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Nolan L, Jacobson LA, Peterson RK. Practical adaptive skills in pediatric brain tumor survivors: the contribution of medical factors and social determinants of health. Child Neuropsychol 2024; 30:847-860. [PMID: 37930038 DOI: 10.1080/09297049.2023.2275826] [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: 02/13/2023] [Accepted: 10/21/2023] [Indexed: 11/07/2023]
Abstract
Pediatric brain tumor survivors demonstrate weaknesses in adaptive functioning, most notably practical adaptive skills; however, the specific areas of weakness within practical skills are unknown. This study examined the aspects of practical adaptive functions that are most impacted in brain tumor survivors, and identified medical and socio-demographic variables that predicted outcomes. The sample included 117 pediatric brain tumor patients seen for a clinical neuropsychological evaluation and whose parents completed the Adaptive Behavior Assessment System, Second or Third Edition. T-tests compared practical adaptive skills to normative means. Correlations examined associations between medical and socio-demographic variables and each of the practical adaptive subscales (Community Use, Home Living, Health & Safety, Self-Care). Significant correlations were entered into linear regression models for each practical adaptive skill. All practical subscales were significantly below the normative mean. Community Use was positively correlated with age at diagnosis and negatively correlated with treatment burden, time since diagnosis, and neighborhood deprivation. Health and Safety was positively correlated with age at diagnosis. Home Living was positively correlated with neighborhood deprivation. Self-Care was positively correlated with age at diagnosis and parental education. Specific medical and socio-demographic factors predicted practical adaptive functioning, highlighting the importance of considering the role of medical and socio-demographic determinants of health on adaptive functioning outcomes in pediatric brain tumors.
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Affiliation(s)
- Lily Nolan
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Lisa A Jacobson
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Rachel K Peterson
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
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Thomas T, Grieco JA, Pulsifer M. Long term neuropsychological outcomes of a pediatric ETANTR brain tumor: A case study. APPLIED NEUROPSYCHOLOGY. CHILD 2024; 13:180-189. [PMID: 38447131 DOI: 10.1080/21622965.2024.2322735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
Survivors of pediatric brain tumors are at high risk for long-term neuropsychological difficulties. In the current case study, we present longitudinal neuropsychological data spanning 10 years (from age 9 to 19 years) of a patient with a rare, very large, bifrontal, embryonal tumor with abundant neuropil and true rosettes (ETANTR), which is typically associated with poor survivorship and significant neurological impact. Results demonstrated that the patient had largely intact cognitive functioning with specific difficulties in executive functioning, fine motor skills, and adaptive functioning at her most recent neuropsychology 10-year follow-up. These results highlight outcomes for a patient with remarkable resiliency in the context of numerous risk factors (a very large tumor size, multi-modal treatment, and seizure history). Patient protective factors (a high level of cognitive reserve, family support, and appropriate comprehensive educational services) likely contributed to the patient's favorable neuropsychological outcome. The patient's age at brain tumor diagnosis (9 years) and associated treatment was at a critical period of development for emerging higher order cognitive functions which likely impacted acquisition of executive functioning skills and secondarily adaptive skill outcomes. Consequently, pediatric brain tumor survivors with ETANTR or other frontal tumors require targeted screening of executive functions and proactive interventions.
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Affiliation(s)
- Tina Thomas
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Julie A Grieco
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Margaret Pulsifer
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Svaldi C, Paquier P, Keulen S, van Elp H, Catsman-Berrevoets C, Kingma A, Jonkers R, Kohnen S, de Aguiar V. Characterising the Long-Term Language Impairments of Children Following Cerebellar Tumour Surgery by Extracting Psycholinguistic Properties from Spontaneous Language. CEREBELLUM (LONDON, ENGLAND) 2024; 23:523-544. [PMID: 37184608 PMCID: PMC10951034 DOI: 10.1007/s12311-023-01563-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/26/2023] [Indexed: 05/16/2023]
Abstract
Following cerebellar tumour surgery, children may suffer impairments of spontaneous language. Yet, the language processing deficits underlying these impairments are poorly understood. This study is the first to try to identify these deficits for four levels of language processing in cerebellar tumour survivors. The spontaneous language of twelve patients who underwent cerebellar tumour surgery (age range 3-24 years) was compared against his or her controls using individual case statistics. A distinction was made between patients who experienced postoperative cerebellar mutism syndrome (pCMS) and those who did not. Time since surgery ranged between 11 months and 12;3 years. In order to identify the impaired language processing levels at each processing level (i.e., lexical, semantic, phonological and/or morphosyntactic) nouns and verbs produced in the spontaneous language samples were rated for psycholinguistic variables (e.g., concreteness). Standard spontaneous language measures (e.g., type-token ratio) were calculated as well. First, inter-individual heterogeneity was observed in the spontaneous language outcomes in both groups. Nine out of twelve patients showed language processing deficits three of whom were diagnosed with pCMS. Results implied impairments across all levels of language processing. In the pCMS-group, the impairments observed were predominantly morphosyntactic and semantic, but the variability in nature of the spontaneous language impairments was larger in the non-pCMS-group. Patients treated with cerebellar tumour surgery may show long-term spontaneous language impairments irrespective of a previous pCMS diagnosis. Individualised and comprehensive postoperative language assessments seem necessary, given the inter-individual heterogeneity in the language outcomes.
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Affiliation(s)
- Cheyenne Svaldi
- Center for Language and Cognition, University of Groningen, PO box 716, 9700 AS, Groningen, the Netherlands.
- Clinical and Experimental Neurolinguistics (CLIEN), Brussels Centre for Language Studies (BCLS), Language, Brain and Cognition, Vrije Universiteit Brussel (VUB), Pleinlaan 2, 1050, Brussels, Belgium.
- School of Psychological Sciences, Macquarie University, University Avenue, Macquarie Park, NSW, 2109, Australia.
- International Doctorate for Experimental Approaches to Language and Brain (IDEALAB), Newcastle University, Newcastle Upon Tyne, UK; Macquarie University, Sydney, Australia; University of Potsdam, Potsdam, Germany; University of Groningen, , Groningen, the Netherlands.
| | - Philippe Paquier
- Clinical and Experimental Neurolinguistics (CLIEN), Brussels Centre for Language Studies (BCLS), Language, Brain and Cognition, Vrije Universiteit Brussel (VUB), Pleinlaan 2, 1050, Brussels, Belgium
- Centre for Research in Cognition and Neurosciences (CRCN), Université Libre de Bruxelles (ULB), Avenue Franklin D. Roosevelt 50, 1050, Brussels, Belgium
- Department of Translational Neurosciences (TNW), Universiteit Antwerpen (UA), Universiteitsplein 1, 2610, Antwerp, Belgium
| | - Stefanie Keulen
- Clinical and Experimental Neurolinguistics (CLIEN), Brussels Centre for Language Studies (BCLS), Language, Brain and Cognition, Vrije Universiteit Brussel (VUB), Pleinlaan 2, 1050, Brussels, Belgium
| | - Henrieke van Elp
- Center for Language and Cognition, University of Groningen, PO box 716, 9700 AS, Groningen, the Netherlands
| | - Coriene Catsman-Berrevoets
- Department of Paediatric Neurology Erasmus Medical Centre, Sophia Children's Hospital Rotterdam, Dr Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
| | - Annet Kingma
- Department of Paediatrics, University Medical Centre Groningen, Hanzeplein 1, 9700 RB, Groningen, the Netherlands
| | - Roel Jonkers
- Center for Language and Cognition, University of Groningen, PO box 716, 9700 AS, Groningen, the Netherlands
| | - Saskia Kohnen
- School of Psychological Sciences, Macquarie University, University Avenue, Macquarie Park, NSW, 2109, Australia
| | - Vânia de Aguiar
- Center for Language and Cognition, University of Groningen, PO box 716, 9700 AS, Groningen, the Netherlands
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Deviaterikova A, Kasatkin V, Malykh S. The Role of the Cerebellum in Visual-Spatial Memory in Pediatric Posterior Fossa Tumor Survivors. CEREBELLUM (LONDON, ENGLAND) 2024; 23:197-203. [PMID: 36737535 DOI: 10.1007/s12311-023-01525-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/30/2023] [Indexed: 02/05/2023]
Abstract
The cerebellum is involved in motor and non-motor functions. Cerebellar lesions can underlie the disruption of various executive functions. The violation of executive functions in cerebellar lesions is a serious problem, since children, after completing treatment, must return to school, finish their education, and get a profession. One of the important executive functions is working memory, which contributes to academic success. Deficits of verbal working memory in cerebellar tumors have been studied, in contrast to visual-spatial working memory. To assess this issue, 101 patients who survived cerebellar tumors and 100 healthy control subjects performed a visual-spatial working memory test. As a result, in children who survived cerebellar tumors, visual-spatial working memory is impaired compared to the control group. Moreover, with age, and hence the time since the end of treatment, the number of elements that children can retain in visual-spatial working memory increases, but still remains smaller compared to the control group. Our findings complement the idea of cerebellar involvement in visual-spatial working memory and suggest that it is disrupted by cerebellar lesions in children.
