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Whitaker AM, Wood ZB, Hawthorne K, Mendoza L. Assessing learning and memory among patients with pediatric brain tumor (PBT): a comparison of measures. Child Neuropsychol 2024; 30:551-562. [PMID: 37395295 DOI: 10.1080/09297049.2023.2229026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 06/16/2023] [Indexed: 07/04/2023]
Abstract
Patients with pediatric brain tumor (PBT) can have memory deficits due to tumor location, medical complications, and treatment. The main objective of this study was to investigate whether the California Verbal Learning Test-Children's Version (CVLT-C; 1994) and briefer Child and Adolescent Memory Profile (ChAMP; 2015) similarly identify such deficits. Seventy-five patients with PBT ages 8-16 (x ‾ = 13.1 years, SD = 2.1) were administered the ChAMP or CVLT-C. Rote verbal learning, long-term retrieval, and recognition were analyzed using standardized z-scores. Analyses of differences between measures did not reach statistical significance. Both measures indicated significant downward shifts across free retrieval trials from normative means, with scores approximately 1/3 (ChAMP) to 1/2 (CVLT-C) SD below means across learning and long-term retrieval trials. Scores on recognition trials did not differ significantly from the normative mean. Post-hoc analyses using a subset of the sample who received cranial irradiation (n = 45) similarly found no significant differences between memory measures. Additional post-hoc examination of proportion of participants falling within or below the "below average" range (≤8th percentile) revealed comparable performance between the two measures, whereas the proportion of participants falling at or below 1.5 SDs below the mean on retrieval trials was lower using ChAMP Lists as compared to the CVLT-C. Given the ChAMP is less demanding in terms of time and effort and utilizes more updated and representative normative data, this study supports the ChAMP as a useful tool to evaluate learning and memory within this population.
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Affiliation(s)
- Ashley M Whitaker
- Cancer and Blood Disease Institute, Children's Hospital Los Angeles, Los Angeles, CA, USA
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Zachary B Wood
- Cancer and Blood Disease Institute, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Kelsey Hawthorne
- Cancer and Blood Disease Institute, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Leanne Mendoza
- Cancer and Blood Disease Institute, Children's Hospital Los Angeles, Los Angeles, CA, USA
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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2
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Samargia-Grivette S, Hartley H, Walsh K, Lemiere J, Payne AD, Litke E, Knight A. REhabilitation Approaches in CHildren with cerebellar mutism syndrome (REACH): An international cross-disciplinary survey study. J Pediatr Rehabil Med 2024; 17:185-197. [PMID: 38393929 DOI: 10.3233/prm-230006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2024] Open
Abstract
OBJECTIVE Pediatric cerebellar mutism syndrome (pCMS) can occur following resection of a posterior fossa tumor and, although some symptoms are transient, many result in long-lasting neurological deficits. A multi-disciplinary rehabilitation approach is often used in cases of pCMS; however, there have been no clinical trials to determine gold standards in rehabilitation practice in this population, which remains a research priority. The purpose of this study was to identify and compare intervention practices used in pCMS throughout the disciplines of occupational and physical therapy, speech-language pathology, and neuropsychology across geographic regions. METHODS A 55-question e-survey was created by an international multidisciplinary research group made up of members of the Posterior Fossa Society and sent to rehabilitation professionals in pediatric neuro-oncology centers in the US, Canada, and Europe. RESULTS Although some differences in the type of intervention used in pCMS were identified within each discipline, many of the targeted interventions including dose, frequency, and intensity were similar within disciplines across geographic regions. In addition, there were common themes identified across disciplines regarding challenges in the rehabilitation of this population. CONCLUSION These results provide a foundation of current practices on which to build future intervention-based clinical trials.
