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Junqueira Fleury Silva P, Martins Silva C, Machado de Campos B, de Melo Campos P, de Souza Medina S, Lamonica A, Coimbra Trindade JV, Cendes F, Costa FF, Olalla Saad ST, Deltreggia Benites B. Montreal cognitive assessment in Brazilian adults with sickle cell disease: The burdens of poor sociocultural background. EJHAEM 2024; 5:308-315. [PMID: 38633117 PMCID: PMC11020111 DOI: 10.1002/jha2.875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 02/09/2024] [Accepted: 02/21/2024] [Indexed: 04/19/2024]
Abstract
Sickle cell disease (SCD) patients are at higher risk of developing silent cerebral infarcts and overt stroke, which may reflect cognitive impairment, functional limitations, and worse quality of life. The cognitive function of Brazilian adult SCD patients (n = 124; 19-70 years; 56 men; 79 SS, 28 SC, 10 S/β0, 7 S/β+) was screened through Montreal Cognitive Assessment (MoCA) and correlated the results with possible predictive factors for test performance, including sociocultural, clinical, laboratory data and brain imaging. The Median MoCA score was 23 (8-30); 70% had a 25-or-less score, suggesting some level of cognitive impairment. There were no significant associations between MoCA results and any clinical or laboratory data in SS and SC patients; however, a significant correlation (P = 0.03) with stroke was found in HbS/β-thalassemic patients. Correlations were further detected according to sociodemographic conditions, such as age (r = -0.316; P < 0.001), age at first job (r = 0.221; P = 0.018), personal (r = 0.23; P = 0.012) and per capita familiar incomes (r = 0.303; P = 0.001), personal (r = 0.61; P = 0), maternal (r = 0.536; P = 0), and paternal educational status (r = 0.441; P = 0). We further sought independent predictors of performance using multivariable regressions and increased education was an independent predictor of better scores in MoCA (0.8099, 95% confidence interval [CI]: 0.509-1.111). Brain imaging analysis showed significant and progressive atrophy in important cerebral areas related to memory, learning, and executive function. These data point to the high prevalence and impact of cognitive decline in adult SCD patients, mirrored in brain atrophic areas. It is also possible to observe the influence of sociodemographic conditions on patients' cognitive performances and the need for creating focused therapeutic plans that address these deficiencies. Moreover, the absence of a significant correlation of MoCA values with stroke in the SS and SC groups may be related to the worst sociocultural and economic conditions of the Brazilian African descent population, in which the impact of low educational stimulation on cognitive function can outweigh even the anatomical damage caused by the disease.
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Affiliation(s)
| | - Caroline Martins Silva
- Hematology and Transfusion Medicine CenterUniversity of Campinas (UNICAMP)CampinasBrazil
| | | | - Paula de Melo Campos
- Hematology and Transfusion Medicine CenterUniversity of Campinas (UNICAMP)CampinasBrazil
| | - Samuel de Souza Medina
- Hematology and Transfusion Medicine CenterUniversity of Campinas (UNICAMP)CampinasBrazil
| | - Andreza Lamonica
- Hematology and Transfusion Medicine CenterUniversity of Campinas (UNICAMP)CampinasBrazil
| | | | - Fernando Cendes
- Neuroimaging LaboratoryDepartment of NeurologyUniversity of Campinas (UNICAMP)CampinasBrazil
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Heitzer AM, MacArthur E, Tamboli M, Wilson A, Hankins JS, Hoyt CR. Awareness, access, and communication: provider perspectives on early intervention services for children with sickle cell disease. Front Pediatr 2024; 12:1366522. [PMID: 38590772 PMCID: PMC11000123 DOI: 10.3389/fped.2024.1366522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 03/13/2024] [Indexed: 04/10/2024] Open
Abstract
Purpose This study aimed to identify determinants influencing the utilization of early intervention services among young children with sickle cell disease (SCD) based on perspectives from medical and early intervention providers. Design and methods Early intervention and medical providers from the catchment area surrounding St. Jude Children's Research Hospital and Washington University were recruited (20 total providers). Interviews were completed over the phone and audio recorded. All interviews were transcribed verbatim, coded, and analyzed using inductive thematic analysis. Results Three overarching themes were identified from both groups: Awareness (e.g., lack of awareness about the EI system and SCD), Access (e.g., difficulties accessing services), and Communication (e.g., limited communication between medical and early intervention providers, and between providers and families). Although these three themes were shared by medical and early intervention providers, the differing perspectives of each produced subthemes unique to the two professional fields. Conclusions Early intervention services can limit the neurodevelopmental deficits experienced by young children with SCD; however, most children with SCD do not receive these services. The perspectives of early intervention and medical providers highlight several potential solutions to increase early intervention utilization among young children with SCD.
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Affiliation(s)
- Andrew M. Heitzer
- Department of Psychology and Biobehavioral Sciences, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Erin MacArthur
- Department of Psychology and Biobehavioral Sciences, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Mollie Tamboli
- Department of Psychology and Biobehavioral Sciences, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Ashley Wilson
- Program in Occupational Therapy, Washington University in St. Louis, St. Louis, MO, United States
| | - Jane S. Hankins
- Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN, United States
- Department of Hematology, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Catherine R. Hoyt
- Program in Occupational Therapy, Departments of Neurology and Pediatrics, Washington University in St. Louis, St. Louis, MO, United States
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Schlenz AM, Phillips S, Mueller M, Kanter J. Practice Patterns for Addressing Developmental-Behavioral Concerns in Sickle Cell Specialty Care. CLINICAL PRACTICE IN PEDIATRIC PSYCHOLOGY 2023; 11:280-290. [PMID: 37876414 PMCID: PMC10593419 DOI: 10.1037/cpp0000461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Abstract
Objective Children with sickle cell disease (SCD) are at elevated risk for neurodevelopmental and behavioral disorders. This report describes developmental-behavioral practice patterns among sites who were part of the Dissemination and Implementation of Stroke Prevention Looking at the Care Environment (DISPLACE) consortium in the context of current guidelines for addressing these concerns. Methods An internal survey was developed for the Principal Investigators of the DISPLACE study to identify developmental-behavioral clinical practices across the 28-site consortium, including methods for identification, referral practices, access to psychologists, and barriers to services. Descriptive data were pulled from the survey to describe practice patterns. Results Most sites used informal methods to detect developmental-behavioral concerns, though over 1/3 of sites were using a structured protocol. The most common referral indications for further developmental and neuropsychological evaluation were parent, provider, or school concerns or stroke. Evaluations were predominantly completed by pediatric neuropsychologists and pediatric psychologists. Despite most sites reporting access to a psychologist within the SCD clinic, sites also reported long waitlists and difficulty accessing providers for evaluation and treatment services. Insurance difficulties were also a common barrier. A range of additional barriers were reported at the patient, provider, organizational, and policy/socio-environmental levels. Conclusions Many sites in the DISPLACE consortium were adhering to existing care guidelines for pediatric SCD; however, there was also wide variation in practices for which guidelines are absent or unclear. Additional work is needed to inform guidelines, to specify the role of psychology within specialty SCD care, and to overcome barriers to care. Implications for Impact Statement Optimal developmental-behavioral care for children with SCD involves collaboration among specialty care providers and pediatric psychologists; however, these efforts may be hampered by dispersed or unclear guidelines and several barriers to care. Future studies and guidelines have the potential to improve care by providing clear, consistent, and unified care recommendations specific to psychologists and related care professionals who are supporting children with SCD.