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Affiliation(s)
- Alena Deviaterikova
- Neurocognitive Laboratory, Dmitry Rogachev National Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, 117997, Russia.
- Research Institute for Brain Development and Peak Performance, Peoples' Friendship University of Russia, Moscow, 117198, Russia.
| | - Vladimir Kasatkin
- Research Institute for Brain Development and Peak Performance, Peoples' Friendship University of Russia, Moscow, 117198, Russia
| | - Sergey Malykh
- Developmental Behavioral Genetics Lab, Psychological Institute of Russian Academy of Education, Moscow, 125009, Russia
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Zheng Y, Ong SH, Vellayappan B, Nga VDW. Management of first recurrence or progression of craniopharyngioma after resection alone: A systematic review and individual-participant data meta-analysis. J Clin Neurosci 2023; 118:123-131. [PMID: 37922728 DOI: 10.1016/j.jocn.2023.10.014] [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: 08/19/2023] [Revised: 09/29/2023] [Accepted: 10/23/2023] [Indexed: 11/07/2023]
Abstract
The initial management of craniopharyngioma is generally either gross total resection (GTR) or subtotal resection (STR) with adjuvant radiotherapy (RT). However, the optimal management strategy for recurrent/progressive craniopharyngioma remains unclear. In this systematic review and individual participant data meta-analysis, we aimed to compare the outcomes of surgery and/or RT for the first recurrence/progression of craniopharyngioma after resection alone. The exposure was the treatment that was administered for the first recurrence/progression, and the outcomes were tumor regrowth and overall survival (OS). Subgroup analyses were performed by age at the treatment for the first recurrence/progression (<18 or ≥ 18 years old), duration between the first treatment and the first recurrence/progression (<2 or ≥ 2 years), and the initial treatment that was administered (STR or GTR). Of the 2932 studies screened, 11 studies reporting a total of 80 patients were included. Across almost all subgroups, patients who received RT for the first recurrence/progression had a significantly lower risk of tumor regrowth than those who did not, regardless of whether surgery was performed and the extent of resection. There was no significant association between the treatment administered for the first recurrence/progression and OS, except for patients with a recurrence/progression < 2 years after the first treatment, where GTR was associated with a higher risk of mortality. For patients with the first recurrence/progression of craniopharyngioma after resection alone, RT should be considered for better local control. In cases where RT is not administered, GTR is preferred over STR provided it can be safely performed, for improved local control.
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Affiliation(s)
- Yilong Zheng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Shi Hui Ong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Balamurugan Vellayappan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Radiation Oncology, National University Cancer Institute, Singapore
| | - Vincent Diong Weng Nga
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Neurosurgery, National University Hospital, Singapore
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De Benedictis A, Rossi-Espagnet MC, de Palma L, Sarubbo S, Marras CE. Structural networking of the developing brain: from maturation to neurosurgical implications. Front Neuroanat 2023; 17:1242757. [PMID: 38099209 PMCID: PMC10719860 DOI: 10.3389/fnana.2023.1242757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 11/09/2023] [Indexed: 12/17/2023] Open
Abstract
Modern neuroscience agrees that neurological processing emerges from the multimodal interaction among multiple cortical and subcortical neuronal hubs, connected at short and long distance by white matter, to form a largely integrated and dynamic network, called the brain "connectome." The final architecture of these circuits results from a complex, continuous, and highly protracted development process of several axonal pathways that constitute the anatomical substrate of neuronal interactions. Awareness of the network organization of the central nervous system is crucial not only to understand the basis of children's neurological development, but also it may be of special interest to improve the quality of neurosurgical treatments of many pediatric diseases. Although there are a flourishing number of neuroimaging studies of the connectome, a comprehensive vision linking this research to neurosurgical practice is still lacking in the current pediatric literature. The goal of this review is to contribute to bridging this gap. In the first part, we summarize the main current knowledge concerning brain network maturation and its involvement in different aspects of normal neurocognitive development as well as in the pathophysiology of specific diseases. The final section is devoted to identifying possible implications of this knowledge in the neurosurgical field, especially in epilepsy and tumor surgery, and to discuss promising perspectives for future investigations.
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Affiliation(s)
| | | | - Luca de Palma
- Clinical and Experimental Neurology, Bambino Gesù Children’s Hospital, Rome, Italy
| | - Silvio Sarubbo
- Department of Neurosurgery, Santa Chiara Hospital, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
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Peterson RK, King TZ. A systematic review of pediatric neuropsychological outcomes with proton versus photon radiation therapy: A call for equity in access to treatment. J Int Neuropsychol Soc 2023; 29:798-811. [PMID: 36323679 DOI: 10.1017/s1355617722000819] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE There is increasing interest in the utilization of proton beam radiation therapy (PRT) to treat pediatric brain tumors based upon presumed advantages over traditional photon radiation therapy (XRT). PRT provides more conformal radiation to the tumor with reduced dose to healthy brain parenchyma. Less radiation exposure to brain tissue beyond the tumor is thought to reduce neuropsychological sequelae. This systematic review aimed to provide an overview of published studies comparing neuropsychological outcomes between PRT and XRT. METHOD PubMed, PsychINFO, Embase, Web of Science, Scopus, and Cochrane were systematically searched for peer-reviewed published studies that compared neuropsychological outcomes between PRT and XRT in pediatric brain tumor patients. RESULTS Eight studies were included. Six of the studies utilized retrospective neuropsychological data; the majority were longitudinal studies (n = 5). XRT was found to result in lower neuropsychological functioning across time. PRT was associated with generally stable neuropsychological functioning across time, with the exception of working memory and processing speed, which showed variable outcomes across studies. However, studies inconsistently included or considered medical and sociodemographic differences between treatment groups, which may have impacted neuropsychological outcomes. CONCLUSIONS Despite methodological limitations, including limited baseline neuropsychological evaluations, temporal variability between radiation treatment and first evaluation or initial and follow-up evaluations, and heterogenous samples, there is emerging evidence of sociodemographic inequities in access to PRT. With more institutions dedicating funding towards PRT, there may be the opportunity to objectively evaluate the neuropsychological benefits of patients matched on medical and sociodemographic variables.