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Affiliation(s)
- Sharyl Samargia-Grivette
- Department of Communication Sciences and Disorders, University of Minnesota Duluth, Duluth, MN, USA
| | - Helen Hartley
- Department of Physical Therapy, Alder Hey Children's Hospital, Liverpool, UK
| | - Karin Walsh
- Department of Neuropsychology, National Children's Medical Center, Washington, DC, USA
| | - Jurgen Lemiere
- Department Oncology, Pediatric Oncology, KU Leuven, Leuven, Belgium
- Pediatric Hemato-Oncology, Universitair Ziekenhuis Leuven (UZ Leven), Leuven, Belgium
| | - Allison D Payne
- Department of Neuropsychology, National Children's Medical Center, Washington, DC, USA
| | - Emma Litke
- Department of Communication Sciences and Disorders, University of Minnesota Duluth, Duluth, MN, USA
| | - Ashley Knight
- Department of Communication Sciences and Disorders, University of Minnesota Duluth, Duluth, MN, USA
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3
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Singh R, Yu S, Osman M, Inde Z, Fraser C, Cleveland AH, Almanzar N, Lim CB, Joshi GN, Spetz J, Qin X, Toprani SM, Nagel Z, Hocking MC, Cormack RA, Yock TI, Miller JW, Yuan ZM, Gershon T, Sarosiek KA. Radiotherapy-Induced Neurocognitive Impairment Is Driven by Heightened Apoptotic Priming in Early Life and Prevented by Blocking BAX. Cancer Res 2023; 83:3442-3461. [PMID: 37470810 PMCID: PMC10570680 DOI: 10.1158/0008-5472.can-22-1337] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 04/23/2023] [Accepted: 07/17/2023] [Indexed: 07/21/2023]
Abstract
Although external beam radiotherapy (xRT) is commonly used to treat central nervous system (CNS) tumors in patients of all ages, young children treated with xRT frequently experience life-altering and dose-limiting neurocognitive impairment (NI) while adults do not. The lack of understanding of mechanisms responsible for these differences has impeded the development of neuroprotective treatments. Using a newly developed mouse model of xRT-induced NI, we found that neurocognitive function is impaired by ionizing radiation in a dose- and age-dependent manner, with the youngest animals being most affected. Histologic analysis revealed xRT-driven neuronal degeneration and cell death in neurogenic brain regions in young animals but not adults. BH3 profiling showed that neural stem and progenitor cells, neurons, and astrocytes in young mice are highly primed for apoptosis, rendering them hypersensitive to genotoxic damage. Analysis of single-cell RNA sequencing data revealed that neural cell vulnerability stems from heightened expression of proapoptotic genes including BAX, which is associated with developmental and mitogenic signaling by MYC. xRT induced apoptosis in primed neural cells by triggering a p53- and PUMA-initiated, proapoptotic feedback loop requiring cleavage of BID and culminating in BAX oligomerization and caspase activation. Notably, loss of BAX protected against apoptosis induced by proapoptotic signaling in vitro and prevented xRT-induced apoptosis in neural cells in vivo as well as neurocognitive sequelae. On the basis of these findings, preventing xRT-induced apoptosis specifically in immature neural cells by blocking BAX, BIM, or BID via direct or upstream mechanisms is expected to ameliorate NI in pediatric patients with CNS tumor. SIGNIFICANCE Age- and differentiation-dependent apoptotic priming plays a pivotal role in driving radiotherapy-induced neurocognitive impairment and can be targeted for neuroprotection in pediatric patients.
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Affiliation(s)
- Rumani Singh
- John B. Little Center for Radiation Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Laboratory of Systems Pharmacology, Harvard Program in Therapeutic Science, Department of Systems Biology, Harvard Medical School, Boston, Massachusetts
- Molecular and Integrative Physiological Sciences Program, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Stacey Yu
- John B. Little Center for Radiation Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Laboratory of Systems Pharmacology, Harvard Program in Therapeutic Science, Department of Systems Biology, Harvard Medical School, Boston, Massachusetts
- Molecular and Integrative Physiological Sciences Program, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Marwa Osman
- John B. Little Center for Radiation Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Laboratory of Systems Pharmacology, Harvard Program in Therapeutic Science, Department of Systems Biology, Harvard Medical School, Boston, Massachusetts
- Molecular and Integrative Physiological Sciences Program, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Zintis Inde
- John B. Little Center for Radiation Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Laboratory of Systems Pharmacology, Harvard Program in Therapeutic Science, Department of Systems Biology, Harvard Medical School, Boston, Massachusetts
- Molecular and Integrative Physiological Sciences Program, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Cameron Fraser
- John B. Little Center for Radiation Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Laboratory of Systems Pharmacology, Harvard Program in Therapeutic Science, Department of Systems Biology, Harvard Medical School, Boston, Massachusetts
- Molecular and Integrative Physiological Sciences Program, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Abigail H. Cleveland
- Department of Neurology, University of North Carolina, Chapel Hill, North Carolina
- Lineberger Comprehensive Cancer Center, North Carolina Cancer Hospital, Chapel Hill, North Carolina
| | - Nicole Almanzar
- Molecular and Integrative Physiological Sciences Program, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Chuan Bian Lim
- John B. Little Center for Radiation Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Molecular and Integrative Physiological Sciences Program, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Gaurav N. Joshi
- John B. Little Center for Radiation Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Laboratory of Systems Pharmacology, Harvard Program in Therapeutic Science, Department of Systems Biology, Harvard Medical School, Boston, Massachusetts
- Molecular and Integrative Physiological Sciences Program, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Johan Spetz
- John B. Little Center for Radiation Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Laboratory of Systems Pharmacology, Harvard Program in Therapeutic Science, Department of Systems Biology, Harvard Medical School, Boston, Massachusetts
- Molecular and Integrative Physiological Sciences Program, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Xingping Qin
- John B. Little Center for Radiation Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Laboratory of Systems Pharmacology, Harvard Program in Therapeutic Science, Department of Systems Biology, Harvard Medical School, Boston, Massachusetts