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Affiliation(s)
- Alyssa M Schlenz
- Department of Pediatrics, Medical University of South Carolina
- Department of Pediatrics, University of Colorado School of Medicine
| | | | - Martina Mueller
- College of Nursing, Medical University of South Carolina
- Department of Public Health Sciences, Medical University of South Carolina
| | - Julie Kanter
- Division of Hematology & Oncology, University of Alabama Birmingham
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Bhatt N, Calhoun C, Longoria J, Nwosu C, Howell KE, Varughese T, Kang G, Jacola L, Hankins JS, King A. Health literacy correlates with abbreviated full-scale IQ in adolescent and young adults with sickle cell disease. Pediatr Blood Cancer 2023; 70:e30281. [PMID: 36861391 PMCID: PMC10425156 DOI: 10.1002/pbc.30281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 01/27/2023] [Accepted: 02/14/2023] [Indexed: 03/03/2023]
Abstract
INTRODUCTION Sickle cell disease (SCD) is a chronic condition with progressive neurocognitive deficits. Health literacy (HL) is essential during adolescence and young adulthood, as the transition to adult care requires healthcare decisions. HL is known to be low in SCD; however, relation between general cognitive ability and HL has not been investigated. METHODS This cross-sectional study included adolescent and yound adults (AYAs) with SCD from two institutions. Logistic regression measured the association between HL, measured by the Newest Vital Sign tool, and general cognitive ability, measured with abbreviated full-scale intelligence quotient (FSIQ) on the Wechsler Abbreviated Scale of Intelligence. RESULTS Our cohort contained 93 participants at two sites: 47 (51%) at Memphis, TN and 46 (49%) at St. Louis, MO, ranging from ages 15-45 years (mean = 21 years) and with a majority (70%) possessing a high school education or greater. Only 40/93 participants (43%) had adequate HL. Lower abbreviated FSIQ (p < .0001) and younger age at assessment (p = .0003) were associated with inadequate HL. For every standard score point increase in abbreviated FSIQ, the odds of having adequate HL compared to limited or possibly limited HL increase by 1.142 (95% confidence interval [CI]: 1.019-1.322) and 1.116 (95% CI: 1.045-1.209), respectively, after adjusting for age, institution, income, and educational attainment. CONCLUSIONS Understanding and addressing HL is imperative in improving self-management and health outcomes. Among AYA with SCD, low HL was prevalent and influenced by abbreviated FSIQ. Routine screening for neurocognitive deficits and HL should be performed to guide development of interventions to adapt to the HL of AYA with SCD.
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Affiliation(s)
- Nidhi Bhatt
- Departments of Hematology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Cecelia Calhoun
- Department of Internal Medicine, Section of Hematology, Yale University School of Medicine, New Haven, CT
| | - Jennifer Longoria
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Chinonyelum Nwosu
- Departments of Hematology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Kristen E. Howell
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Taniya Varughese
- Program in Occupational Therapy and Departments of Pediatrics and Medicine, Washington University, St. Louis, MO
| | - Guolian Kang
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, TN
| | - Lisa Jacola
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Jane S. Hankins
- Departments of Hematology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Allison King
- Program in Occupational Therapy and Departments of Pediatrics and Medicine, Washington University, St. Louis, MO
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Heitzer AM, Okhomina VI, Trpchevska A, MacArthur E, Longoria J, Potter B, Raches D, Johnson A, Porter JS, Kang G, Hankins JS. Social determinants of neurocognitive and academic performance in sickle cell disease. Pediatr Blood Cancer 2023; 70:e30259. [PMID: 36815529 PMCID: PMC10339212 DOI: 10.1002/pbc.30259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 01/26/2023] [Accepted: 01/30/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND Sickle cell disease (SCD) is associated with poor neurocognitive outcomes due to biomedical and psychosocial factors. The aims of this study were to investigate associations between household and neighborhood socioeconomic status (SES) with cognitive and academic outcomes in SCD and to determine if these relationships were modified by sickle genotype, fetal hemoglobin, or age. PROCEDURE We prospectively recruited patients to complete a battery of neurocognitive and academic measures. Household SES was measured using the Barratt Simplified Measure of Social Status, a composite index of parent education and occupation. The Social Vulnerability Index was used to classify individuals based on social vulnerabilities at the neighborhood level. RESULTS Overall, 299 patients between the ages of 4 and 18 (mean = 11.4, standard deviation = 4.3) years diagnosed with SCD (57% SS/SB0 -thalassemia) completed testing. Stepwise multivariate models demonstrated that patients with low social vulnerability (i.e., high SES) at the neighborhood level displayed intelligence and math scores that were 4.70 and 7.64 points higher than those living in areas with moderate social vulnerability, respectively (p < .05). Reading performance did not differ based on neighborhood SES; however, the effect of neighborhood SES was dependent on age, such that older participants living in neighborhoods with moderate or high levels of social vulnerability displayed poorer reading scores than those with low social vulnerability (p < .05). CONCLUSIONS This study identified patients with SCD at higher risk of poor academic performance based on SES. Interventions addressing academic difficulties should be offered to all children with SCD, but should be emergently offered to this subpopulation.