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Affiliation(s)
- Rachel K Peterson
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Psychiatry and Behavioral Science, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Tricia Z King
- Department of Psychology, Georgia State University, Atlanta, USA
- Neuroscience Institute, Georgia State University, Atlanta, USA
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Peterson RK, Ng R, Ludwig NN, Jacobson LA. Working Memory and Processing Speed Predict Math Skills in Pediatric Brain Tumor Survivors. J Pediatr Hematol Oncol 2023; 45:e350-e355. [PMID: 36219703 PMCID: PMC10101561 DOI: 10.1097/mph.0000000000002561] [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: 02/28/2022] [Accepted: 08/28/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Childhood brain tumor (BT) survivors are at risk for working memory (WM) and processing speed (PS) deficits, which impact other cognitive domains. This study aimed to characterize WM, PS, and untimed mathematics calculation performance in pediatric BT survivors at least 2 years post-diagnosis, identify medical factors associated with deficits in mathematics, and examine whether WM and/or PS predict mathematics performance in this clinical sample. METHODS Retrospective data were gathered from 72 BT survivors between 7 and 21 years of age ( M =13.64 y, SD =4.01 y) for a clinical neuropsychologic evaluation. All participants completed Wechsler measures of WM and PS and a measure of untimed mathematics calculation. RESULTS WM, PS, and the mathematics calculation were significantly lower than the normative mean. Math scores were not correlated with any of the examined medical factors. PS was negatively correlated with the Neurological Predictor Scale and positively correlated with age at diagnosis. Both WM and PS were associated with math outcomes and accounted for 30.4% and 19.2% of the variance, respectively. CONCLUSIONS The findings indicate that WM and PS contribute to mathematics performance in pediatric BT survivors. Examining mathematics performance should be a part of clinical neuropsychological evaluations. Interventions to improve mathematics performance in this population should also focus on WM and compensatory strategies for slowed PS.
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Affiliation(s)
- Rachel K Peterson
- Department of Neuropsychology, Kennedy Krieger Institute
- Department of Psychiatry and Behavioral Science, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Rowena Ng
- Department of Neuropsychology, Kennedy Krieger Institute
- Department of Psychiatry and Behavioral Science, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Natasha N Ludwig
- Department of Neuropsychology, Kennedy Krieger Institute
- Department of Psychiatry and Behavioral Science, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Lisa A Jacobson
- Department of Neuropsychology, Kennedy Krieger Institute
- Department of Psychiatry and Behavioral Science, Johns Hopkins University School of Medicine, Baltimore, MD
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Barnett T, Tollit M, Ratnapalan S, Sawyer SM, Kelaher M. Education support services for improving school engagement and academic performance of children and adolescents with a chronic health condition. Cochrane Database Syst Rev 2023; 2:CD011538. [PMID: 36752365 PMCID: PMC9907052 DOI: 10.1002/14651858.cd011538.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND Chronic health conditions in children and adolescents can have profound impacts on education, well-being and health. They are described as non-communicable illnesses that are prolonged in duration, do not resolve spontaneously, and rarely cured completely. Due to variations in the definition of chronic health conditions and how they are measured prevalence estimates vary considerably and have been reported to be as high as 44% in children and adolescents. Of young people with a chronic health condition, an estimated 5% are affected by severe conditions characterised by limitations to daily activities impacting their ability to attend school. School attendance is important for academic and social skill development as well as well-being. When children and adolescents are absent from school due to a chronic health condition, school engagement can be affected. Disengagement from school is associated with poorer academic achievement, social-emotional functioning and career choices. Education support services for children and adolescents with chronic health conditions aim to prevent disengagement from school, education and learning during periods where their illness caused them to miss school. However, there is limited evidence on the effectiveness of educational support interventions at improving school engagement and educational/learning outcomes for children and adolescents with chronic health conditions. OBJECTIVES To describe the nature of educational support interventions for children and adolescents with a chronic health condition, and to examine the effectiveness of these interventions on school engagement and academic achievement. SEARCH METHODS We searched eight electronic databases which span the health/medical, social sciences and education disciplines between 18 and 25 January 2021: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid), Embase (Ovid). CINAHL (EBSCO), PsycINFO (EBSCO), ERIC (Education Resources Information Center), Applied Social Sciences Index and Abstracts: ASSIA (ProQuest), and PubMed (from 2019). We also searched five grey literature trials registers and databases between 8 and 12 February 2021 to identify additional published and unpublished studies, theses and conference abstracts, as well as snowballing reference lists of included studies. SELECTION CRITERIA Randomised controlled trials (RCTs), controlled before-and-after studies and interrupted time series studies that met the inclusion criteria were selected. Other inclusion criteria were: participants - must include children or adolescents (aged four to 18 years) with a chronic health condition, intervention - must include educational support, outcomes - must report the primary outcomes (i.e. school engagement or academic achievement) or secondary outcomes (i.e. quality of life, transition to school/school re-entry, mental health or adverse outcomes). DATA COLLECTION AND ANALYSIS Two people independently screened titles and abstracts, and full-text articles, to identify included studies. Where disagreements arose between reviewers, the two reviewers discussed the discrepancy. If resolution was unable to be achieved, the issues were discussed with a senior reviewer to resolve the matter. We extracted study characteristic data and risk of bias data from the full texts of included studies using a data extraction form before entering the information into Review Manager 5.4.1. Two people independently extracted data, assessed risk of bias of individual studies and undertook GRADE assessments of the quality of the evidence. Meta-analysis was not possible due to the small number of studies for each outcome. Our synthesis, therefore, used vote-counting based on the direction of the effect/impact of the intervention. MAIN RESULTS The database searches identified 14,202 titles and abstracts. Grey literature and reference list searches did not identify any additional studies that met the inclusion criteria. One hundred and twelve full-text studies were assessed for eligibility, of which four studies met the eligibility criteria for inclusion in the review. All studies were randomised controlled studies with a combined total of 359 participants. All included studies were disease-specific; three studies focused on children with cancer, and one study focused on children with Attention Deficit Hyperactivity Disorder (ADHD). There was evidence that education support improved school engagement with three of four studies favouring the intervention. Three studies measured academic achievement but only two studies provided effect estimates. Based on the vote-counting method, we found contradictory results from the studies: one study showed a positive direction of effect and the other study showed a negative direction of effect. One study measured transition back to school and found a positive impact of education support favouring the intervention (SMD 0.18, 95% CI -0.46 to 0.96, no P value reported). The result came from a single study with a small sample size (n = 30), and produced a confidence interval that indicated the possibility of a very small or no effect. The overall certainty of evidence for these three outcomes was judged to be 'very low'. Two of four studies measured mental health (measured as self-esteem). Both studies reported a positive impact of education support interventions on mental health; this was the only outcome for which the overall certainty of evidence was judged to be 'low' rather than 'very low'. No studies measured or reported quality of life or adverse effects. Risk of bias (selection, performance, detection, attrition, reporting and other bias) was assessed using the Cochrane risk of bias tool for randomised trials (version 1). Overall risk of bias for all studies was assessed as 'high risk' because all studies had at least one domain at high risk of bias. AUTHORS' CONCLUSIONS This review has demonstrated the infancy of quality research on the effectiveness of education support interventions for children and adolescents with chronic health conditions. At best, we can say that we are uncertain whether education support interventions improve either academic achievement or school engagement. Of the secondary outcomes, we are also uncertain whether education support interventions improve transition back to school, or school re-entry. However, we suggest there is some evidence that education support may slightly improve mental health, measured as self-esteem. Given the current state of the evidence of the effectiveness of education support interventions for children and adolescents with chronic health conditions, we highlight some important implications for future research in this field to strengthen the evidence that can inform effective practice and policy.