- Molecular and Integrative Physiological Sciences Program, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Sneh M. Toprani
- John B. Little Center for Radiation Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Molecular and Integrative Physiological Sciences Program, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Zachary Nagel
- John B. Little Center for Radiation Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Molecular and Integrative Physiological Sciences Program, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Matthew C. Hocking
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania
- Cancer Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Robert A. Cormack
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Torunn I. Yock
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Pediatric Radiation Oncology, Francis H. Burr Proton Therapy Center, Massachusetts General Hospital, Boston, Massachusetts
| | - Jeffrey W. Miller
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Zhi-Min Yuan
- John B. Little Center for Radiation Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Molecular and Integrative Physiological Sciences Program, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Timothy Gershon
- Department of Neurology, University of North Carolina, Chapel Hill, North Carolina
- Lineberger Comprehensive Cancer Center, North Carolina Cancer Hospital, Chapel Hill, North Carolina
| | - Kristopher A. Sarosiek
- John B. Little Center for Radiation Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Laboratory of Systems Pharmacology, Harvard Program in Therapeutic Science, Department of Systems Biology, Harvard Medical School, Boston, Massachusetts
- Molecular and Integrative Physiological Sciences Program, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Medical Oncology, Dana-Farber Cancer Institute/Harvard Cancer Center, Boston, Massachusetts
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4
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Mash LE, Kahalley LS, Raghubar KP, Goodrich-Hunsaker NJ, Abildskov TJ, De Leon LA, MacLeod M, Stancel H, Parsons K, Biekman B, Desai NK, Grosshans DR, Paulino AC, Chu ZD, Whitehead WE, Okcu MF, Chintagumpala M, Wilde EA. Cognitive Sparing in Proton versus Photon Radiotherapy for Pediatric Brain Tumor Is Associated with White Matter Integrity: An Exploratory Study. Cancers (Basel) 2023; 15:cancers15061844. [PMID: 36980730 PMCID: PMC10047305 DOI: 10.3390/cancers15061844] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 02/28/2023] [Accepted: 03/06/2023] [Indexed: 03/30/2023] Open
Abstract
Radiotherapy for pediatric brain tumors is associated with reduced white matter structural integrity and neurocognitive decline. Superior cognitive outcomes have been reported following proton radiotherapy (PRT) compared to photon radiotherapy (XRT), presumably due to improved sparing of normal brain tissue. This exploratory study examined the relationship between white matter change and late cognitive effects in pediatric brain tumor survivors treated with XRT versus PRT. Pediatric brain tumor survivors treated with XRT (n = 10) or PRT (n = 12) underwent neuropsychological testing and diffusion weighted imaging >7 years post-radiotherapy. A healthy comparison group (n = 23) was also recruited. Participants completed age-appropriate measures of intellectual functioning, visual-motor integration, and motor coordination. Tractography was conducted using automated fiber quantification (AFQ). Fractional anisotropy (FA), axial diffusivity (AD), and radial diffusivity (RD) were extracted from 12 tracts of interest. Overall, both white matter integrity (FA) and neuropsychological performance were lower in XRT patients while PRT patients were similar to healthy control participants with respect to both FA and cognitive functioning. These findings support improved long-term outcomes in PRT versus XRT. This exploratory study is the first to directly support for white matter integrity as a mechanism of cognitive sparing in PRT.
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Affiliation(s)
- Lisa E Mash
- Department of Pediatrics, Division of Psychology, Baylor College of Medicine, Houston, TX 77030, USA
- Psychology Service, Texas Children's Hospital, Houston, TX 77030, USA
| | - Lisa S Kahalley
- Department of Pediatrics, Division of Psychology, Baylor College of Medicine, Houston, TX 77030, USA
- Texas Children's Cancer and Hematology Centers, Texas Children's Hospital, Houston, TX 77030, USA
| | - Kimberly P Raghubar
- Department of Pediatrics, Division of Psychology, Baylor College of Medicine, Houston, TX 77030, USA
- Psychology Service, Texas Children's Hospital, Houston, TX 77030, USA
| | | | - Tracy J Abildskov
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT 84132, USA
| | - Luz A De Leon
- Department of Pediatrics, Division of Psychology, Baylor College of Medicine, Houston, TX 77030, USA
- Psychology Service, Texas Children's Hospital, Houston, TX 77030, USA
| | - Marianne MacLeod
- Department of Pediatrics, Division of Psychology, Baylor College of Medicine, Houston, TX 77030, USA
- Psychology Service, Texas Children's Hospital, Houston, TX 77030, USA
| | - Heather Stancel
- Department of Pediatrics, Division of Psychology, Baylor College of Medicine, Houston, TX 77030, USA
- Psychology Service, Texas Children's Hospital, Houston, TX 77030, USA
| | - Kelley Parsons
- Department of Pediatrics, Division of Psychology, Baylor College of Medicine, Houston, TX 77030, USA
- Psychology Service, Texas Children's Hospital, Houston, TX 77030, USA
| | - Brian Biekman
- Department of Psychology, University of Houston, Houston, TX 77204, USA
| | - Nilesh K Desai
- Department of Radiology, Division of Neuroradiology, Texas Children's Hospital, Houston, TX 77030, USA
- Department of Radiology, Baylor College of Medicine, Houston, TX 77030, USA
| | - David R Grosshans
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Arnold C Paulino
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Zili D Chu
- Department of Radiology, Division of Neuroradiology, Texas Children's Hospital, Houston, TX 77030, USA
- Department of Radiology, Baylor College of Medicine, Houston, TX 77030, USA
| | - William E Whitehead
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX 77030, USA
| | - Mehmet Fatih Okcu
- Department of Pediatrics, Division of Hematology Oncology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Murali Chintagumpala
- Department of Pediatrics, Division of Hematology Oncology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Elisabeth A Wilde
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT 84132, USA
- Department of Pediatrics, Division of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX 77030, USA
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5