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Affiliation(s)
| | | | - Ana Trpchevska
- St. Jude Children’s Research Hospital, Department of Psychology
| | - Erin MacArthur
- St. Jude Children’s Research Hospital, Department of Psychology
| | | | - Brian Potter
- St. Jude Children’s Research Hospital, Department of Psychology
| | - Darcy Raches
- St. Jude Children’s Research Hospital, Department of Psychology
| | - Ayanna Johnson
- St. Jude Children’s Research Hospital, Department of Psychology
| | | | - Guolian Kang
- St. Jude Children’s Research Hospital, Department of Biostatistics
| | - Jane S. Hankins
- St. Jude Children’s Research Hospital, Department of Hematology
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Abdi SS, De Haan M, Kirkham FJ. Neuroimaging and Cognitive Function in Sickle Cell Disease: A Systematic Review. CHILDREN 2023; 10:children10030532. [PMID: 36980090 PMCID: PMC10047189 DOI: 10.3390/children10030532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/07/2023] [Accepted: 02/13/2023] [Indexed: 03/12/2023]
Abstract
Sickle cell disease (SCD) is the most common inherited single-gene disease. Complications include chronic anaemia, reduced oxygen-carrying capability, and cerebral vasculopathy, resulting in silent cerebral infarction, stroke, and cognitive dysfunction with impairments in measures of executive function, attention, reasoning, language, memory, and IQ. This systematic review aims to investigate the association between neuroimaging findings and cognition in children with SCD. Searches of PubMed and Embase were conducted in March 2022. Studies were included if participants were <18 years, if original data were published in English between 1960 and 2022, if any genotype of SCD was included, and if the relationship between cognition and neuroimaging was examined. Exclusion criteria included case studies, editorials, and reviews. Quality was assessed using the Critical Appraisal Skills Programme Case Control Checklist. A total of 303 articles were retrieved; 33 met the eligibility criteria. The presence of overt or silent strokes, elevated blood flow velocities, abnormal functional connectivity, and decreased fMRI activation were associated with neuropsychological deficits in children with SCD when compared to controls. There is a critical need to address the disease manifestations of SCD early, as damage appears to begin at a young age. Most studies were cross-sectional, restricting the interpretation of the directionality of relationships. Future research employing longitudinal neuroimaging and neuropsychological assessments could improve our understanding of the cumulative consequences of SCD on the developing brain.
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Affiliation(s)
- Suad S. Abdi
- Developmental Neurosciences Section, UCL Great Ormond Street Institute of Child Health, London WC1N 1EH, UK
| | - Michelle De Haan
- Developmental Neurosciences Section, UCL Great Ormond Street Institute of Child Health, London WC1N 1EH, UK
| | - Fenella J. Kirkham
- Developmental Neurosciences Section, UCL Great Ormond Street Institute of Child Health, London WC1N 1EH, UK
- Clinical and Experimental Sciences, University of Southampton, Southampton SO16 6YD, UK
- Child Health, University Hospital Southampton, Southampton SO16 6YD, UK
- Correspondence:
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Heitzer AM, Schreiber JE, Yuan X, Wang F, Pan H, Graff JC, Murphy L, Rupff R, Russell K, Wang W, Estepp JH, Hankins JS, Porter JS, Jacola LM. Working memory and school readiness in preschool children with sickle cell disease compared to demographically matched controls. Br J Haematol 2023; 200:358-366. [PMID: 36264030 PMCID: PMC9852012 DOI: 10.1111/bjh.18507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 09/07/2022] [Accepted: 09/28/2022] [Indexed: 01/22/2023]
Abstract
Children diagnosed with sickle cell disease (SCD) are at risk of the development of neurobehavioural problems early in life. Specific impairments in executive function skills, including working memory, have been documented in school-aged children with SCD. These executive skills are known to strongly contribute to early academic skills and preparedness for entering kindergarten. This study examined working memory and school readiness in preschool children with SCD compared to a healthy control group matched for race, sex and parent education. A total of 84 patients diagnosed with SCD (61.9% haemoglobin [Hb]SS/HbSβ0 -thalassaemia) and 168 controls completed testing. The mean (SD) ages of patients and controls at testing were 4.53 (0.38) and 4.44 (0.65) years respectively. The SCD group performed worse than controls on measures of executive function, working memory and school readiness (p < 0.01; Cohen's D range: 0.32-0.39). Measures of working memory were associated with school readiness after accounting for early adaptive development. Multiple linear regression models among patients diagnosed with SCD revealed that college education of the primary caregiver was positively associated with school readiness (p < 0.001) after controlling for sex, genotype, age and early adaptive development. These results highlight the need to implement school readiness interventions in young children diagnosed with SCD emphasising executive function skills.
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Affiliation(s)
- Andrew M. Heitzer
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Jane E. Schreiber
- Child & Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Xiaomeng Yuan
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, TN
| | - Fang Wang
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, TN
| | - Haitao Pan
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, TN
| | - J. Carolyn Graff
- College of Nursing, University of Tennessee Health Science Center, Memphis, TN
| | - Laura Murphy
- Department of Psychiatry, University of Tennessee Health Science Center, Memphis, TN
| | - Rebecca Rupff
- Alabama College of Osteopathic Medicine, Dothan, AL, USA
| | - Kathryn Russell
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Winfred Wang
- Department of Hematology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Jeremie H. Estepp
- Department of Hematology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Jane S. Hankins
- Department of Hematology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Jerlym S. Porter
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Lisa M. Jacola
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN
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Sahu T, Pande B, Sinha M, Sinha R, Verma HK. Neurocognitive Changes in Sickle Cell Disease: A Comprehensive Review. Ann Neurosci 2022; 29:255-268. [PMID: 37064288 PMCID: PMC10101159 DOI: 10.1177/09727531221108871] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 06/02/2022] [Indexed: 11/15/2022] Open
Abstract
Background: Sickle cell disease (SCD) is a type of hemoglobinopathy characterized by abnormal hemoglobin molecules, which includes numerous acute and chronic complications. Ischemic stroke, silent cerebral infarction, headache, and neurocognitive impairment are the most common neurological complications associated with SCD. Summary: Acute anemia because of SCD can cause cognitive impairments because of cerebral hypoxia. Cognitive abnormalities in SCD manifest in various aspects such as working memory, verbal learning, executive functions, and attention. These neurocognitive impairments have been associated with poor functional results, such as transitioning from juvenile to adult care, adherence to medications, and unemployment. Key message: In this review, we focus on neurocognitive aspects of SCD patients based on different imaging techniques, psychological batteries, associated neuromarkers, and interventions for managing of cognitive deficiencies..
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Affiliation(s)
- Tarun Sahu
- Department of Physiology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Babita Pande
- Department of Physiology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Meenakshi Sinha
- Department of Physiology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Ramanjan Sinha
- Department of Physiology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Henu Kumar Verma
- Department of Immunopathology, Institute of lungs Biology and Disease, Comprehensive Pneumology Center, Helmholtz Zentrum, Neuherberg, Munich, Germany
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Schatz J, Reinman L, Bills SE, Johnston JD. Sociodemographic and Biomedical Correlates of Developmental Delay in 2- and 4-Year-Olds with Sickle Cell Disease. J Dev Behav Pediatr 2022; 43:224-232. [PMID: 34570066 PMCID: PMC8942869 DOI: 10.1097/dbp.0000000000001011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 08/12/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Developmental delay occurs frequently in sickle cell disease (SCD). Psychosocial and biomedical factors contribute to delays, but most studies have not examined the timing of risk factors and developmental delay. We examined sociodemographic and biomedical factors to evaluate whether risks of developmental delay differed across 2 developmental periods. METHODS We examined Ages and Stages Questionnaire, second edition (ASQ-2), outcomes in 2-year-olds (n = 100) and 4-year-olds (n = 101) with SCD. ASQ-2 data were obtained from routine developmental screenings administered as part of health care between 2009 and 2016 at a single hematology clinic. Medical record reviews were used to identify sociodemographic and biomedical factors associated with positive screenings for developmental delay. RESULTS Two-year-olds with positive ASQ-2 screenings (n = 32; 32%) were less likely to have private health insurance or to have been in formal daycare and more likely to have a severe SCD genotype. Four-year-olds with positive screenings (n = 40; 40%) were more likely to have a severe SCD genotype or an abnormal transcranial Doppler ultrasound (TCD) examination indicating high stroke risk. The strength of the association between positive screenings and insurance status, severe genotypes, and TCD examinations differed across the 2 age groups. Domain-level outcomes on the ASQ-2 also differed across the 2 age groups. CONCLUSION The cross-sectional data indicate biomedical and psychosocial risks are related to developmental delay, but the association with specific risk factors differs across age.