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Affiliation(s)
- Tony Barnett
- Education Institute, Royal Children's Hospital, Parkville, Australia
- Murdoch Childrens Research Institute, Parkville, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Melbourne, Australia
| | - Michelle Tollit
- Education Institute, Royal Children's Hospital, Parkville, Australia
- Murdoch Childrens Research Institute, Parkville, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
- Centre for Adolescent Health, Royal Children's Hospital, Parkville, Australia
- Melbourne Graduate School of Education, The University of Melbourne, Melbourne, Australia
| | - Savithiri Ratnapalan
- Departments of Paediatrics & Dalla Lana School of Public Health, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Susan M Sawyer
- Murdoch Childrens Research Institute, Parkville, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
- Centre for Adolescent Health, Royal Children's Hospital, Parkville, Australia
| | - Margaret Kelaher
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Melbourne, Australia
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Chipeeva N, Deviaterikova A, Glebova E, Romanova E, Karelin A, Kasatkin V. Comparison of Neurocognitive Functioning and Fine Motor Skills in Pediatric Cancer Survivors and Healthy Children. Cancers (Basel) 2022; 14:cancers14235982. [PMID: 36497461 PMCID: PMC9738267 DOI: 10.3390/cancers14235982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/29/2022] [Accepted: 12/01/2022] [Indexed: 12/07/2022] Open
Abstract
Background: The late treatment outcomes of pediatric brain tumors and of hematopoietic and lymphoid tissue tumors are an important focus of both rehabilitation and research. Neurocognitive and motor disorders induce further learning problems impeding social-emotional adaptation throughout a whole lifespan. Core deficits in short-term and working memory, visuospatial constructional ability, verbal fluency, and fine motor skills underlie distorted intellectual and academic achievement. This study aimed to assess the individual differences in cognitive ability and fine motor skills of pediatric tumor survivors and the age-matched healthy controls. Methods: A total of 504 tumor survivors after treatment and 646 age-matched healthy controls underwent neurocognitive and fine motor assessments. Findings: The group of tumor survivors scored significantly worse in both neurocognitive and fine motor skill in compared with the healthy control group. The pediatric brain tumor survivors (PBT group) performed worse in cognitive (p < 0.001 for verbal fluency and p < 0.001 for visuospatial constructional ability) and motor tests (p < 0.001) compared to the healthy controls. Hematopoietic and Lymphoid Tissues tumors survivors (THL group) performed worse in verbal fluency (p < 0.01) and visuospatial constructional test (p < 0.001) compared to the control group. Furthermore, the PBT group had worse results in visuospatial constructional ability (p < 0.05) and fine motor (p < 0.001) ability than the THL group. Significant differences between females and males were found in fine motor test performance in the PBT group (p < 0.05), as well as in verbal fluency (p < 0.01) and visuospatial constructional ability (p < 0.01) in the control group. Neurocognitive and fine motor skill characteristics in the THL group did not correlate with age.
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Affiliation(s)
- Nadezda Chipeeva
- Research Institute for Brain Development and Peak Performance, Peoples Friendship University of Russia, 117198 Moscow, Russia
- Correspondence: ; Tel.: +7-950-737-08-43
| | - Alena Deviaterikova
- Research Institute for Brain Development and Peak Performance, Peoples Friendship University of Russia, 117198 Moscow, Russia
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology, and Immunology, 117198 Moscow, Russia
| | - Elena Glebova
- Research Institute for Brain Development and Peak Performance, Peoples Friendship University of Russia, 117198 Moscow, Russia
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology, and Immunology, 117198 Moscow, Russia
| | - Elizaveta Romanova
- Research Institute for Brain Development and Peak Performance, Peoples Friendship University of Russia, 117198 Moscow, Russia
| | - Alexander Karelin
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology, and Immunology, 117198 Moscow, Russia
| | - Vladimir Kasatkin
- Research Institute for Brain Development and Peak Performance, Peoples Friendship University of Russia, 117198 Moscow, Russia
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology, and Immunology, 117198 Moscow, Russia
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11
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Trapani JA, Murdaugh DL. Processing efficiency in pediatric cancer survivors: A review and operationalization for outcomes research and clinical utility. Brain Behav 2022; 12:e2809. [PMID: 36330565 PMCID: PMC9759139 DOI: 10.1002/brb3.2809] [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: 01/13/2022] [Revised: 09/27/2022] [Accepted: 10/11/2022] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE Childhood cancer and cancer-related treatments disrupt brain development and maturation, placing survivors at risk for cognitive late effects. Given that assessment tools vary widely across researchers and clinicians, it has been daunting to identify distinct patterns in outcomes across diverse cancer types and to implement systematic neurocognitive screening tools. This review aims to operationalize processing efficiency skill impairment-or inefficient neural processing as measured by working memory and processing speed abilities-as a worthwhile avenue for continued study within the context of childhood cancer. METHODS A comprehensive literature review was conducted to examine the existing research on cognitive late effects and biopsychosocial risk factors in order to conceptualize processing efficiency skill trends in childhood cancer survivors. RESULTS While a frequently reported pattern of neurobiological (white matter) and cognitive (working memory and processing speed) disruption is consistent with processing efficiency skill impairment, these weaknesses have not yet been fully operationalized in this population. We offer a theoretical model that highlights the impacts of a host of biological and environmental factors on the underlying neurobiological substrates of cancer survivors that precede and may even predict long-term cognitive outcomes and functional abilities following treatment. CONCLUSION The unified construct of processing efficiency may be useful in assessing and communicating neurocognitive skills in both outcomes research and clinical practice. Deficits in processing efficiency may serve as a possible indicator of cognitive late effects and functional outcomes due to the unique relationship between processing efficiency skills and neurobiological disruption following cancer treatment. Continued research along these lines is crucial for advancing childhood cancer outcomes research and improving quality of life for survivors.
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Affiliation(s)
- Julie A Trapani
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Donna L Murdaugh
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
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12
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Seck S, Kim YJ(G, Cunningham WA, Olshefski R, Yeates KO, Vannatta K, Hoskinson KR. Pilot Study of Associations Among Functional Connectivity and Neurocognition in Survivors of Pediatric Brain Tumor and Healthy Peers. J Child Neurol 2022; 37:927-938. [PMID: 36069044 PMCID: PMC9691531 DOI: 10.1177/08830738221114501] [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] [Indexed: 11/16/2022]
Abstract
This pilot study examined the associations among functional connectivity in the salience, central executive, and default mode networks, and neurocognition in pediatric brain tumor survivors and healthy children. Thirteen pediatric brain tumor survivors (9 boys, M = 12.76 years) and 10 healthy children (6 boys, M = 12.70 years) completed magnetic resonance imaging (MRI) and assessment of processing speed and executive function. Pediatric brain tumor survivors performed more poorly than healthy children on measures of processing speed, divided attention, and working memory; parent ratings of day-to-day executive function did not differ significantly by group, though both pediatric brain tumor survivors who underwent only surgical resection and healthy children were rated by parents as having difficulties approaching a standard deviation above the normative mean. Connectivity was lower in the salience network and greater in the default mode network in pediatric brain tumor survivors. Cross-method correlations showed that increased salience network and default mode network connectivity were associated with better task performance and parent-rated executive skills and higher central executive network connectivity with poorer parent-rated executive skills. This perhaps reflects an adaptive pattern of hyperconnectivity in pediatric brain tumor survivors.