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Peterson RK, Jacobson LA. Changes in executive function in pediatric brain tumor survivors. Pediatr Blood Cancer 2022; 69:e29483. [PMID: 34842333 DOI: 10.1002/pbc.29483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 10/29/2021] [Accepted: 11/01/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Pediatric oncology survivors are at risk for executive function (EF) and working memory (WM) deficits, which can be measured via performance-based measures or rating scales. Previous studies have shown these measurement methods to be weakly correlated. This study aimed to describe parent-rated EF and performance-based WM (PBWM) in pediatric brain tumor (BT) survivors, examine change in EF and PBWM across time, and investigate the relationship between parent-rated WM and PBWM. METHOD The sample included 56 patients diagnosed with a BT in childhood (Mage = 6.94 years; SD = 4.05) seen twice for clinical neuropsychological evaluation. PBWM was examined via the auditory WM scale from a Wechsler intelligence measure or Differential Ability Scales-II. Parents completed the Behavior Rating Inventory of Executive Function (BRIEF)/BRIEF-P/BRIEF-2 as a measure of global EF (Global Executive Composite [GEC]), metacognitive skills (Metacognitive Index/Cognitive Regulation Index [MI/CRI]), behavioral regulation (Behavior Regulation Index [BRI]), and emotional regulation (Emotion Regulation Index [ERI]). RESULTS GEC, MI/CRI, and ERI at Time 1 were significantly above the mean (p < .01); BRI and PBWM did not differ from the normative mean. All measures were significantly higher than the normative mean at Time 2 (p < .05). PBWM was both clinically and statistically elevated (p < .001). There was a significant change across time in PBWM (p < .05), but not GEC, MI/CRI, ERI, or BRI. PBWM was weakly correlated with the BRIEF WM subscale at Time 1 and Time 2 (all p > .05). CONCLUSIONS Multiple measures of EF should be considered when providing diagnoses and recommendations for pediatric BT survivors. Furthermore, given declines across time, findings document need for continued monitoring and reassessment of survivors as they get further out from treatment.
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Affiliation(s)
- Rachel K Peterson
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, Maryland, USA.,Department of Psychiatry and Behavioral Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Lisa A Jacobson
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, Maryland, USA.,Department of Psychiatry and Behavioral Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Doris HL, Irene R, Ulrike L, Irene S, Thomas P. The assessment of executive functioning in pediatric patients with posterior fossa tumors: A recommendation to combine caregiver-based ratings and performance-based tests. Dev Neurorehabil 2022; 25:19-28. [PMID: 33977851 DOI: 10.1080/17518423.2021.1915404] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE This study addresses the issue of drawing valid conclusions about the assessment of executive functioning (EF) in long-term survivors of pediatric posterior fossa tumors (PPFT). METHOD All 44 patients (females = 18, mean age = 11 years) were treated consecutively at our department for PPFTs (medulloblastomas, ependymomas, low-grade-gliomas). Four years after diagnosis, their EF was investigated, considering age at diagnosis and treatment type. The validity, sensitivity, and specificity of different EF measures (TMT-B, Number Repetition, WCST, BRIEF) were compared and Strengths-and-Difficulties-Questionnaire was incorporated as a potential screening for EF issues. RESULTS EF impairments were found, especially in patients with chemo-/radiotherapy. Caregiver-ratings and performance-based-EF-tests identified different patients as below average. Sensitivity was highest in TMT-B. Strengths-and-Difficulties-Questionnaire was not an adequate screening for EF. CONCLUSION It is essential to assess patients with PPFT with performance-based-tests as well as caregiver-questionnaires, since EF impairments are not always visible at the behavioral level but may still influence everyday life.
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Affiliation(s)
- Hoffmann-Lamplmair Doris
- Department of Paediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Ritter Irene
- Department of Paediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Leiss Ulrike
- Department of Paediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Slavc Irene
- Department of Paediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Pletschko Thomas
- Department of Paediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
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Day AM, Slomine BS, Salama C, Quinton TL, Suskauer SJ, Salorio CF. Functional Gains in Children Receiving Inpatient Rehabilitation After Brain Tumor Resection. Arch Phys Med Rehabil 2021; 102:2134-2140. [PMID: 34044002 DOI: 10.1016/j.apmr.2021.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 05/05/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine whether children with brain tumors treated with resection benefit from inpatient rehabilitation and to explore what factors present at admission may predict better functional outcomes. DESIGN Retrospective cohort design. SETTING Pediatric inpatient rehabilitation unit. PARTICIPANTS Forty patients (N=40; ages 3-21y; 42.5% female) admitted to the rehabilitation unit between 2003 and 2015 after brain tumor resection. INTERVENTIONS Patients received multidisciplinary rehabilitation therapies as part of their admission to inpatient rehabilitation, including occupational, physical, and speech-language therapy. MAIN OUTCOME MEASURES Functional outcomes included the FIM for Children (WeeFIM) at discharge and 3-month follow-up as well as WeeFIM efficiency. RESULTS A repeated-measures analysis of variance using patient WeeFIM Developmental Functional Quotients (DFQs) at admission, discharge, and 3-month follow-up showed significant gains in total WeeFIM DFQ scores across time. Admission WeeFIM DFQ, time from surgery to admission, and age at admission provided the strongest model for predicting discharge and 3-month follow-up WeeFIM DFQ scores. Admission WeeFIM DFQ and time from surgery to admission provided the strongest model for predicting WeeFIM efficiency. Total Neurological Predictor Scale (NPS) at admission did not add predictive power to any of the 3 models over and above patient characteristics (admission WeeFIM DFQ, age at admission, time from surgery to admission). CONCLUSIONS Patients admitted to inpatient rehabilitation after brain tumor resection made significant functional gains (as measured by the WeeFIM) during inpatient rehabilitation and continued to make significant gains 3 months after discharge. Age and timing of admission provided the strongest models for predicting patient outcomes. The NPS did not predict functional outcomes after rehabilitation when controlling for other variables known to influence rehabilitation outcomes.