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Affiliation(s)
- Jeffrey Schatz
- Department of Psychology, University of South Carolina, Columbia, SC
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10
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Heitzer AM, Cohen DL, Okhomina VI, Trpchevska A, Potter B, Longoria J, Porter JS, Estepp JH, King A, Henley M, Kang G, Hankins JS. Neurocognitive functioning in preschool children with sickle cell disease. Pediatr Blood Cancer 2022; 69:e29531. [PMID: 34971013 PMCID: PMC9207743 DOI: 10.1002/pbc.29531] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 11/12/2021] [Accepted: 11/23/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Children with sickle cell disease (SCD) experience neurodevelopmental delays; however, there is limited research with preschool-age children. This study examined neurocognitive risk and protective factors in preschoolers with SCD. PROCEDURE Sixty-two patients with SCD (60% HbSS/HbSβ0 -thalassemia; 40% HbSC/HbSβ+ -thalassemia) between the ages of 3 and 6 years (mean = 4.77 years) received a neuropsychological evaluation as routine systematic surveillance. Patients were not selected for disease severity, prior central nervous system findings, or existing cognitive concerns. Thirty-four patients (82% HbSS/HbSβ0 -thalassemia) were prescribed hydroxyurea (HU) at the time of their neuropsychological evaluation. On average, these patients had been prescribed HU at 2.15 (standard deviation = 1.45) years of age. The average dose was 28.8 mg/kg/day. Besides genotype, there were no group differences in medical or demographic factors based on HU treatment status. RESULTS Patients with HbSS/HbSβ0 -thalassemia scored below normative expectations on measures of intelligence, verbal comprehension, and school readiness (false discovery rate-adjusted p-value [pFDR ] < .05). Age, sickle genotype, and HU treatment exposure were not associated with measured neurocognitive outcomes (pFDR > .05). Greater social vulnerability at the community level was associated with poorer performance on measures of intellectual functioning, verbal comprehension, visuomotor control, and school readiness, as well as parent report of executive dysfunction (pFDR < .05). Greater household socioeconomic status was positively associated with academic readiness. CONCLUSIONS Preschoolers with severe SCD (HbSS/HbSβ0 -thalassemia) perform below age expectations on measures of intelligence and academic readiness. Sociodemographic factors were stronger drivers of neurocognitive performance than disease severity or disease-modifying treatment. Neurodevelopmental interventions targeting the home and broader community environment are needed.
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Affiliation(s)
- Andrew M. Heitzer
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Diana L. Cohen
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN
| | | | - Ana Trpchevska
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Brian Potter
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Jennifer Longoria
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Jerlym S. Porter
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Jeremie H. Estepp
- Department of Hematology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Allison King
- Program in Occupational Therapy and Departments of Pediatrics and Medicine, Washington University, St. Louis, MO
| | - Misham Henley
- Department of Hematology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Guolian Kang
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, TN
| | - Jane S. Hankins
- Department of Hematology, St. Jude Children’s Research Hospital, Memphis, TN
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11
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Longoria JN, Heitzer AM, Hankins JS, Trpchevska A, Porter JS. Neurocognitive risk in sickle cell disease: Utilizing neuropsychology services to manage cognitive symptoms and functional limitations. Br J Haematol 2022; 197:260-270. [PMID: 35118643 DOI: 10.1111/bjh.18041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 12/10/2021] [Accepted: 12/31/2021] [Indexed: 11/28/2022]
Abstract
Sickle cell disease (SCD) is an inherited blood disorder that is associated with developmental delays and neurocognitive deficits. This review details key findings related to neurocognitive outcomes for children and adults with emphasis on the impact of neurological correlates and disease severity. Associations between neurocognition, demographic factors and social determinants of health are also reviewed. Emerging literature has reported on the neurocognitive impact of SCD in children and adolescents in Africa and Europe, including children from immigrant communities. Neurocognitive deficits are linked to poor functional outcomes, including transition from paediatric to adult care, medication adherence and unemployment. Integrating neuropsychology into multidisciplinary care for individuals with SCD can assist with identification and management of neurocognitive concerns, intervention development, individualized care plan development and continued multidisciplinary research.
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Affiliation(s)
- Jennifer N Longoria
- Department of Psychology, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Andrew M Heitzer
- Department of Psychology, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Jane S Hankins
- Department of Hematology, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Ana Trpchevska
- Department of Psychology, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Jerlym S Porter
- Department of Psychology, St Jude Children's Research Hospital, Memphis, Tennessee, USA
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Heitzer AM, Hamilton L, Stafford C, Gossett J, Ouellette L, Trpchevska A, King AA, Kang G, Hankins JS. Academic Performance of Children With Sickle Cell Disease in the United States: A Meta-Analysis. Front Neurol 2021; 12:786065. [PMID: 34966350 PMCID: PMC8711768 DOI: 10.3389/fneur.2021.786065] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 11/17/2021] [Indexed: 11/22/2022] Open
Abstract
Background: Students with sickle cell disease are at risk for poor academic performance due to the combined and/or interactive effects of environmental, psychosocial, and disease-specific factors. Poor academic performance has significant social and health consequences. Objective: To study academic achievement and attainment in children with sickle cell disease in the United States. Design: Medline, Embase, SCOPUS, CINAHL, ERIC, and PsycINFO were searched for peer-reviewed articles. Studies of children (ages 5-18) diagnosed with sickle cell disease of any genotype reporting academic achievement (standardized tests of reading, math, and spelling) or attainment (grade retention or special education) outcomes were included. Outcomes were analyzed using a random effects model. Achievement scores were compared to within study controls or normative expectations. Prevalence of grade retention and special education services were compared to national (United States) estimates for Black students. Age at assessment and overall IQ were evaluated separately for association with reading and mathematics scores. Subgroup analyses of reading and math scores were analyzed by cerebral infarct status (no cerebrovascular accident, silent infarct, stroke). Results: There were 44 eligible studies. Students with sickle cell disease scored 0.70, 0.87, and 0.80 (p < 0.001) SD below normative expectations on measures of reading, mathematics, and spelling, respectively. Compared to unaffected sibling and/or healthy controls (k = 8, n = 508), reading and math scores were 0.40 (p = 0.017) and 0.36 (p = 0.033) SD below expectations. Grade retention was approximately 10 times higher in students with sickle cell disease than Black students nationally. Intellectual functioning explained 97.3 and 85.8% of the variance in reading and mathematics performance, respectively (p < 0.001). Subgroup analyses revealed significant differences in reading (p = 0.034) and mathematics (p < 0.001) based on infarct status, with lower performance associated with presence of a silent infarct or stroke. Conclusion: Students with sickle cell disease demonstrate notable academic difficulties and are at high risk for grade retainment. Development of academic interventions and increased access to school support services are needed for this vulnerable population. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020179062.
