregnant mothers is 1 per 1,000 around the age of 30, 10 per 1,000 around the age of 40, and 20 per 1,000 around the age of 45; mental health status. Poor mental health, depression, anxiety, fear and sadness; in addition, placental insufficiency, pre-eclampsia and multiple pregnancies also often lead to mental retardation. 3. congenital cranial anomalies such as primary microcephaly, neural tube closure insufficiency, meningoencephalomalacia, congenital hydrocephalus, microcephaly, cerebral gyrus anomaly, cerebral penetrance anomaly cranial stenosis, etc. (ii) Perinatal period Prematurity, low birth weight, birth injury, umbilical cord wrapping around the neck, umbilical cord too short or knotted, prolonged labor, neonatal intracranial hemorrhage, etc., can to lead to neonatal hypoxic-ischemic encephalopathy, so that the central nervous system is damaged. (iii) After birth 1. Central nervous system infection Chemobrain, sick brain, nodal brain, rheumatoid brain and other infections caused by various toxic encephalopathies can damage the central nervous system. 2. Nuclear jaundice ABO hemolysis, Rh hemolysis, neonatal septicemia, hemolysis caused by aspirin or sulfonamides. 3. cerebral hypoxia Convulsive seizures, epileptic seizures, etc. can cause asphyxia and hypoxia, which can damage the central nervous system if it lasts too long. 4. Traumatic brain injury The more severe the degree of traumatic brain injury, the more severe the damage to the nervous system. 5. Malnutrition Sugar, fat, protein, vitamins, minerals (iron, zinc), DHA, etc. 6. Endocrine and metabolic disorders Hypothyroidism, hypogonadotropic hypogonadism, etc. 7. Psychosocial factors Parents, children deprived of cultural education opportunities, sensory deprivation (such as deaf, dumb, blind or often locked up alone, etc.) may occur mental retardation, if provided with good education can be significantly improved. Physical characteristics of mental retardation 1. Delayed growth Slow growth in height, head circumference, weight, etc. compared to peers. 2. Facial features: such as tongue-stretching dementia, typical face of Cretinism. 3. Skin and hair abnormalities: such as yellow hair and fair skin in children with ketonuria; facial sebaceous adenoma in children with tuberous sclerosis. 4. Abnormal head morphology: such as microcephaly, hydrocephalus. 5. Abnormal body odor: such as the smell of rat urine in phenylketonuria. 6. Limb movement disorders: such as cerebral palsy, etc. resulting in inflexible movements, ataxia and other symptoms. 7. Congenital malformations: such as malformations of the ears, eye fissures, joints, fingers and toes, internal organs, etc. 8. Sensory impairment: visual and hearing impairment. Mental activity characteristics of intellectual disorders 1. Thinking disorders Slow and incoherent thinking, poor comprehension, loss of dominant thinking, inability to distinguish between concrete and abstract concepts. 2. Language disorders: Delayed language and speech development, unclear pronunciation, very little language, poor vocabulary, unclear bite, inability to express the meaning, speech can not be understood, some patients show “screaming” or language loss, etc. 3. Memory: Poor memory, forgetfulness of recent events and past events, or even loss of memory, etc. 4. Perceptual impairment: Poor perceptual ability, failure to recognize people and objects, inability to avoid danger, numbness to surroundings, reversal of day and night, narrow perceptual range, etc. 5. Attention disorders: inattentiveness, lack of persistence, narrow attention span, poor memory. 6. Emotional disorders: childish, simple experience, superficial, easily provoked, excitement, poor self-control. Often manifested as timid, nervous, withdrawn, withdrawn, shy. 7. Behavior disorders Stereotyped repetitive actions, such as head-banging, hand biting, teeth grinding, tearing clothes, hair pulling, self-injurious behavior, some have aggression, vandalism and other anti-social violence. 8. Personality formation disorder Difficulty in personality formation, lack of self-control, easily suggestible, easily abetted. Severity grading analysis Mild, moderate, severe, very severe Grading is based on a comprehensive judgment of the conceptual, social, and practical domains. (DSM-5) Grading according to intelligence level. Mild: IQ 50-69; Moderate: IQ 35-49; Moderate: IQ 20-34 Very severe: IQ <20. (ICD-10 and CCMD-3) Diagnostic basis (refer to CCMD-3, no clear diagnostic basis in ICD-10 and DSM) 1. Mild mental retardation About 75%-80% Usually detected at school age (1) IQ 50-69 score, mental Age 9-12 years old; (2) poor academic performance (often failing or repeating grades when studying in ordinary schools) or poor working ability (only being able to perform relatively simple manual tasks); (3) able to take care of oneself; (4) no obvious speech impairment, but with varying degrees of delay in understanding and using language. 2. Moderate mental retardation About 12%, usually detected at the age of 3-5 years. (1) IQ score 35-49, mental age 6-9 years old; (2) cannot adapt to ordinary school learning, can perform single-digit addition and subtraction calculation; can perform simple work, but the quality is low and efficiency is poor; (3) can learn to take care of simple life on their own, but need supervision and help; (4) can master simple life language, but the vocabulary is poor. 3. Severe mental retardation About 7%-8%, usually found in the back before 2 years old. (1) IQ score 20-34, mental age 3-years; (2) show significant motor impairment or other related defects, unable to learn and work; (3) unable to take care of themselves; (4) speech function is severely impaired, unable to communicate effectively in language. 