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Affiliation(s)
- Alyssa M Day
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD
| | - Beth S Slomine
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD; Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Christina Salama
- Department of Clinical Foundations, Ross University School of Medicine, St. Michael, Barbados
| | - Thea L Quinton
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Stacy J Suskauer
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Pediatric Rehabilitation, Kennedy Krieger Institute, Baltimore, MD
| | - Cynthia F Salorio
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD; Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD.
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8
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Remes TM, Hovén E, Ritari N, Pohjasniemi H, Puosi R, Arikoski PM, Arola MO, Lähteenmäki PM, Lönnqvist TRI, Ojaniemi MK, Riikonen VP, Sirkiä KH, Winqvist S, Rantala HMJ, Harila M, Harila-Saari AH. Neurocognitive impairment, employment, and social status in radiotherapy-treated adult survivors of childhood brain tumors. Neurooncol Pract 2021; 8:266-277. [PMID: 34055374 PMCID: PMC8153831 DOI: 10.1093/nop/npab004] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background Little is known of the cognitive functions, employment, and social status in adult survivors of childhood brain tumor (BT). We aimed to determine the long-term neurocognitive profile of radiotherapy-treated adult survivors of childhood BT and the relationship between cognitive functions and employment and social status. Methods Neurocognitive profiles of survivors were assessed in a Finnish national cohort of 71 radiotherapy-treated survivors of childhood BT (median follow-up time: 21 years [range: 5-33 years]) using a cross-sectional design. Neurocognitive outcomes were compared to control (n = 45) and normative values. Tumor- and treatment-related data were collected from the patient files. Information on employment and social status was gathered. Results Survivors’ (median age: 27 years [range: 16-43 years]) median verbal and performance intelligence quotient (IQ) was 90 (range: 49-121) and 87 (range: 43-119), respectively. The cognitive domains with the greatest impairment were executive functions (median z score, −3.5 SD [range: −25.0 to 1.3 SD]), and processing speed and attention (median z score, −2.5 SD [range: −24.9 to 0.5 SD]). Executive functions were associated with employment, educational level, living independently, having an intimate relationship, and having a driving license. Processing speed and attention were related to educational level, living independently, having an intimate relationship, and having a driving license. Performance IQ was associated with educational level and employment status. Working memory was associated with educational level and living independently. Conclusions Radiotherapy-treated adult survivors of childhood BT experience significant neurocognitive impairment, which is associated with difficulties related to employment and social status.
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Affiliation(s)
- Tiina M Remes
- Department of Pediatrics and Adolescence, PEDEGO Research Unit and Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland.,Department of Child Neurology, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Emma Hovén
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Niina Ritari
- Department of Child Neurology, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Heli Pohjasniemi
- Department of Pediatrics and Adolescence, PEDEGO Research Unit and Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Riina Puosi
- Department of Child Neurology, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Pekka M Arikoski
- Department of Pediatrics and Adolescence, Kuopio University Hospital, University of Eastern Finland, Kuopio, Finland
| | - Mikko O Arola
- Department of Pediatrics, Tampere University Hospital and University of Tampere, Tampere, Finland
| | - Päivi M Lähteenmäki
- Department of Pediatrics and Adolescent Medicine, Turku University Hospital, and Turku University, Turku, Finland
| | - Tuula R I Lönnqvist
- Department of Child Neurology, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Marja K Ojaniemi
- Department of Pediatrics and Adolescence, PEDEGO Research Unit and Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - V Pekka Riikonen
- Department of Pediatrics and Adolescence, Kuopio University Hospital, University of Eastern Finland, Kuopio, Finland
| | - Kirsti H Sirkiä
- Department of Pediatrics and Adolescence, Helsinki University, and Helsinki University Hospital, Helsinki, Finland
| | - Satu Winqvist
- Department of Neurology, Oulu University Hospital, Oulu, Finland
| | - Heikki M J Rantala
- Department of Pediatrics and Adolescence, PEDEGO Research Unit and Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Marika Harila
- Department of Neurology, Oulu University Hospital, Oulu, Finland
| | - Arja H Harila-Saari
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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9
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Vanclooster S, Van Hoeck K, Peremans L, Bilsen J, Van Der Werff Ten Bosch J, Laureys G, Paquier P, Jansen A. Reintegration into school of childhood brain tumor survivors: a qualitative study using the International Classification of Functioning, Disability and Health – Children and Youth framework. Disabil Rehabil 2020; 43:2610-2620. [DOI: 10.1080/09638288.2019.1708484] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