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Affiliation(s)
- Andrew M. Heitzer
- Psychology, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Latacha Hamilton
- School Program, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Claire Stafford
- Psychology, Nova Southeastern College of Psychology, Fort Lauderdale, FL, United States
| | - Jeffrey Gossett
- Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Lara Ouellette
- Health Sciences Resource Center, Texas Medical Center Library, Houston, TX, United States
| | - Ana Trpchevska
- Psychology, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Allison A. King
- Program in Occupational Therapy and Departments of Pediatrics and Medicine, Washington University, St. Louis, MO, United States
| | - Guolian Kang
- Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Jane S. Hankins
- Hematology, St. Jude Children's Research Hospital, Memphis, TN, United States
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13
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Longoria JN, Pugh NL, Gordeuk V, Hsu LL, Treadwell M, King AA, Gibson R, Kayle M, Crego N, Glassberg J, Melvin CL, Hankins JS, Porter J. Patient-reported neurocognitive symptoms influence instrumental activities of daily living in sickle cell disease. Am J Hematol 2021; 96:1396-1406. [PMID: 34350622 PMCID: PMC8855994 DOI: 10.1002/ajh.26315] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 07/29/2021] [Accepted: 08/02/2021] [Indexed: 12/12/2022]
Abstract
Individuals with sickle cell disease (SCD) experience neurocognitive decline, low medication adherence, increased unemployment, and difficulty with instrumental activities of daily living (IADL). The relationship between self-perceived cognitive difficulties and IADLs, including employment, school enrollment, independence, engagement in leisure activities, and medication adherence is unknown. We hypothesized that self-reported difficulties across neurocognitive areas would predict lower IADL skills. Adolescent and adult participants of the multi-site Sickle Cell Disease Implementation Consortium (SCDIC) (n = 2436) completed patient-reported outcome (PRO) measures of attention, executive functioning, processing speed, learning, and comprehension. Cognitive symptoms were analyzed as predictors in multivariable modeling. Outcome variables included 1) an IADL composite that consisted of employment, participation in school, reliance on others, and leisure pursuits, and 2) hydroxyurea adherence. Participants reported cognitive difficulty across areas of attention (55%), executive functioning (51%), processing speed (57%), and reading comprehension (65%). Executive dysfunction (p < 0.001) and sometimes or often experiencing learning difficulties (p < 0.001 and p = 0.04) and poor comprehension (p = 0.000 and p = 0.001), controlled for age (p < 0.001), pain (p < 0.001), and hydroxyurea use (p = 0.001), were associated with poor IADL skills. Executive functioning difficulties (p = 0.021), controlled for age (p = 0.013 for ages 25-34), genotype (p = 0.001), and hemoglobin (p = 0.004), predicted hydroxyurea non-adherence. Analysis of PRO measures indicated that cognitive dysfunction is prevalent in adolescents and adults with SCD. Cognitive dysfunction translated into clinically meaningful outcomes. PRO of cognitive symptoms can be used as an important adjunct clinical tool to monitor symptoms that impact functional skills, including engagement in societal activities and medication adherence.
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Affiliation(s)
- Jennifer N Longoria
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Norma L Pugh
- Center for Clinical Research Network Coordination, RTI International, Research Triangle Park, North Carolina, USA
| | - Victor Gordeuk
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Lewis L Hsu
- Department of Pediatrics, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Marsha Treadwell
- Department of Pediatrics, University of California San Francisco Benioff Children's Hospital Oakland, San Francisco, California, USA
| | - Allison A King
- Program in Occupational Therapy and Departments of Pediatrics and Medicine, Washington University, St. Louis, Missouri, USA
| | - Robert Gibson
- Department of Emergency Medicine and Hospitalist Services, Augusta University, Augusta, Georgia, USA
| | - Mariam Kayle
- Clinical Health Systems and Analytics Division, Duke University, Durham, North Carolina, USA
| | - Nancy Crego
- Women, Children and Families Division, Duke University School of Nursing, Durham, NC
| | - Jeffrey Glassberg
- Department of Emergency Medicine, Icahn School of Medicine at Mt. Sinai, New York, New York, USA
| | - Cathy L Melvin
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jane S Hankins
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Jerlym Porter
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
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14
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Wang WC, Zou P, Hwang SN, Kang G, Ding J, Heitzer AM, Schreiber JE, Helton K, Hankins JS. Effects of hydroxyurea on brain function in children with sickle cell anemia. Pediatr Blood Cancer 2021; 68:e29254. [PMID: 34331507 DOI: 10.1002/pbc.29254] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 06/10/2021] [Accepted: 07/07/2021] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Sickle cell anemia (SCA) results in numerous adverse effects on the brain, including neurocognitive dysfunction. Hydroxyurea has been utilized extensively for management of SCA, but its effects on brain function have not been established. METHODS We examined prospectively the effects of 1 year of treatment with hydroxyurea on brain function in children with SCA (HbSS/HbSβ0 -thalassemia) by baseline and exit evaluations, including comprehensive neurocognitive testing, transcranial Doppler ultrasound (TCD), and brain MRI (silent cerebral infarcts [SCI], gray matter cerebral blood flow [GM-CBF], and blood oxygen level-dependent [BOLD] signal from visual stimulation). RESULTS Nineteen patients with SCA, mean age 12.4 years (range 7.2-17.8), were evaluated. At baseline, subjects had these mean values: full-scale IQ (FSIQ) 82.8, TCD velocity 133 cm/s, GM-CBF 64.4 ml/100 g/min, BOLD signal 2.34% increase, and frequency of SCI 47%. After 1 year of hydroxyurea, there were increases in FSIQ (+2, p = .059) and reading passage comprehension (+4, p = .033), a significant decrease in TCD velocity (-11 cm/s, p = .007), and no significant changes in GM-CBF, BOLD, or SCI frequency. Hemoglobin F (HbF) was associated with passage comprehension, hemoglobin with lower TCD velocity, and lower GM-CBF with greater working memory. Higher BOLD signal was associated with higher processing speed and lower TCD velocity with higher math fluency. DISCUSSION Improvements in neurocognition and decreased TCD velocity following 1 year of treatment support hydroxyurea use for improving neurocognitive outcomes in SCA. Understanding the mechanisms of benefit, as indicated by relationships of neurocognitive function with HbF, hemoglobin, and CBF, requires further evaluation.