4.Extremely severe mental retardation About 1%-2%. (1) IQ score below 20, mental age about 3 years old or less; (2) complete loss of social function, will not escape from danger; (3) complete inability to take care of oneself, incontinence; (4) loss of speech function. Borderline intelligence IQ is 70-85, which is a transitional state between mental retardation and normal intelligence, and may be accompanied by mild social maladjustment. Strictly speaking, borderline intelligence is generally not diagnosed as mental retardation. The co-morbidity of mental retardation with other mental disorders is higher than that of the general population, with some reports reaching more than 50%. 1. Combined schizophrenia Domestic Zhang Minglian (1990) found that the frequency of symptoms of schizophrenia associated with mental retardation were, in order of frequency, catatonic behavior, emotional discomfort, blandness; sexual misconduct; poor thinking; hallucinations, relaxed thinking; logic disorder; victimization or delusions; bizarre delusions. Behavioral and affective disorders are the prominent manifestations. Symptoms of schizophrenia in a person of normal intelligence are, in order of prevalence: hallucinations, delusions of victimization, logical disorders, lax thinking, catatonic behavior, emotional discomfort, blandness, and sexual misbehavior. Cognitive activity disorder is the prominent manifestation. 2. Combined bipolar disorder The co-morbidity rate of combined bipolar disorder in people with mental retardation is 2%-12%. Combined mania, highlighted by the activity, irritability, impulsiveness, emotional outbursts, etc. Combined with depression, the prominent manifestation is less activity, less speech, crying, agitation, insomnia, etc. 3. comorbid epilepsy Studies have reported a co-morbidity rate of 20%-25% in patients with intellectual disability in inpatient institutions with comorbid epilepsy. The co-morbidity rate for the presence of intellectual disability in epilepsy is 15%. It is generally accepted that the lower the level of intelligence, the more severe the epilepsy, the more difficult it is to control seizures, and the more prominent the combined behavioral and personality disorders. 4. Combined hyperactivity Hyperactivity is a prominent feature of mental retardation, with a co-morbidity rate of more than 20%, mainly manifesting as attention deficit, hyperactivity and impulsivity. 5. Combined autism The co-morbidity rate of autistic patients with mental retardation is about 75%, and its clinical manifestations are related to different IQ levels. 6. Combined behavioral disorders Behavioral disorders are commonly associated with mental retardation, such as aggressive behavior, destructive behavior, stereotyped behavior, and social withdrawal. They may be noisy, shouting, aggressive or self-injurious behavior, repeatedly turning their bodies, banging their heads against the wall, sucking fingers or local skin, etc. Mental developmental assessment (1) Intelligence assessment Standardized intelligence measures were used Screening scales: Denver Developmental Screening Test (DDST): 0-6 years old infants and children 20 minutes. Picture Person Test: 4-12 years old 50-item questioning intelligence test: 4-7 years old children 15-20 minutes Also commonly used are the Peabody Picture Vocabulary Test (PPVT) and the Raven Reasoning Test. Diagnostic scales: Gesell Developmental Diagnostic Scale: infants and toddlers under 5 years old 30 minutes Bailey Infant and Toddler Developmental Scale: infants and toddlers 2 months-30 months old 45 minutes Wechsler Intelligence Scale (WIS): preschool, Wechsler Preschool Scale of Intelligence (WPPSI); school-age, Wechsler Intelligence Scale for School-Age Children (WISC-R); Chinese Binay The Chinese Binay test is also commonly used. (2) Social Adaptive Behavior Assessment The Adaptive Behavior Scale for Infants and Toddlers-Middle Schoolers revised by Zuo Qihua et al: 6 months-15 years. Yao Shuqiao and Gong Yaoxian's Adaptive Behavior Rating Scale for Children: 3-12 years old children:. USA: Adaptive Behavior Scale developed by the Association for Mental Retardation (AAMD): Vineland Adaptive Behavior Scale. The appropriate screening scale is selected according to the age of the child and if the test result is below the cut-off, the diagnosis is confirmed with a diagnostic scale. 2. Laboratory and other tests Select the necessary tests according to the possible etiology, such as genetic-metabolic screening (blood screening, urine screening), chromosomal analysis, genetic diagnosis, examination of X-fragile loci, electroencephalography, electroencephalographic topography, and cranial X-ray, CT, and MRI. In particular, detailed examination is necessary when there is a family history or mental retardation with other diseases. Diagnostic criteria (CCMD-3) 1. Onset before the age of 18. 2. IQ is below 70. 