| | | | - Lieve Peremans
- Department of Public Health, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Primary and Interdisciplinary Care, University of Antwerp, Antwerp, Belgium
| | - Johan Bilsen
- Department of Public Health, Vrije Universiteit Brussel, Brussels, Belgium
| | | | - Geneviève Laureys
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, Ghent University Hospital, Ghent, Belgium
| | - Philippe Paquier
- Center for Linguistics, Vrije Universiteit Brussel, Brussels, Belgium
| | - Anna Jansen
- Department of Public Health, Vrije Universiteit Brussel, Brussels, Belgium
- Pediatric Neurology Unit, UZ Brussel, Brussels, Belgium
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10
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Duda TA, Ris MD, Yeates KO, Mahone EM, Haut JS, Raghubar KP. [Formula: see text] Reliable change in pediatric brain tumor: A preliminary investigation. Child Neuropsychol 2020; 26:15-26. [PMID: 31161873 PMCID: PMC10155288 DOI: 10.1080/09297049.2019.1620715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 05/11/2019] [Indexed: 12/30/2022]
Abstract
Children treated for brain tumor show evidence of declines in general intellectual abilities (i.e., IQ). Group-level data indicate subtle declines over time on average, but no study has utilized a clinical criterion to identify and describe a reliable change in survivors of pediatric brain tumor (PBT). In this study, we discuss the utility of reliable change index (RCI) methodology to supplement group-level analysis (e.g., repeated measures ANOVA). This pilot sample consisted of 22 children (M age = 10.47 years) treated for PBT who completed initial and follow-up assessments (M interval = 23.58 months). Cognitive data included composite scores from the WISC-IV. An RCI z-score was calculated for each participant on each composite score based on two different test-retest reliability coefficients. As a group, survivors of PBT did not demonstrate a statistically significant change from initial to follow-up on any WISC-IV composite score. When RCI was calculated based on reliability coefficients with shorter test-retest intervals provided by the test publisher, 77% of survivors demonstrated a reliable change in performance on at least one measure. The frequency of RCI decreases in working memory was significantly higher than expected. In contrast, only 32% of survivors showed reliable changes on at least one measure when RCI was based on a reliability coefficient derived from a clinical sample with a longer retest interval. This study demonstrates that highly divergent results may be obtained with RCI and the importance of the source of reliability estimates.
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Affiliation(s)
- Thomas A. Duda
- Department of Pediatrics, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX, USA
| | - M. Douglas Ris
- Department of Pediatrics, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX, USA
| | - Keith Owen Yeates
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - E. Mark Mahone
- Department of Neuropsychology, Kennedy Krieger Institute and Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jennifer S. Haut
- Department of Pediatrics, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX, USA
| | - Kimberly P. Raghubar
- Department of Pediatrics, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX, USA
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11
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The Effects of Radiation and Sex Differences on Adaptive Functioning in Adult Survivors of Pediatric Posterior Fossa Brain Tumors. J Int Neuropsychol Soc 2019; 25:729-739. [PMID: 31084659 DOI: 10.1017/s135561771900033x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Radiation therapy (RT) improves rates of survival of patients with childhood brain tumors but increases deficits in cognition and independent living skills. Previous literature has studied difficulties in basic cognitive processes, but few explore impairment in higher-order skills such as adaptive functioning. Some studies identify females as at risk for cognitive deficits due to RT, but few investigate sex differences in adaptive functioning. It was hypothesized that females would exhibit poorer long-term independent living skills and core cognitive skills relative to males following RT. METHODS Forty-five adult survivors of posterior fossa childhood brain tumors (24 females) completed the Wechsler Abbreviated Scale of Intelligence (WASI-II), Wechsler Memory Scale, Third Edition (WMS-III) Digit Span Forward (DSF) and Backward (DSB), and Oral Symbol Digit Modalities Test (OSDMT). Informants completed the Scales of Independent Behavior-Revised (SIB-R). RESULTS DSF and OSDMT were positively correlated with all five SIB-R domains, full-scale IQ (FSIQ) was positively correlated with four SIB-R domains, and DSB was positively correlated with three SIB-R domains. There was an interaction between sex and RT for OSDMT and community living skills with trend level interactions for personal living skills and broad independent living skills, where females without RT had higher scores than females with RT. CONCLUSIONS Female survivors were more affected by RT than males across the community living skills domain of adaptive functioning as well as processing speed. Processing speed deficits may have a cascading impact on daily living skills. Future studies should investigate how clinical and biological factors may contribute to personalized treatment plans between sexes. (JINS, 2019, 25, 729-739).