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Affiliation(s)
- Winfred C Wang
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Ping Zou
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Scott N Hwang
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Guolian Kang
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Juan Ding
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Andrew M Heitzer
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Jane E Schreiber
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Kathleen Helton
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Jane S Hankins
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
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15
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Wang W, Freeman M, Hamilton L, Carroll Y, Kang G, Moen J, Smeltzer MP, Schreiber J, Heitzer AM, Estepp J, Aygun B. Developmental screening of three-year-old children with sickle cell disease compared to controls. Br J Haematol 2021; 195:621-628. [PMID: 34396511 DOI: 10.1111/bjh.17780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 07/13/2021] [Accepted: 08/02/2021] [Indexed: 11/30/2022]
Abstract
We previously found that neurodevelopmental deficits commonly occurred in three-year-olds with sickle cell disease (SCD), but clinical significance was uncertain because a comparison group was lacking. Our objective in the current study was to prospectively compare neurodevelopment in three-year-old children with SCD to an age-appropriate control group. The Brigance Preschool Screen II is a neurodevelopmental screening examination which can be administered in 15-20 min. SCD patients (Group 1) were compared with community controls of similar age and ethnicity enrolled in daycare/preschool (Group 2). SCD patients who were receiving hydroxycarbamide treatment were also compared (Group 3). Two hundred forty-five three-year-olds were evaluated: Group 1, 111; Group 2, 114; and Group 3, 20. The below cut-off rate on the Brigance test was higher in Group 1 (73%) than in Group 2 (61%; P = 0·04). In multivariate analysis of Group 1 patients, only lower household income and more persons living in the home were independent predictors of this. Patients with SCD and matched controls had high rates of 'failing' the Brigance test. The below cut-off rate in untreated children with SCD was associated with low household income and increased number of persons living in the home.
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Affiliation(s)
- Winfred Wang
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Molly Freeman
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Latacha Hamilton
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Yvonne Carroll
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, TN, USA
| | - Guolian Kang
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Joseph Moen
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Matthew P Smeltzer
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, TN, USA
| | - Jane Schreiber
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Andrew M Heitzer
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Jeremie Estepp
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Banu Aygun
- Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Cohen Children's Medical Center of New York, New Hyde Park, NY, USA
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16
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Knight LM, King AA, Strouse JJ, Tanabe P. Pediatric Neurodevelopmental Delays in Children 0 to 5 Years of Age With Sickle Cell Disease: A Systematic Literature Review. J Pediatr Hematol Oncol 2021; 43:104-111. [PMID: 33560086 PMCID: PMC8254873 DOI: 10.1097/mph.0000000000002091] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 12/28/2020] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Sickle cell disease (SCD) is the most common abnormal genetic blood disease that affects ∼100,000 Americans. Approximately 20% to 37% of children with sickle cell anemia have silent cerebral infarcts by the age of 14 years old. Neurocognitive deficits are identified in infants and preschool children with SCD. The purpose of this systematic literature review is to provide a comprehensive understanding of the prevalence, severity, and the associated risk factors for neurodevelopmental delays (NDDs) in children with SCD 5 years of age and younger. METHODS Systematic search of 6 databases identified 2467 potentially relevant publications and 8 were identified through a manual search. Only 24 articles met the inclusion criteria. RESULTS We identified an increased prevalence of NDDs (cognitive, motor, or both). Children experienced deficits with language, attention and behavior, executive functioning, school readiness and/or academic performance, and motor skills (fine and gross motor functioning). Risk factors include silent cerebral infarcts and strokes, SCD genotype (HbSS>HbSC), other biologic, and social factors. CONCLUSION NDDs are common in children ages 0 to 5 years old with SCD. There is an opportunity to improve adherence to national guideline recommendations and early detection practices by pediatricians, hematologists, and other health care providers.
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End points for sickle cell disease clinical trials: renal and cardiopulmonary, cure, and low-resource settings. Blood Adv 2020; 3:4002-4020. [PMID: 31809537 DOI: 10.1182/bloodadvances.2019000883] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 10/07/2019] [Indexed: 01/19/2023] Open
Abstract
To address the global burden of sickle cell disease and the need for novel therapies, the American Society of Hematology partnered with the US Food and Drug Administration to engage the work of 7 panels of clinicians, investigators, and patients to develop consensus recommendations for clinical trial end points. The panels conducted their work through literature reviews, assessment of available evidence, and expert judgment focusing on end points related to patient-reported outcome, pain (non-patient-reported outcomes), the brain, end-organ considerations, biomarkers, measurement of cure, and low-resource settings. This article presents the findings and recommendations of the end-organ considerations, measurement of cure, and low-resource settings panels as well as relevant findings and recommendations from the biomarkers panel.
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18
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Downes M, de Haan M, Telfer PT, Kirkham FJ. The Role of Family Functioning in the Development of Executive Functions in Preschool Children with Sickle Cell Anemia. Dev Neuropsychol 2019; 44:452-467. [PMID: 31450996 DOI: 10.1080/87565641.2019.1660779] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Executive functions are compromised in children with sickle cell anemia. There is limited research on the development of executive functions in preschool children with sickle cell anemia and the factors that contribute to executive dysfunction. We looked at the relation between biomedical and environmental factors, including family functioning and socioeconomic status, and executive functions in 22 preschool children with sickle cell anemia. We found that family functioning was the strongest predictor of executive outcomes in young children with sickle cell anemia with no evidence for an influence of disease severity at this early stage.
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Affiliation(s)
- Michelle Downes
- School of Psychology, University College Dublin , Dublin , Ireland
| | - Michelle de Haan
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health , London , UK
| | - Paul T Telfer
- Department of Hematology, Barts Health NHS Trust , London , UK
| | - Fenella J Kirkham
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health , London , UK
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19
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Hirtz D, Kirkham FJ. Sickle Cell Disease and Stroke. Pediatr Neurol 2019; 95:34-41. [PMID: 30948147 DOI: 10.1016/j.pediatrneurol.2019.02.018] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 02/21/2019] [Accepted: 02/22/2019] [Indexed: 01/04/2023]
Abstract
Cerebral infarction is a common complication of sickle cell disease and may manifest as overt stroke or cognitive impairment associated with "silent" cerebral infarction on magnetic resonance imaging. Vasculopathy may be diagnosed on transcranial Doppler or magnetic resonance angiography. The risk factors in sickle cell disease for cognitive impairment, overt ischemic stroke, silent cerebral infarction, overt hemorrhagic stroke, and vasculopathy defined by transcranial Doppler or magnetic resonance angiography overlap, with severe acute and chronic anemia, acute chest crisis, reticulocytosis, and low oxygen saturation reported with the majority. However, there are differences reported in different cohorts, which may reflect age, geographic location, or neuroimaging techniques, for example, magnetic resonance imaging field strength. Regular blood transfusion reduces, but does not abolish, the risk of neurological complications in children with sickle cell disease and either previous overt stroke or silent cerebral infarction or abnormal transcranial Doppler. There are relatively few data on the use of hydroxyurea or other management strategies. Early assessment of the risk of neurocognitive complications is likely to become increasingly important in the management of sickle cell disease.