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Affiliation(s)
- Safiyah Seck
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH
| | - Young Jin (Ginnie) Kim
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH
| | | | - Randal Olshefski
- Section of Hematology/Oncology/BMT, Nationwide Children’s Hospital, Columbus, OH,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH
| | - Keith Owen Yeates
- Department of Psychology, University of Calgary, Calgary AB,Alberta Children’s Hospital Research Institute and Hotchkiss Brain Institute, University of Calgary, Calgary AB
| | - Kathryn Vannatta
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH
| | - Kristen R. Hoskinson
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH
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13
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Cox E, Tseng J, Bells S, Dockstader C, Laughlin S, Bouffet E, de Medeiros C, Mabbott DJ. Neural and cognitive function in a pediatric brain injury model: The impact of task complexity. Cortex 2022; 155:307-321. [DOI: 10.1016/j.cortex.2022.05.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 03/26/2022] [Accepted: 05/23/2022] [Indexed: 11/03/2022]
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14
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Fox ME, King TZ. Considerations for Reliable Digit Span as a performance validity test for long-term survivors of childhood brain tumors. APPLIED NEUROPSYCHOLOGY. ADULT 2022; 29:469-477. [PMID: 32503366 DOI: 10.1080/23279095.2020.1771714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The Reliable Digit Span (RDS) is a performance validity test (PVT) used widely within non-clinical samples, but its utility is in question in clinical groups with cognitive impairment. To investigate, RDS scores were calculated and correlated with the Neurological Predictor Scale, an informant-reported Activities of Daily Living score, and a proxy measure of intelligence (Vocabulary) for 83 adult survivors of childhood brain tumors and 105 healthy controls. Analyses were covaried for age at examination. Participants were divided into passing and failing groups at each RDS cutoff, and ANCOVAs for each of the three variables of interest covaried for age at the examination were run. RDS was correlated with all three variables of interest in survivors but only Vocabulary in controls. At the ≤7 cutoff, passing and failing survivors demonstrated significant differences across all variables of interest, while passing and failing controls differed only on Vocabulary. Differences were also found between passing and failing survivors at lower cutoffs. RDS is related to and likely impacted by various neurological and cognitive challenges faced by brain tumor survivors. Using the standard RDS cutoff of ≤7 may result in inaccurate interpretation of valid performance in this population; therefore, the use of other PVTs is recommended.
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Affiliation(s)
| | - Tricia Z King
- Department of Psychology and the Neuroscience Institute, Georgia State University, Atlanta, GA, USA
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15
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Olsthoorn IM, Holland AA, Hawkins RC, Cornelius AE, Baig MU, Yang G, Holland DC, Zaky W, Stavinoha PL. Sleep Disturbance and Its Association With Sluggish Cognitive Tempo and Attention in Pediatric Brain Tumor Survivors. Front Neurosci 2022; 16:918800. [PMID: 35812214 PMCID: PMC9259867 DOI: 10.3389/fnins.2022.918800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 06/07/2022] [Indexed: 11/15/2022] Open
Abstract
Background Pediatric brain tumor (PBT) survivors are at risk for developing sleep disturbances. While in other pediatric populations sleep disturbance has been associated with worse cognitive functioning, it is unclear to what extent this relationship generalizes to PBT survivors. The aim of the current study was to assess the relationship between sleep disturbance and aspects of cognition, including sluggish cognitive tempo (SCT) as well as attention and working memory. Materials and Methods Eighty-three PBT survivors 6–18 years of age who were at least 3 months post-treatment were included in the present cross-sectional study. Level of sleep disturbance was measured as a composite score reflecting various sleep problems as rated by caregivers. Cognitive measures included caregiver-ratings of sluggish cognitive tempo and attention problems, as well as performance-based cognitive measures assessing attention and executive functioning. Hierarchical regression analysis was used to assess associations between sleep and cognition. Results Of all caregivers, 32.5% reported one or more sleep disturbances as “very/often true” and over 68% of caregivers rated at least one sleep-related item as “somewhat true.” Of all cognitive variables, scores were most frequently impaired for SCT (30%). A higher level of sleep disturbance was associated with worse SCT and parent-rated attention problems. Associations between sleep and performance-based cognitive measures assessing attention and working memory were not statistically significant. Conclusion Findings of the current study highlight the importance of further investigation into the relationship between sleep and cognition in PBT survivors, which may assist efforts to maximize cognitive outcome and health-related quality of life in PBT survivors. The current study additionally suggests further investigation of SCT in this population is warranted, as it may be more sensitive to detecting possible associations with sleep disturbance relative to discrete measures that assess cognitive performance under ideal circumstances.
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Affiliation(s)
- Ineke M. Olsthoorn
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston (UT Health), Houston, TX, United States
| | - Alice Ann Holland
- Department of Psychiatry, University of Texas Southwestern Medical School, Dallas, TX, United States
- Department of Psychiatry, Children’s Medical Center of Dallas, Dallas, TX, United States
| | - Raymond C. Hawkins
- School of Psychology, Fielding Graduate University, Santa Barbara, CA, United States
| | - Allen E. Cornelius
- School of Psychology, Fielding Graduate University, Santa Barbara, CA, United States
| | - Muhammad Usman Baig
- Department of Pediatrics, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Grace Yang
- Department of Pediatrics, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Daniel C. Holland
- School of Psychology, Fielding Graduate University, Santa Barbara, CA, United States
| | - Wafik Zaky
- Department of Pediatrics, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Peter L. Stavinoha
- Department of Pediatrics, University of Texas MD Anderson Cancer Center, Houston, TX, United States
- *Correspondence: Peter L. Stavinoha,
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16
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Chieffo DPR, Lino F, Arcangeli V, Moriconi F, Frassanito P, Massimi L, Tamburrini G. Posterior Fossa Tumor Rehabilitation: An Up-to-Date Overview. CHILDREN (BASEL, SWITZERLAND) 2022; 9:904. [PMID: 35740841 PMCID: PMC9221689 DOI: 10.3390/children9060904] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 05/27/2022] [Accepted: 06/10/2022] [Indexed: 12/03/2022]
Abstract
This narrative review highlights the latest achievements in the field of post-surgical rehabilitation of posterior fossa tumors. Studies investigating the effects of cognitive rehabilitation programs have been considered, following a comprehensive literature search in the scientific electronic databases: Pubmed, Scopus, Plos One, and ScienceDirect. This review investigates the effects of cognitive remediation, with specific highlights for single cognitive domains. The results revealed that in spite of the increasing number of children who survive into adulthood, very few studies investigated the effects of rehabilitation programs in this specific population. This study details new, promising therapeutic opportunities for children after brain surgery. More research in this filed is needed to identify the most effective protocols for clinical use.
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Affiliation(s)
- Daniela Pia Rosaria Chieffo
- Clinical Psychology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (F.L.); (V.A.); (F.M.)
- Department Women Children and Public Health, Catholic University of Sacred Heart, 00168 Rome, Italy
| | - Federica Lino
- Clinical Psychology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (F.L.); (V.A.); (F.M.)
| | - Valentina Arcangeli
- Clinical Psychology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (F.L.); (V.A.); (F.M.)
| | - Federica Moriconi
- Clinical Psychology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (F.L.); (V.A.); (F.M.)
| | - Paolo Frassanito
- Pediatric Neurosurgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (P.F.); (L.M.); (G.T.)
| | - Luca Massimi
- Pediatric Neurosurgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (P.F.); (L.M.); (G.T.)
- Department Ageing, Neurosciences Head Neck and Orthopedics Sciences, Catholic University of Sacred Heart, 00168 Rome, Italy
| | - Gianpiero Tamburrini
- Pediatric Neurosurgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (P.F.); (L.M.); (G.T.)
