Journal of Neurology

, Volume 260, Issue 1, pp 214–220 | Cite as

Paired associate learning in children with neurofibromatosis type 1: implications for clinical trials

  • Jonathan M. PayneEmail author
  • Belinda Barton
  • E. Arthur Shores
  • Kathryn N. North
Original Communication


Studies investigating behavior in mice with a heterozygous null mutation of the NF1 gene (Nf1 +/) have provided critical insights into the molecular and cellular mechanisms underlying cognitive impairments associated with neurofibromatosis type 1 (NF1). Hyperactivation of the Ras-MAPK signaling cascade, which results in increased GABA-mediated inhibition and significantly reduced long-term potentiation, has been proposed as a core mechanism underlying Nf1 +/ mice deficits in visuospatial learning and attention. This assertion has been reinforced by preclinical trials that reveal that these impairments can be rescued both at a cognitive and cellular level. We attempted to demonstrate a phenotypic parallel between Nf1 +/ mice and children with NF1 using a well-validated measure of visuospatial learning. Children with NF1 (n = 71) and healthy controls (n = 29) were assessed on a computerized paired associate learning task. Interrelationships between visuospatial learning and other cognitive abilities that may influence performance, such as intelligence, attention and visuospatial function, were explored. Children with NF1 displayed significant impairments in visuospatial learning, with reduced initial retention and poorer learning across repeated trials. Importantly, we demonstrated that visuospatial learning was inferior in NF1 even after accounting for group differences in intelligence, sustained attention and visuospatial abilities. We have thus identified impaired visuospatial learning as a core phenotypic feature in children with NF1. These findings imply that hippocampal-based learning networks are dysfunctional in children with NF1 and provide validation for a primary outcome measure for clinical trials aiming to correct aberrant Ras signaling.


Neurofibromatosis type 1 Visuospatial learning Ras-MAPK signaling cascade CANTAB Clinical trials 



This study was funded by the Sherman Fellowship in Neurofibromatosis 1 Research Australia, awarded to Dr. Payne.

Conflicts of interest

The authors declare that they have no conflict of interest.

Ethical standard

This research has been approved by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki.


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Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Jonathan M. Payne
    • 1
    • 2
    Email author
  • Belinda Barton
    • 2
    • 3
  • E. Arthur Shores
    • 4
  • Kathryn N. North
    • 1
    • 2
  1. 1.Institute for Neuroscience and Muscle ResearchThe Children’s Hospital at WestmeadWestmead, SydneyAustralia
  2. 2.Discipline of Paediatrics and Child Health, Faculty of MedicineUniversity of SydneySydneyAustralia
  3. 3.Children’s Hospital Education Research InstituteThe Children’s Hospital at WestmeadWestmead, SydneyAustralia
  4. 4.Department of PsychologyMacquarie UniversitySydneyAustralia

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