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Affiliation(s)
- Deborah Hirtz
- University of Vermont School of Medicine, Burlington, Vermont
| | - Fenella J Kirkham
- Developmental Neurosciences Section and Biomedical Research Unit, Clinical and Experimental Sciences, University of Southampton, UCL Great Ormond Street Institute of Child Health, London, UK.
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20
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Schatz J, Schlenz AM, Smith KE, Roberts CW. Predictive validity of developmental screening in young children with sickle cell disease: a longitudinal follow-up study. Dev Med Child Neurol 2018; 60:520-526. [PMID: 29488622 DOI: 10.1111/dmcn.13689] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/13/2017] [Indexed: 11/30/2022]
Abstract
AIM To assess the predictive validity of developmental screenings in children with sickle cell disease (SCD) for academic outcomes and stroke risk. METHOD Parent questionnaires and medical record data were collected for a cohort receiving developmental screenings between September 2004 and May 2008 as toddlers or early school age. Screening outcomes were dichotomized (positive, negative) by a priori criteria. Questionnaires assessed school and social functioning, services received, and quality of life. Medical record data assessed general SCD morbidity and stroke risk. RESULTS Forty-one toddlers (mean age 2y 5mo; 25 males, 16 females) and 49 early school-age children (mean age 6y 5mo; 26 males, 23 females) completed follow-up. The mean follow-up period was 8 years 6 months (range 6.1-10.8y). For toddlers, positive screenings for language delays predicted lower academic performance (p=0.023). For older children, positive screenings for cognitive delays predicted more frequent academic/attentional problems at school (p<0.001), grade retention (p=0.007), and lower academic performance (p=0.001). Positive screenings were associated with an earlier onset of school problems and lower quality of life. Positive screenings for language/cognitive delays predicted increased stroke risk (both p<0.05). INTERPRETATION Screening for language or cognitive development in young children with SCD predicts academic outcomes and stroke risk. WHAT THIS PAPER ADDS Developmental screening predicts academic outcomes in sickle cell disease. Children with concerning language/cognitive screenings have early-onset school difficulties. Developmental screenings may help predict cerebrovascular complications.
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Affiliation(s)
- Jeffrey Schatz
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Alyssa M Schlenz
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
| | - Kelsey E Smith
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Carla W Roberts
- Department of Pediatrics, University of South Carolina, Columbia, SC, USA
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21
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Developmental Screening in Pediatric Sickle Cell Disease: Disease-Related Risk and Screening Outcomes in 4 Year Olds. J Dev Behav Pediatr 2017; 38:654-662. [PMID: 28816916 PMCID: PMC5617784 DOI: 10.1097/dbp.0000000000000486] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Studies of early child development in sickle cell disease (SCD) have found modest associations between disease-related risks and developmental status in infants and toddlers, but such associations are evident by early elementary school. We screened 4-year-old children with SCD using 2 screening strategies to assess if biomedical risk factors for neurologic disease are related to developmental screening outcomes at this intermediate age. METHODS Seventy-seven 4-year-old children with SCD (M = 4.5 yrs, SD = 0.3 yrs) completed developmental screenings at routine hematology visits using child testing (Fluharty Preschool Speech and Language Screenings Test, 2nd edition) and parent-report (Ages and Stages Questionnaire, 2nd edition) procedures. Genotype and other biomedical variables were coded from medical records. RESULTS Children with higher-risk SCD genotypes (n = 52) showed lower performance than children with lower-risk genotypes (n = 25) on a measure related to neurologic disease risk in older children (syntactic processing); genotype risk was also related to rates of positive screenings on parent-reported developmental milestones (52% positive screenings in high-risk genotypes vs 12% in low-risk genotypes). Screening outcomes were also related to transcranial Doppler ultrasound findings assessing cerebral blood flow. CONCLUSION Developmental screening at age 4 may be a useful target age for identifying preschoolers with sickle cell-related neurodevelopmental concerns. Parent report of developmental milestones and behavioral testing each may have a role in screening for children in need of follow-up services to address potential neurodevelopmental effects from SCD.
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Fields ME, Hoyt-Drazen C, Abel R, Rodeghier MJ, Yarboi JM, Compas BE, King AA. A pilot study of parent education intervention improves early childhood development among toddlers with sickle cell disease. Pediatr Blood Cancer 2016; 63:2131-2138. [PMID: 27509845 PMCID: PMC5344022 DOI: 10.1002/pbc.26164] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 06/10/2016] [Accepted: 06/28/2016] [Indexed: 11/05/2022]
Abstract
BACKGROUND Young children with sickle cell disease (SCD) are at risk for cognitive delay. In addition to biologic risk factors associated with SCD, environmental factors contribute to cognitive dysfunction within this cohort. METHODS We completed a single-arm, prospective cohort study. Children with SCD between the ages of 3 and 36 months and their caregivers were followed between October 2010 and December 2013. The aim was to describe the role of a home visitation model, the home environment, and socioeconomic status in the development of young children with SCD. Primary outcome measures were the Bayley Scales of Infant and Toddler Development, Third Edition (BSID-III) and the Home Observation for Measurement of the Environment (HOME). We hypothesized that the home visitation model, Parents as Teachers® (PAT), would encourage positive parent-child interactions and improve cognitive outcomes. RESULTS Thirty-five participants had at least two PAT visits and BSID-III assessments. Mean scores within all five subtests of the BSID-III improved between enrollment and exit, with significant changes within cognitive (P = 0.016) and expressive language (EL) domains (P = 0.002). Multivariate modeling found the HOME score associated with the exit results of the cognitive domain. CONCLUSION We report longitudinal results of the first home visitation program within the early childhood SCD population and show significant improvement in cognitive and EL development. Additionally, home environment was a significant predictor of cognitive development. Randomized controlled trials to test the impact of interventions targeting the home environment are warranted for this vulnerable population.