- Department Ageing, Neurosciences Head Neck and Orthopedics Sciences, Catholic University of Sacred Heart, 00168 Rome, Italy
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17
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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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18
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Youn SH, Ha B, Lee EH, Park B, Yang SE, Yu ES, Kim JY. Neurocognitive and psychological functioning of pediatric brain tumor patients undergoing proton beam therapy for three different tumor types. Pediatr Blood Cancer 2022; 69:e29430. [PMID: 34766721 DOI: 10.1002/pbc.29430] [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] [Received: 02/19/2021] [Revised: 10/12/2021] [Accepted: 10/15/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND A high proportion of pediatric patients with brain tumors (BTs) are known to experience a decline in neurocognitive function after treatment. We prospectively examined neuropsychological functioning of patients with BTs of varying tumor types at different time points before, during, and after proton beam therapy. MATERIALS AND METHODS A total of 98 patients with posterior fossa tumors (PFTs; n = 33), germ cell tumors (GCTs; n = 52), and other supratentorial tumors (STTs; n = 13) underwent baseline neuropsychological assessments and 57 patients underwent follow-up assessments. RESULTS All groups displayed significantly lower performance intelligence quotient (PIQ) and processing speed (PS) scores than the normative means at baseline. The PFT group exhibited significantly lower scores for full-scale IQ, PIQ, PS, attention, and executive function. The GCT group displayed full-scale IQ scores within the normal range, but a significantly high proportion had memory deficits. In the STT group, all functions except for the PIQ and PS were intact. Longitudinal evaluations demonstrated stable global IQ scores over time in all groups. In the PFT group, verbal comprehension, attention, and PS improved over time. However, in the GCT group, verbal IQ scores declined significantly and psychological problems worsened over time, which were correlated with poorer neurocognitive function at 3-5 years after treatment. In the STT group, no significant changes were observed. CONCLUSION Because patients with BTs exhibit various types of neurocognitive deficit before radiotherapy, early cognitive treatment tailored to the tumor type maybe beneficial. Interventions for psychological problems and memory function may be necessary, especially for patients with GCT.
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Affiliation(s)
- Sang Hee Youn
- Proton Therapy Center, National Cancer Center, Goyang, Republic of Korea
| | - Boram Ha
- Proton Therapy Center, National Cancer Center, Goyang, Republic of Korea
| | - Eun-Hee Lee
- Proton Therapy Center, National Cancer Center, Goyang, Republic of Korea
| | - Boram Park
- Biostatistics Collaboration Unit, National Cancer Center, Goyang, Republic of Korea
| | - Song Ei Yang
- Proton Therapy Center, National Cancer Center, Goyang, Republic of Korea
| | - Eun-Seung Yu
- Mental Health Clinic, National Cancer Center, Goyang, Republic of Korea
| | - Joo-Young Kim
- Proton Therapy Center, National Cancer Center, Goyang, Republic of Korea
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19
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Moscato E, Patronick J, Wade SL. Family functioning and adaptation following pediatric brain tumor: A systematic review. Pediatr Blood Cancer 2022; 69:e29470. [PMID: 34842339 DOI: 10.1002/pbc.29470] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 10/29/2021] [Accepted: 11/02/2021] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Pediatric brain tumor survivors (PBTS) experience psychosocial difficulties and poor quality of life (QOL). Family functioning may be adversely impacted by the stress of diagnosis and associated symptoms, which may, in turn, affect PBTS outcomes. The objective of this study was to complete a systematic review of family functioning and psychosocial outcomes in PBTS. METHODS We conducted systematic searches of PubMed and PsychInfo. Full-text articles (n = 324) were screened and 14 were included. A risk-of-bias assessment was conducted to evaluate the quality of study conclusions. RESULTS Studies examined associations of family functioning with adaptive, social, emotional, and behavioral outcomes, and QOL. More adaptive family functioning (cohesiveness, effective communication, lower conflict) was associated with better PBTS outcomes. Studies were limited by heterogeneous/small samples and cross-sectional designs. CONCLUSIONS Results provide preliminary support for the relationship between family functioning and psychosocial outcomes. Common outcome measures and prospective research designs can further advance understanding.
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Affiliation(s)
- Emily Moscato
- Department of Psychology, University of Cincinnati, Cincinnati, Ohio, USA.,Pediatric Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Jamie Patronick
- Department of Psychology, University of Cincinnati, Cincinnati, Ohio, USA.,Pediatric Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Shari L Wade
- Department of Psychology, University of Cincinnati, Cincinnati, Ohio, USA.,Pediatric Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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20
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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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21
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Wolfe KR, Hutaff-Lee C, Wilkening G. Neuropsychological Screening in Pediatric Multidisciplinary Clinics: Group Characteristics and Predictive Utility. Arch Clin Neuropsychol 2021; 37:789-797. [PMID: 34747436 DOI: 10.1093/arclin/acab090] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To evaluate the feasibility of administering caregiver-report neuropsychological screening measures in pediatric multidisciplinary clinics (MDCs) and investigate predictive utility for cognitive and academic difficulties on follow-up testing. METHOD The Pediatric Perceived Cognitive Functioning (Peds PCF) and Colorado Learning Difficulties Questionnaire (CLDQ) were administered to caregivers of youth with history of brain tumor (BT), non-central nervous system (CNS) cancer, or Fontan circulation as part of routine neuropsychological consultation in MDCs from 2017 to 2019. We examined cross-sectional differences on screening measures, and relationships between screening and intellectual and academic test performance in a subset who presented for follow-up neuropsychological evaluation. Receiver operating characteristic (ROC) curve analysis was used to identify suggested cut scores on screening measures for predicting who would most benefit from further evaluation. RESULTS Screening was completed with 192 families. Children with history of non-CNS cancer (n = 29) had fewer parent-reported cognitive and academic concerns compared with either BT (n = 88) or Fontan (n = 75) groups. Peds PCF and CLDQ scores were related to intellectual and academic test performance in the group presenting for neuropsychological evaluation (n = 68). ROC curve analysis identified cut scores across screening measures with maximal sensitivity and specificity for detecting neuropsychological difficulties. CONCLUSIONS It is feasible to utilize parent rating measures during neuropsychological consultation in pediatric MDCs. The Peds PCF and CLDQ demonstrated sensitivity to intellectual and academic difficulties in children with significant medical histories. Screening may be a helpful tool for pediatric neuropsychologists and other professionals during MDC consultation to inform clinical management.
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Affiliation(s)
- Kelly R Wolfe
- Section of Neurology, Department of Pediatrics, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA
| | - Christa Hutaff-Lee
- Section of Neurology, Department of Pediatrics, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA
| | - Greta Wilkening
- Section of Neurology, Department of Pediatrics, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA
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22
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Oprandi MC, Oldrati V, delle Fave M, Panzeri D, Gandola L, Massimino M, Bardoni A, Poggi G. Processing Speed and Time since Diagnosis Predict Adaptive Functioning Measured with WeeFIM in Pediatric Brain Tumor Survivors. Cancers (Basel) 2021; 13:cancers13194776. [PMID: 34638261 PMCID: PMC8508451 DOI: 10.3390/cancers13194776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 09/20/2021] [Accepted: 09/22/2021] [Indexed: 12/31/2022] Open
Abstract
Simple Summary Brain tumor (BT) survivors show difficulties in adaptive functioning (AF) and in acquiring independence (e.g., graduating, finding employment, building strong relationships, and being independent). The aim of our observational retrospective study is to explore the contribution of different clinical and cognitive variables in explaining and predicting the AF outcomes of BT survivors, measured with the Functional Independence Measure for Children (WeeFIM). The analysis demonstrated that processing speed and time since diagnosis are the main explanatory variables. Other clinical factors, such as age at diagnosis and hydrocephalus, differentially influence functional skills according to distinct domains (i.e., self-care, mobility, and cognition). The identification of the clinical factors influencing AF could suggest targets on which to focus attention. By successfully assessing, understanding, and managing AF, it will be possible to improve its management in pediatric BT survivors. Abstract (1) Background: Brain tumor (BT) survivors show difficulties in the acquisition of developmental milestones, related to academic achievement, vocational employment, social relationships, and autonomy. The skills underlying adaptive functioning (AF) are usually damaged in BT survivors due to the presence of the brain tumor, treatment-related factors, and other neurological sequelae. In this study, we aimed to explore the contribution of different cognitive factors in children with BT to AF, considering diagnosis-related variables. (2) Methods: Standardized cognitive assessment was undertaken and clinical information was collected from a retrospective cohort of 78 children with a BT, aged between 6 and 18 year old at the time of the assessment. Regression models were computed to investigate the influence of the selected variables on daily functional skills as measured by the Functional Independence Measure for Children (WeeFIM). (3) Results: The analyses showed that the main explanatory variables are processing speed and time since diagnosis. Other clinical variables, such as age at diagnosis and hydrocephalus, differentially influence functional skills according to distinct domains (i.e., self-care, mobility, and cognition). (4) Conclusions: The main explanatory variables of AF that emerged in our models point to a potential target of improving AF management in pediatric BT survivors.