3. There are varying degrees of social adjustment difficulties. Mild ⑴IQ 50-69 points, mental age 9-12 years ⑵ Poor academic performance (often failing or repeating grades when studying in ordinary school) or poor working ability (only able to perform relatively simple manual tasks) ⑶ Able to take care of oneself ⑷ No obvious speech impairment, but there are different degrees of delay in understanding and using language Moderate ⑴IQ 35-49 points, mental age 6-9 years ⑵ Unable to adapt to ordinary school (3) Can learn to take care of simple life on their own, but need supervision and assistance (4) Can master simple life terms, but have poor vocabulary Severe (1) IQ score of 20-34, mental age of 3 years; (2) Show significant motor impairment or other related deficits, unable to learn and work; (3) Cannot take care of themselves; (4) Speech function is severely impaired Very severe (1) IQ score below 20, psychological age below 3 years; (2) complete loss of social function, unable to escape from danger; (3) complete inability to take care of oneself, incontinence; (4) loss of speech function. The mental and physical development of normal children is not a steady-state linear development, but is faster in some stages and slower in others. Some normal children have slow development of language skills and motor functions, but once they start to develop, they can catch up with normal children with normal understanding and ability to adapt to the environment, and they do not lag behind in all aspects. Chronic physical illness, malnutrition, and poor educational environment can cause delayed intellectual development such as slow reaction time and poor vocabulary, which can be mistaken for mental retardation. If these external disadvantages are eliminated, their intelligence can recover rapidly after their living and learning conditions are improved or they recover physically. 2. Childhood autism Most children with autism are accompanied by mental retardation, and it is difficult to distinguish between the two in severe cases of mental retardation. The prominent clinical manifestations of autism are impaired social interaction, verbal and nonverbal communication, narrow interests and stereotypical repetitive behavioral patterns, excessive attachment to inanimate objects, or associated sensory abnormalities. Patients with intellectual disability are better socialized, willing to interact with others and even initiate interaction with others, have insufficient level of speech development but no qualitative impairment, are able to engage in role play, and do not have a stereotypical manner of behavior. 3. Childhood schizophrenia Patients with schizophrenia that begins in childhood may present with impairment of intelligence, impairment of speech function, apathy, and poor exposure and adaptation to the surrounding environment. However, most of them do not have true mental retardation, but are characterized by thought disorders, hallucinations, delusions, emotional indifference, catatonic fears, reduced volition, and behavioral disturbances, and are progressive in course. 4. Attention deficit hyperactivity disorder in children This disease can be manifested as poor academic performance, indiscipline, low social adaptation ability due to inattentiveness, similar to mental retardation, but the main clinical manifestations are attention deficit, hyperactivity and impulsivity, and the intelligence examination is mostly in the normal range, and its academic performance is obviously lower than the intelligence level. Diagnostic ideas 1. Collect detailed medical history Whether there is a family history, whether the parents are inbred, whether there are harmful factors interfering before birth, perinatal period and after birth, growth and development history, parenting history, past history, family culture and economic education status, etc. 2. Comprehensive physical examination (1) Physical examination: height, weight, head circumference, skin, fingerprints and the presence of hair, head, spine, facial features, limbs, internal organs and external genitalia and other deformities. (2) Neurological examination: presence of visual acuity, hearing impairment, limb paralysis, seizures, etc. (3) Mental status examination: patient's contact with the surrounding environment, language communication ability, facial expressions and emotional reactions, behavioral patterns and movements, etc. 3. psychological developmental assessment 4. laboratory tests Common types of clinical disorders 1. Down's syndrome 2. phenylketonuria 3. galactosemia 4. congenital testicular hypoplasia 5. Congenital ovarian hypoplasia 6. Fragile X syndrome 7. Congenital hypothyroidism 8. Tuberous sclerosis 9. Fetal alcohol syndrome Treatment Mechanism: Stages of brain development and repairability of damaged nerve cells. Treatment principles: early detection, early diagnosis; identification of causes, early intervention; comprehensive and integrated treatment; integrated treatment: rehabilitation training is the main focus, supplemented by drug treatment; hospitals, schools, communities and community organizations participate together. I. Rehabilitation training 1. Good stimulation of the external environment can promote intellectual development. 