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Affiliation(s)
- Melanie E. Fields
- Washington University School of Medicine, Department of Pediatrics, Division of Pediatric Hematology/Oncology, St. Louis, Missouri
| | - Catherine Hoyt-Drazen
- Washington University School of Medicine, Program in Occupational Therapy, St. Louis, Missouri
| | - Regina Abel
- Washington University School of Medicine, Program in Occupational Therapy, St. Louis, Missouri
| | | | - Janet M. Yarboi
- Vanderbilt University, Department of Psychology and Human Development
| | - Bruce E. Compas
- Vanderbilt University, Department of Psychology and Human Development
| | - Allison A. King
- Washington University School of Medicine, Department of Pediatrics, Division of Pediatric Hematology/Oncology, St. Louis, Missouri,Washington University School of Medicine, Program in Occupational Therapy, St. Louis, Missouri,Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
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23
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Drazen CH, Abel R, Gabir M, Farmer G, King AA. Prevalence of Developmental Delay and Contributing Factors Among Children With Sickle Cell Disease. Pediatr Blood Cancer 2016; 63:504-10. [PMID: 26575319 DOI: 10.1002/pbc.25838] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 10/16/2015] [Indexed: 11/05/2022]
Abstract
BACKGROUND Children with sickle cell disease (SCD) are at higher risk for deficits in cognition compared to the general population, even at young ages. Disease severity has been co-assessed in earlier studies, but the home environment has not. The purpose of the current study was to investigate the development of young children with SCD and secondarily, the impact of environmental and family factors. METHODS The current study is a baseline cross-sectional evaluation of a prospective, single-center cohort. Children with SCD between the ages of 1 and 42 months and their primary caregiver were included. Participants lived within 30 miles of the site and spoke English. Children underwent developmental evaluation using the Bayley Scales of Infant and Toddler Development, Third Edition (BSID-III). Home visits were completed and screened using the Home Observation for Measurement of the Environment (HOME). RESULTS Over 3 years, 43 caregiver-child dyads consented and participated. Over 50% of children scored significantly below average on cognition and expressive language subscales. SCD severity was not associated with BSID-III scores. Socioeconomic status (SES) determined by the Diez-Roux method positively correlated (r = 0.401, P < 0.01) with the home environment. The HOME correlated (r = 0.360, P < 0.05) with the cognitive subscale on the BSID-III. CONCLUSIONS Given the high prevalence of developmental delay in this population, identifying modifiable factors to maximize developmental progress is essential. The home environment would be a targeted method for intervention. Future research is needed to identify the benefits of home-based intervention for this population.
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Affiliation(s)
- Catherine Hoyt Drazen
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, Missouri
| | - Regina Abel
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, Missouri
| | - Mohamed Gabir
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, Missouri
| | - Grant Farmer
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Allison A King
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, Missouri.,Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri.,Department of Pediatrics Hematology/Oncology, St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, Missouri
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Bakker MJ, Hofmann J, Churches OF, Badcock NA, Kohler M, Keage HAD. Cerebrovascular function and cognition in childhood: a systematic review of transcranial Doppler studies. BMC Neurol 2014; 14:43. [PMID: 24602446 PMCID: PMC3975716 DOI: 10.1186/1471-2377-14-43] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 02/26/2014] [Indexed: 11/21/2022] Open
Abstract
Background The contribution of cerebrovascular function to cognitive performance is gaining increased attention. Transcranial doppler (TCD) is portable, reliable, inexpensive and extremely well tolerated by young and clinical samples. It enables measurement of blood flow velocity in major cerebral arteries at rest and during cognitive tasks. Methods We systematically reviewed evidence for associations between cognitive performance and cerebrovascular function in children (0-18 years), as measured using TCD. A total of 2778 articles were retrieved from PsychInfo, Pubmed, and EMBASE searches and 25 relevant articles were identified. Results Most studies investigated clinical groups, where decreased blood flow velocities in infants were associated with poor neurological functioning, and increased blood flow velocities in children with Sickle cell disease were typically associated with cognitive impairment and lower intelligence. Studies were also identified assessing autistic behaviour, mental retardation and sleep disordered breathing. In healthy children, the majority of studies reported cognitive processing produced lateralised changes in blood flow velocities however these physiological responses did not appear to correlate with behavioural cognitive performance. Conclusion Poor cognitive performance appears to be associated with decreased blood flow velocities in premature infants, and increased velocities in Sickle cell disease children using TCD methods. However knowledge in healthy samples is relatively limited. The technique is well tolerated by children, is portable and inexpensive. It therefore stands to make a valuable contribution to knowledge regarding the underlying functional biology of cognitive performance in childhood.
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Affiliation(s)
| | | | | | | | | | - Hannah A D Keage
- Cognitive Neuroscience Laboratory, School of Psychology, Social Work and Social Policy, University of South Australia, GPO BOX 2471, 5001 Adelaide, SA, Australia.
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25
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Hoyt Drazen C, Abel R, Lindsey T, King AA. Development and feasibility of a home-based education model for families of children with sickle cell disease. BMC Public Health 2014; 14:116. [PMID: 24499305 PMCID: PMC3942208 DOI: 10.1186/1471-2458-14-116] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Accepted: 01/31/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Children with sickle cell disease (SCD) commonly have cognitive deficits, even among toddlers. Much medical literature emphasizes disease-based factors to account for these deficits. However, the social environment plays a large role in child development. To address the specific needs of early childhood, a monthly hospital-based education program was initiated to educate parents about child development. Education sessions were poorly attended (20-25%) and deemed unsuccessful. This study describes the development and implementation of a home-based education service to teach parents about SCD, developmental milestones and positive parenting techniques. METHODS This was a prospective, single-arm intervention to study the feasibility of a home-based caregiver education program for families with infants and toddlers with SCD. Parents of children aged 0-3 years with SCD from one Midwestern hospital were approached to participate in a home-based program. The program followed the Born to Learn™ curriculum provided through the Parents as Teachers™ National Center. Reminder calls or texts were provided the day before each visit. Results of the first twenty-six months of the program are presented. RESULTS A total of 62% (56 of 91) of families approached agreed to participate; all were African American. The majority of caregivers were single mothers with a high school education or less and whose children had Medicaid for health coverage. The phenotypes of SCD represented in this sample were similar to those in the general SCD population. Over 26 months, 39 families received at least one home visit. Parents of infants (younger than 8 months) were more likely to participate in the home-based education program than parents of older children, (Fisher's exact test, p < .001). CONCLUSIONS For participating families, home-based visits were a feasible method for reinforcing clinic education. About 43% of eligible families participated in the education, a two-fold increase in the poor attendance (20%) for a previous hospital-based program. A home visitation program for parents of infants with SCD could offer an effective approach to helping these children overcome adverse environmental conditions that are compounded by the complexities of a chronic health condition.
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Affiliation(s)
| | | | | | - Allison A King
- Washington University in St, Louis School of Medicine, Program in Occupational Therapy, 4444 Forest Park Pkwy, Box 8505, St, Louis, MO 63108, USA.
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