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12
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Treviño M, Breitmeyer BG, Ris MD, Fletcher JM, Kamdar K, Okcu MF, Parke EM, Raghubar KP. Interactions between visual working memory and visual attention among survivors of pediatric acute lymphoblastic leukemia (ALL) and their healthy peers. J Clin Exp Neuropsychol 2019; 41:974-986. [PMID: 31327287 DOI: 10.1080/13803395.2019.1643453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction: There is increasing concern for adverse cognitive late effects among survivors of pediatric acute lymphoblastic leukemia (ALL) given the widespread impact they have on academic achievement, particularly working memory and attention. We assessed performance among survivors and their healthy peers on a dual task paradigm measuring visual working memory (VWM) and visual attention independently and the dynamic relationship between the two. Assessing specific subsets within cognitive domains allows for understanding the distinct nature of cognitive impairments. Method: Participants were 34 survivors of ALL who have been off-treatment and disease free for 7.5 years; and 20 healthy controls, all between the ages of 10 and 18 years. We utilized behavioral single- and dual-task paradigms. In the dual tasks, participants maintained several items in VWM while performing a visual attention task (Eriksen Flanker Task) that required processing of a target stimulus while inhibiting the processing of distractor stimuli. The single tasks involved performing only the VWM task or only the visual attention task. Results: Results revealed survivors of ALL performed significantly worse than their healthy peers on the single visual attention task but not the single VWM task. Of particular interest, group differences were obtained on the dual VWM and visual attention tasks, such that the VWM and attention tasks reciprocally interfered with each other only among survivors and not their healthy peers. Conclusions: Our results highlight a core deficit in visual attention that is exacerbated by VWM demands among survivors of ALL. The implementation of tasks from cognitive neuroscience paradigms may be sensitive to cognitive impairments experienced by cancer survivors. Assessment and intervention practices among survivors of pediatric ALL are discussed.
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Affiliation(s)
- Melissa Treviño
- Department of Psychology, University of Houston , Houston , TX , USA
| | - Bruno G Breitmeyer
- Department of Psychology, University of Houston , Houston , TX , USA.,Center for Neuro-engineering & Cognitive Science, University of Houston , Houston , TX , USA
| | - M Douglas Ris
- Department of Pediatrics, Section of Psychology, Baylor College of Medicine , Houston , TX , USA
| | - Jack M Fletcher
- Department of Psychology, University of Houston , Houston , TX , USA
| | - Kala Kamdar
- Department of Pediatrics, Section of Hematology-Oncology, Baylor College of Medicine , Houston , TX , USA
| | - M Fatih Okcu
- Department of Pediatrics, Section of Hematology-Oncology, Baylor College of Medicine , Houston , TX , USA
| | - Elyse M Parke
- Department of Pediatrics, Section of Psychology, Baylor College of Medicine , Houston , TX , USA
| | - Kimberly P Raghubar
- Department of Pediatrics, Section of Psychology, Baylor College of Medicine , Houston , TX , USA
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13
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Raghubar KP, Lamba M, Cecil KM, Yeates KO, Mahone EM, Limke C, Grosshans D, Beckwith TJ, Ris MD. Dose-volume metrics and their relation to memory performance in pediatric brain tumor patients: A preliminary study. Pediatr Blood Cancer 2018; 65:e27245. [PMID: 29856521 PMCID: PMC7388179 DOI: 10.1002/pbc.27245] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 03/29/2018] [Accepted: 04/17/2018] [Indexed: 11/12/2022]
Abstract
BACKGROUND Advances in radiation treatment (RT), specifically volumetric planning with detailed dose and volumetric data for specific brain structures, have provided new opportunities to study neurobehavioral outcomes of RT in children treated for brain tumor. The present study examined the relationship between biophysical and physical dose metrics and neurocognitive ability, namely learning and memory, 2 years post-RT in pediatric brain tumor patients. PROCEDURE The sample consisted of 26 pediatric patients with brain tumor, 14 of whom completed neuropsychological evaluations on average 24 months post-RT. Prescribed dose and dose-volume metrics for specific brain regions were calculated including physical metrics (i.e., mean dose and maximum dose) and biophysical metrics (i.e., integral biological effective dose and generalized equivalent uniform dose). We examined the associations between dose-volume metrics (whole brain, right and left hippocampus), and performance on measures of learning and memory (Children's Memory Scale). RESULTS Biophysical dose metrics were highly correlated with the physical metric of mean dose but not with prescribed dose. Biophysical metrics and mean dose, but not prescribed dose, correlated with measures of learning and memory. CONCLUSIONS These preliminary findings call into question the value of prescribed dose for characterizing treatment intensity; they also suggest that biophysical dose has only a limited advantage compared to physical dose when calculated for specific regions of the brain. We discuss the implications of the findings for evaluating and understanding the relation between RT and neurocognitive functioning.
