# Neurocognitive Effects of Late-Childhood Iron Deficiency Anemia

> **NIH NIH R01** · WASHINGTON UNIVERSITY · 2024 · $710,899

## Abstract

PROJECT SUMMARY
 Iron deficiency anemia (IDA) experienced in early childhood causes long-lasting negative
consequences on brain development, connectivity and cognition. Given the high prevalence of IDA in infants
and toddlers and significant neurocognitive consequences, IDA screening is widely recommended in the first
year of life. However, the brain continues to develop throughout childhood, and the incidence of IDA sharply
increases again in late-childhood among menstruating females, occurring in 1 of every 16 adolescent females.
Of greatest concern, recent studies have found that late-childhood IDA negatively impacts cognitive
performance.
 Anemia results in cerebral metabolic stress with compensatory increases in cerebral blood flow and
oxygen extraction fraction. In severe anemia, the compensatory mechanisms may be inadequate to maintain
the expected metabolic rate of oxygen utilization (CMRO2), impacting the structural and functional
development of the brain. The goal of this proposal is to delineate the short and long-term neurocognitive
impact of late-childhood IDA in young females by testing the central hypothesis that late-childhood IDA causes
cerebral metabolic stress that contributes to both reversible and potentially irreversible changes in
neurocognitive function. Eighty-eight young females between 12-21 years of age with IDA will undergo
cognitive evaluation and brain MRI assessing cerebral metabolism and structural and functional connectivity at
time of diagnosis, 6 weeks after iron repletion, and at 1-year post-enrollment. Forty-four age-matched females
without anemia will be enrolled and assessed at similar time-points for comparison. We will compare cerebral
metabolic stress and compromised metabolism between the two groups (Aim 1). A subgroup of females with
IDA that receive IV iron therapy will have brain MRIs weekly for 6 weeks post-repletion. Dense imaging of this
subgroup will determine the hemoglobin threshold resulting in metabolic failure. The change in functional
connectivity and cognitive abilities with resolution of anemia secondary to iron therapy will be measured to
assess the potential reversibility of neurocognitive dysfunction with iron repletion (Aim 2). Lastly, cognitive
evaluation and brain MRIs one year after enrollment will be used to determine the relationship between
cerebral metabolic stress at diagnosis of IDA and long-term integrity of the white matter microstructure as it
relates to cognitive abilities (Aim 3). Determining the neurocognitive effects of late-childhood IDA has
important implications for potential screening and optimizing therapy recommendations at a time when
cognitive performance has life-long implications for educational and career options for young women entering
adulthood.

## Key facts

- **NIH application ID:** 10881010
- **Project number:** 1R01HL169591-01A1
- **Recipient organization:** WASHINGTON UNIVERSITY
- **Principal Investigator:** Melanie Erin Fields
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $710,899
- **Award type:** 1
- **Project period:** 2024-08-15 → 2028-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10881010

## Citation

> US National Institutes of Health, RePORTER application 10881010, Neurocognitive Effects of Late-Childhood Iron Deficiency Anemia (1R01HL169591-01A1). Retrieved via AI Analytics 2026-05-27 from https://api.ai-analytics.org/grant/nih/10881010. Licensed CC0.

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