Inconsistencies between measures of cognitive dysfunction in childhood acute lymphoblastic leukemia survivors: Description and understanding

Attention and executive functioning in children and adolescents treated for high-risk acute lymphoblastic leukemia: A report from the Children's Oncology Group (COG)

OBJECTIVES

Survivors of childhood B-acute lymphoblastic leukemia (B-ALL) are at risk for difficulties with attention and executive functioning (EF) as a late effect of treatment. The present study aimed to identify treatment and demographic factors associated with risk for difficulties with EF in youth treated for high-risk B-ALL.

METHOD

Children and adolescents with B-ALL treated on Children's Oncology Group (COG) protocol AALL0232 were randomized to high-dose or escalating-dose methotrexate (MTX), and either dexamethasone or prednisone during the induction phase. Neuropsychological functioning was evaluated via protocol AALL06N1, including performance-based and parent-report measures, for 177 participants (57% female, 81% white; mean age at diagnosis = 8.4 years; SD = 5.0) 8-24 months following treatment completion.

RESULTS

Mean scores for all attention and EF measures were within the average range, with no significant differences as a function of MTX delivery or steroid treatment (all p > 0.05). In multivariable models, participants with US public insurance exhibited significantly greater parent-reported EF difficulties than those with US private or non-US insurance (p ≤ 0.05). Additionally, participants diagnosed under 10 years of age performed significantly more poorly on measures of attention (i.e., continuous performance task, p ≤ 0.05) and EF (i.e., verbal fluency and tower planning task, p ≤ 0.05).

CONCLUSIONS

For survivors of pediatric B-ALL, treatment-related factors were not associated with attention or EF outcomes. In contrast, outcomes varied by demographic characteristics, including age and insurance type, an indicator of economic hardship. Future research is needed to more directly assess the contribution of socioeconomic status on cognitive outcomes in survivors.

Neurocognitive outcome and associated factors in long-term, adult survivors of childhood acute lymphoblastic leukemia, treated without cranial radiation therapy

OBJECTIVE

There is limited research on neurocognitive outcome and associated risk factors in long-term, adult survivors of childhood acute lymphoblastic leukemia (ALL), without treatment of cranial radiation therapy. Moreover, the impact of fatigue severity and pain interference on neurocognition has received little attention. In this cross-sectional study, we examined neurocognitive outcome and associated factors in this population.

METHOD

Intellectual abilities, verbal learning/memory, processing speed, attention, and executive functions were compared to normative means/medians with one sample t tests or Wilcoxon signed-rank tests. Associations with risk factors, fatigue severity, and pain interference were analyzed with linear regressions.

RESULTS

Long-term, adult survivors of childhood ALL (N = 53, 51% females, mean age = 24.4 years, SD = 4.4, mean = 14.7 years post-diagnosis, SD = 3.4) demonstrated above average intellectual abilities, but performed below average in attention, inhibition, processing speed, and shifting (p < 0.001). Executive functioning complaints were significantly higher than normative means, and positively associated with fatigue (p < 0.001). There was no interaction between sex and fatigue and no neurocognitive impairments were associated with pain interference, risk group, age at diagnosis, or sex.

CONCLUSIONS

Long-term, adult survivors of ALL treated without cranial radiation therapy, demonstrate domain-specific performance-based neurocognitive impairments. However, continued research on the neurocognitive outcome in this population as they age will be important in the coming years. Executive functioning complaints were frequently in the clinical range, and often accompanied by fatigue. This suggests a need for cognitive rehabilitation programs.

The associations of executive functions with resilience in early adulthood: A prospective longitudinal study

BACKGROUND

Executive functions and resilience, the key components of an individual's ability to participate meaningfully and effectively in their environment, have become increasingly researched topics in psychology and education. However, little is known about the longitudinal associations of executive functions and resilience among emergent adults.

METHODS

We conducted a prospective study with 450 (baseline) participants aged 17-24 years; 420 of these participants also completed a 15-month follow-up. Participants answered questionnaires investigating socio-demographics, executive functions, and resilience, and results were analysed with multivariable logistic regression and cross-lagged analyses.

RESULTS

At baseline, the overall prevalence of low executive functions (T-score ≥ 60) among the sample was 18.2%. Relative to persistently low executive functions, newly developed or persistent high executive functions was significantly associated with higher level of resilience at follow-up (bOR = 8.26, 95% CI [2.57, 26.49]; bOR = 8.74, 95% CI [3.69, 20.70], respectively). Further cross-lagged analyses showed bidirectional relationships of executive functions and various executive functions subtypes with resilience.

LIMITATIONS

The use of self-report measures may lead to recall bias, and intervention or experimental studies are needed to examine causality. This study recruited participants from one vocational school, which may limit the generalisability of the results. Also, follow-up dropout was a potential bias in this study; the observed results should be interpreted with caution.

CONCLUSIONS

Our study proposes that enhancing executive functions may be associated with improved resilience, and vice versa. These findings could influence the development of targeted interventions via mental health professionals to support individuals' development.