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Affiliation(s)
- Kimberly P. Raghubar
- Department of Pediatrics, Baylor College of Medicine and Texas Children’s Hospital, Houston, Texas
| | - Michael Lamba
- Department of Radiation Oncology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Kim M. Cecil
- Department of Radiology, University of Cincinnati College of Medicine and the Imaging Research Center, Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Keith Owen Yeates
- Department of Psychology, Alberta Children’s Hospital Research Institute and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - E. Mark Mahone
- Department of Neuropsychology and Department of Psychiatry, Kennedy Krieger Institute and Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - David Grosshans
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Travis J. Beckwith
- Department of Radiology, University of Cincinnati College of Medicine and the Imaging Research Center, Children’s Hospital Medical Center, Cincinnati, Ohio
| | - M. Douglas Ris
- Department of Pediatrics, Baylor College of Medicine and Texas Children’s Hospital, Houston, Texas
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14
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Alias H, Lau SCD, Schuitema I, de Sonneville LMJ. Neuropsychological Consequences for Survivors of Childhood Brain Tumor in Malaysia. Front Psychol 2018; 9:703. [PMID: 29896137 PMCID: PMC5986920 DOI: 10.3389/fpsyg.2018.00703] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 04/23/2018] [Indexed: 01/06/2023] Open
Abstract
Objective: This study aimed to evaluate neuropsychological consequences in survivors of childhood brain tumor. Method: A case-control study was conducted over a period of 4 months in a tertiary referral center in Kuala Lumpur, Malaysia. Fourteen survivors of childhood brain tumor aged 7–18 years, who were off-treatment for at least 1 year and were in remission, and 31 unrelated healthy controls were recruited. The median age at diagnosis was 8.20 years (range: 0.92–12.96 years). The diagnoses of brain tumors were medulloblastoma, germ cell tumor, pineocytoma, pilocystic astrocytoma, suprasellar germinoma, and ependymoma. Eleven survivors received central nervous system irradiation. Seven tasks were selected from the Amsterdam Neuropsychological Tasks program to evaluate alertness (processing speed), and major aspects of executive functioning, such as working memory capacity, inhibition, cognitive flexibility, and sustained attention. Speed, stability and accuracy of responses were the main outcome measures. Results: Survivors of childhood brain tumor showed statistically significant poorer performance on all tasks compared to healthy controls. Both processing speed and accuracy were impaired in the survivors, in particular under more complex task conditions. The survivors demonstrated deficits in alertness, sustained attention, working memory capacity, executive visuomotor control, and cognitive flexibility. Longer duration off treatment appeared to be correlated with poorer alertness, memory capacity, and inhibition. Conclusion: Survivors of childhood brain tumor in our center showed impaired neuropsychological functioning. Development of less toxic treatment protocols is important to prevent late effects of cognitive deficits in survivors of childhood brain tumor.
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Affiliation(s)
- Hamidah Alias
- Department of Pediatrics, UKM Medical Center, Faculty of Medicine, The National University of Malaysia, Kuala Lumpur, Malaysia
| | - Sie Chong D Lau
- Department of Pediatrics, UKM Medical Center, Faculty of Medicine, The National University of Malaysia, Kuala Lumpur, Malaysia
| | - Ilse Schuitema
- Department of Clinical Child and Adolescent Studies, Faculty of Social Sciences, Leiden University, Leiden, Netherlands
| | - Leo M J de Sonneville
- Department of Clinical Child and Adolescent Studies, Faculty of Social Sciences, Leiden University, Leiden, Netherlands
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15
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Biassoni V, Massimino M, Oprandi MC, Clerici CA, Veneroni L, Corti C, Schiavello E, Spreafico F, Poggi G. Rehabilitation for children and young people surviving a brain tumor, and their transition to adult services: the main challenges. ACTA ACUST UNITED AC 2017. [DOI: 10.1080/23809000.2017.1321957] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Veronica Biassoni
- Pediatric Unit, Fondazione IRCCS Istituto Nazionale dei Tumosri, Milano, Italy
| | - Maura Massimino
- Pediatric Unit, Fondazione IRCCS Istituto Nazionale dei Tumosri, Milano, Italy
| | - Maria Chiara Oprandi
- Pediatric Neuro-oncology Rehabilitation, IRCCS Eugenio Medea, Bosisio Parini (LC), Italy
| | - Carlo Alfredo Clerici
- Psychology Unit, Fondazione IRCCS Istituto Nazionale dei tumori, Milano, Italy
- Department of Oncology and Emato-Oncology, Università Statale, Milano, Italy
| | - Laura Veneroni
- Pediatric Unit, Fondazione IRCCS Istituto Nazionale dei Tumosri, Milano, Italy
| | - Claudia Corti
- Pediatric Neuro-oncology Rehabilitation, IRCCS Eugenio Medea, Bosisio Parini (LC), Italy
| | | | - Filippo Spreafico
- Pediatric Unit, Fondazione IRCCS Istituto Nazionale dei Tumosri, Milano, Italy
| | - Geraldina Poggi
- Pediatric Neuro-oncology Rehabilitation, IRCCS Eugenio Medea, Bosisio Parini (LC), Italy
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16
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Raghubar KP, Mahone EM, Yeates KO, Ris MD. Performance-based and parent ratings of attention in children treated for a brain tumor: The significance of radiation therapy and tumor location on outcome. Child Neuropsychol 2017; 24:413-425. [DOI: 10.1080/09297049.2017.1280144] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Kimberly P. Raghubar
- Department of Pediatrics, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX, USA
| | - E. Mark Mahone
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Keith Owen Yeates
- Department of Psychology, Alberta Children’s Hospital Research Institute and Hotchkiss Brain Institute, University of Calgary, Canada
| | - M. Douglas Ris
- Department of Pediatrics, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX, USA
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