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Affiliation(s)
- Maria Chiara Oprandi
- Neuro-Oncological and Neuropsychological Rehabilitation Unit, Scientific Institute, IRCCS E. Medea, Bosisio Parini, 23842 Lecco, Italy; (V.O.); (M.d.F.); (D.P.); (A.B.); (G.P.)
- Correspondence:
| | - Viola Oldrati
- Neuro-Oncological and Neuropsychological Rehabilitation Unit, Scientific Institute, IRCCS E. Medea, Bosisio Parini, 23842 Lecco, Italy; (V.O.); (M.d.F.); (D.P.); (A.B.); (G.P.)
| | - Morena delle Fave
- Neuro-Oncological and Neuropsychological Rehabilitation Unit, Scientific Institute, IRCCS E. Medea, Bosisio Parini, 23842 Lecco, Italy; (V.O.); (M.d.F.); (D.P.); (A.B.); (G.P.)
| | - Daniele Panzeri
- Neuro-Oncological and Neuropsychological Rehabilitation Unit, Scientific Institute, IRCCS E. Medea, Bosisio Parini, 23842 Lecco, Italy; (V.O.); (M.d.F.); (D.P.); (A.B.); (G.P.)
| | - Lorenza Gandola
- Department of Medical Oncology and Hematology, Pediatrics Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (L.G.); (M.M.)
| | - Maura Massimino
- Department of Medical Oncology and Hematology, Pediatrics Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (L.G.); (M.M.)
| | - Alessandra Bardoni
- Neuro-Oncological and Neuropsychological Rehabilitation Unit, Scientific Institute, IRCCS E. Medea, Bosisio Parini, 23842 Lecco, Italy; (V.O.); (M.d.F.); (D.P.); (A.B.); (G.P.)
| | - Geraldina Poggi
- Neuro-Oncological and Neuropsychological Rehabilitation Unit, Scientific Institute, IRCCS E. Medea, Bosisio Parini, 23842 Lecco, Italy; (V.O.); (M.d.F.); (D.P.); (A.B.); (G.P.)
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Zilli T, Dolcemascolo V, Passone E, Maieron M, De Colle MC, Skrap M, Ius T, Liguoro I, Venchiarutti M, Cogo P, Tomasino B. A multimodal approach to the study of children treated for posterior fossa tumor: A review of the literature and a pilot study. Clin Neurol Neurosurg 2021; 207:106819. [PMID: 34274656 DOI: 10.1016/j.clineuro.2021.106819] [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: 05/03/2021] [Revised: 06/24/2021] [Accepted: 07/02/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The aims of the present study were: (1) to review the literature on long-lasting cognitive sequelae in children treated for Posterior Fossa Tumor and (2) to investigate anatomic functional relations in a case series of 7 children treated for PFT using magnetic resonance imaging (MRI) post-processing methods. METHODS We retrospectively analyzed MRIs of children who underwent complete surgical resection of PFT and performed extensive neuropsychological evaluation. Tumor, ventricular volumes, and VPS insertion site were drawn on T1 volumetric MRI scans and normalized to a pediatric template. Children showed worse performances on tasks tapping executive functions, memory, visuo-motor precision, and expressive language. RESULTS Volumes of interest related to these functions showed a maximum overlap on the left vermis and the lateral ventricle enlargement, except for impaired narrative fluency -which was associated with left lateral ventricle enlargement- and narrative memory -which was related to the right vermis and the enlarged fourth ventricle. CONCLUSION Results suggest that anatomic functional relations in children treated for PFT are related to a combination of different pathophysiological factors.
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Affiliation(s)
- Tiziana Zilli
- Scientific Institute Eugenio Medea, Via della Bontà n. 7, 33078 San Vito al Tagliamento, PN, Italy.
| | - Valentina Dolcemascolo
- Division of Pediatrics, Department of Medicine, University Hospital of Udine, Piazzale S.M. della Misericordia 15, 33100, Italy
| | - Eva Passone
- Division of Pediatrics, Department of Medicine, University Hospital of Udine, Piazzale S.M. della Misericordia 15, 33100, Italy
| | - Marta Maieron
- Department of Medical Physics, University Hospital of Udine, P.le S.M. della Misericordia 15, 33100, Italy
| | - Maria Cristina De Colle
- Department of Neuroradiology, University Hospital of Udine, P.le S.M. della Misericordia 15, 33100, Italy
| | - Miran Skrap
- Department of Neurosurgery, University Hospital of Udine, P.le S.M. della Misericordia 15, 33100, Italy
| | - Tamara Ius
- Department of Neurosurgery, University Hospital of Udine, P.le S.M. della Misericordia 15, 33100, Italy
| | - Ilaria Liguoro
- Division of Pediatrics, Department of Medicine, University Hospital of Udine, Piazzale S.M. della Misericordia 15, 33100, Italy
| | - Martina Venchiarutti
- Division of Pediatrics, Department of Medicine, University Hospital of Udine, Piazzale S.M. della Misericordia 15, 33100, Italy; Child Neuropsychiatry, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, P.le L.A. Scuro 10, 37134, Italy
| | - Paola Cogo
- Division of Pediatrics, Department of Medicine, University Hospital of Udine, Piazzale S.M. della Misericordia 15, 33100, Italy
| | - Barbara Tomasino
- Scientific Institute Eugenio Medea, Via della Bontà n. 7, 33078 San Vito al Tagliamento, PN, Italy
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24
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Aleksonis HA, Krishnamurthy LC, King TZ. White matter hyperintensity volumes are related to processing speed in long-term survivors of childhood cerebellar tumors. J Neurooncol 2021; 154:63-72. [PMID: 34231115 DOI: 10.1007/s11060-021-03799-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 06/25/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE Across several clinical populations, higher white matter hyperintensity (WMH) burden is consistently associated with decreases in cognitive performance, especially processing speed. Research of childhood cancer survivors has not utilized WMH quantification methodology to better understand the impact of WMH burden and its relationship with core cognitive skills. The present study aimed to quantify WMH volumes in a sample of long-term survivors of childhood cerebellar tumor and investigate the relationships with performance on a measure of oral processing speed. To further explore brain-behavior relationships, multivariate sparse canonical correlations was employed to identify WMH areas that predict processing speed performance. METHODS Thirty-five survivors and 56 healthy controls underwent neuroimaging and completed a measure of oral processing speed. The survivor group was further divided based on treatment (i.e., chemoradiation therapy (n = 20) vs. surgery only (n = 15)) to better understand the impact of treatment. RESULTS Survivors, and especially those treated with chemoradiation therapy, showed higher total WMH volumes and slower processing speed. Higher total WMH volumes were significantly associated with poorer processing speed (r = - 0.492, p = 0.003). Multivariate brain-behavior relationships revealed that periventricular WMHs were significantly associated with slower processing speed performance (p < 0.05). CONCLUSION Results exemplify that long-term survivors treated with and without chemoradiation therapy are at increased risk of developing higher WMH volumes compared to healthy peers. In addition, processing speed was robustly shown to be related to periventricular WMHs using an automated neuroimaging pipeline. This methodology to monitor WMH burden has the potential to be implemented efficiently with routine clinical neuroimaging of cancer survivors.