2. Content (combined with the characteristics of growth and development) Motor: 3 roll over 6 sit 7 roll 8 crawl week will walk and other gross motor; touch, grasp, beckon, hold things and other fine motor. Perception: sight, hearing, smell, taste, touch, balance sense, etc. Cognition: cognitive activities, such as size, shape, length, front and back, color, use, language: understanding, expression (oral, written) Self-care: urination and defecation, eating, sleeping, dressing and undressing, bathing, washing, cooking, taking out the garbage, labor Exposure to daily life, guide interest in things around them, develop their sensory discrimination, autonomy, language skills, have a certain ability to survive and The ability to engage in simple work and to move towards society. Social adaptation: recognizing parents, expressing emotions, stating home address, expressing requests, and obeying orders. Etiological treatment 1. Congenital hypothyroidism: thyroxine supplementation. Congenital ovarian hypoplasia: take growth hormone at 4-6 years old, if later, add androgens (after 8 years old). After epiphyseal closure, start cycle of estrogen (after 15 years of age) to promote the development of secondary sex characteristics. 2. Dietary treatment of partial genetic metabolic mental retardation Common clinical types Foods to restrict Foods to eat Galactosemia Dairy foods Cereals or milk replacer Glycogen storage disorder type I Fructose, galactose Low-fat diet Glucose supplementation available Phenylketonuria Phenylalanine foods Low phenylalanine foods and milk powder Homocysteinemia Methionine foods (animal protein) Low methionine, cystine foods and milk powder ( Reduce intake) Folic acid and B vitamin supplementation (to lower levels) Histidinemia Histidine foods Low histidine foods and milk powder Congenital hyperacidemia type II High protein foods Low protein diet Arginine-containing foods Hepatomegaly Copper-containing foods Avoid foods high in copper Potassium chloride or foods high in zinc may be consumed 3. Surgical treatment, gene therapy 3. Medication 1. Molecular peptide (cerebrolysin), cytarabine, piracetam (cerebrolysin), compound salvia injection, tanshinone IIA, cerebral nerve growth factor, cytochrome C, cytidine triphosphate and Chinese herbal medicine 2. 3. Chinese herbal medicine Prognosis Mental retardation is a chronic and persistent disease, and the prognosis varies depending on the cause and severity of the disease. Mild to moderate mental retardation may improve with age, but remains below the average for the same age group. Prevention There is no effective treatment for mental retardation, so prevention is especially important. 1. Primary prevention Purpose: To eliminate the causes of mental retardation and prevent the occurrence of the disease. (1) Raise awareness of eugenics: strengthen publicity and education, prohibit marriage between close relatives, appropriate late marriage and late childbirth, avoid high age pregnancy, and do premarital examination. (2) Strengthen pregnancy health care: reasonable nutrition during pregnancy, avoid exposure to harmful substances and radiation, keep pregnant women emotionally stable and happy, eliminate bad habits, prevent pregnancy complications, and pay attention to strengthening early education. (3) Pay attention to perinatal health care: avoid difficult delivery, premature delivery, low birth weight, infection, etc. (4) Do a good job of optimal parenting: feed reasonably, pay attention to the work of children's mental health and sound personality development, and establish a good social and family environment for children. Avoid central nervous system infection and traumatic brain injury. 2. Secondary prevention Purpose: Early detection of diseases with mental retardation, diagnosis and early intervention before symptoms appear as much as possible, so that defects do not occur. (1) Apply knowledge of child development psychology to conduct regular examinations of infants and children in maternal and child health care institutions, kindergartens and schools, and to regularly follow up children suspected of having the disease and provide early intervention. (2) To provide early intensive education and training to children with mental retardation due to social and psychological factors to promote rehabilitation. (3) To popularize the basic knowledge related to mental retardation to the parents and school teachers of the affected children. Actively prevent and treat the emotional and behavioral disorders of children with various types of intellectual disabilities. 3. Tertiary prevention Purpose: After the presence of brain injury, comprehensive treatment measures should be taken to properly diagnose and treat brain diseases and prevent their development into intellectual disability. Treatment of the disease and reduction of disability include training of patients in life, emotion and behavior, and social adaptation to help patients overcome various difficulties so that they can achieve their best functional status. In education and training, the main goal is to improve the ability to take care of oneself and survive, etc. In childhood, the focus is on training of walking, interaction, and bowel and urinary habits. In adolescence, the training of interpersonal communication and other training and education to avoid inappropriate sexual behavior. In adulthood, the focus of education and training should be on social development (finding a job, getting married, raising children).