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Affiliation(s)
- Holly A Aleksonis
- Department of Psychology and the Neuroscience Institute, Georgia State University, Urban Life Building, 11th Floor, 140 Decatur St, Atlanta, GA, 30303, USA
| | - Lisa C Krishnamurthy
- Center for Visual and Neurocognitive Rehabilitation, Atlanta Veteran's Affairs Medical Center, Decatur, GA, USA
- Department of Physics and Astronomy, Georgia State University, Atlanta, GA, USA
| | - Tricia Z King
- Department of Psychology and the Neuroscience Institute, Georgia State University, Urban Life Building, 11th Floor, 140 Decatur St, Atlanta, GA, 30303, USA.
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25
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Fox ME, Turner JA, Crosson B, Morris RD, King TZ. Functional Connectivity Networks and Their Recruitment During Working Memory Tasks in Adult Survivors of Childhood Brain Tumors. Brain Connect 2021; 11:822-837. [PMID: 33858201 DOI: 10.1089/brain.2020.0800] [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] [Indexed: 10/21/2022] Open
Abstract
Background: Assessments of functional connectivity of default mode network (DMN) and positive task-related networks (TRNs) using independent component analysis (ICA) may help describe long-term effects of childhood brain tumors and adjuvant treatments. Methods: Aiming to identify potential neuronal markers that may aid in prognosis and inform interventions to optimize outcomes, this study used ICA to evaluate the presence of functional connectivity networks and their recruitment during a letter n-back task in 23 adult survivors of childhood posterior fossa tumors (9 low grade, 14 high grade) at least 5 years past diagnosis compared with 40 age- and sex-matched healthy peers. Results: DMN components generally demonstrated increasing disengagement as task difficulty increased, and relationships between effective DMN disengagement and improved performance were observed in healthy controls (HCs). Low-grade brain tumor survivors (LGS) demonstrated unique patterns in DMN recruitment that suggested increased involvement of the medial prefrontal cortex in LGS during tasks. TRN components generally demonstrated increasing engagement, which was related to improved task performance in HCs for one executive control network (ECN) component. High-grade brain tumor survivors (HGS) demonstrated distinct challenges recruiting an ECN component at more difficult task levels and showed a relationship between recruitment of another ECN component and task performance, indicating a potential compensatory mechanism for some HGS. Conclusions: Findings suggest the importance of cognitive intervention in both survivor groups and the necessity to track LGS despite their cognitive abilities often resembling those of their healthy peers. Impact statement Distinct functional connectivity patterns were identified between both adult survivor of childhood brain tumor groups and peers during attention and working memory tasks, reflecting different damage and recovery from treatment. Survivors of low-grade tumors demonstrated unique patterns of recruitment of default mode network components in the context of similar cognitive abilities, whereas survivors of high-grade tumors demonstrated poorer cognitive abilities and may be utilizing compensatory executive control network components in the face of challenging tasks. Long-term clinical follow-up and cognitive remediation is warranted for both groups, including low grade cerebellar tumor patients who have traditionally not been monitored as closely.
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Affiliation(s)
- Michelle E Fox
- Department of Psychology, Georgia State University, Atlanta, Georgia, USA
| | - Jessica A Turner
- Department of Psychology, Georgia State University, Atlanta, Georgia, USA.,Neuroscience Institute, Georgia State University, Atlanta, Georgia, USA
| | - Bruce Crosson
- Department of Psychology, Georgia State University, Atlanta, Georgia, USA.,Neuroscience Institute, Georgia State University, Atlanta, Georgia, USA.,Departments of Neurology and of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA.,Atlanta VA Center of Excellence for Visual and Neurocognitive Rehabilitation, Decatur, Georgia, USA
| | - Robin D Morris
- Department of Psychology, Georgia State University, Atlanta, Georgia, USA.,Neuroscience Institute, Georgia State University, Atlanta, Georgia, USA
| | - Tricia Z King
- Department of Psychology, Georgia State University, Atlanta, Georgia, USA.,Neuroscience Institute, Georgia State University, Atlanta, Georgia, USA
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26
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Peterson RK, Williams S, Janzen L. Cognitive Correlates of Math Performance in School-Aged Children with Sickle Cell Disease and Silent Cerebral Infarcts. Arch Clin Neuropsychol 2021; 36:465-474. [PMID: 32890401 DOI: 10.1093/arclin/acaa071] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Attention, processing speed, executive functioning, and math difficulties are common in youth with sickle cell disease (SCD) with silent cerebral infarcts (SCI). This study investigated the cognitive underpinnings of math difficulties in children with SCD and SCI. METHOD Youth (n = 68) with SCD and SCI completed measures of attention [Digit Span forward (DSF); Conners Continuous Performance Test-Third Edition/Kiddie Conners Continuous Performance Test-Second Edition (CPT-3/KCPT-2)]; working memory [Wechsler Intelligence Scales (WPPSI-IV, WISC-IV, WISC-V, WAIS-IV), Working Memory Index (WMI), Digit Span backwards (DSB)]; processing speed [WPPSI-IV, WISC-IV, WISC-V, WAIS-IV Processing Speed Index (PSI)]; math reasoning [Wechsler Individual Achievement Test-Third Edition (WIAT-III) Mathematics composite (MC)]; and math fluency [WIAT-III Math Fluency composite (MF)] as part of a clinical neuropsychological evaluation. Parent ratings of attention and executive functioning were obtained [Behavior Assessment System for Children-Third Edition (BASC-3), Behavior Rating Inventory of Executive Function (BRIEF)]. RESULTS MC was positively correlated with WMI (r = 0.59, p = 0.00), PSI (r = 0.40, p < 0.001), DSF (r = 0.29, p = 0.03), DSB (r = 0.47, p < 0.001), and MF (r = 0.71, p < 0.001). Correlations between MC, sustained attention, and parent ratings were nonsignificant. The linear regression model using correlated variables was significant [F(4,51) = 8.29, R2 = 0.39, p < 0.001]. WMI was the only significant variable within the model (p = 0.02). CONCLUSIONS Working memory deficits account for significant variance in untimed mathematical performance in this population-consistent with other populations with white matter dysfunction. Interventions targeting both mathematics and working memory may be beneficial.
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Affiliation(s)
- Rachel K Peterson
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Suzan Williams
- Department of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Laura Janzen
- Department of Neuropsychology, The Hospital for Sick Children, Toronto, Ontario, Canada
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27
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Wang Y, Zhou C, Luo H, Cao J, Ma C, Cheng L, Yang Y. Prognostic implications of immune-related eight-gene signature in pediatric brain tumors. ACTA ACUST UNITED AC 2021; 54:e10612. [PMID: 34008756 PMCID: PMC8130135 DOI: 10.1590/1414-431x2020e10612] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 02/04/2021] [Indexed: 02/14/2023]
Abstract
Genomic studies have provided insights into molecular subgroups and oncogenic drivers of pediatric brain tumors (PBT) that may lead to novel therapeutic strategies. Participants of the cohort Pediatric Brain Tumor Atlas: CBTTC (CBTTC cohort), were randomly divided into training and validation cohorts. In the training cohort, Kaplan-Meier analysis and univariate Cox regression model were applied to preliminary screening of prognostic genes. The LASSO Cox regression model was implemented to build a multi-gene signature, which was then validated in the validation and CBTTC cohorts through Kaplan-Meier, Cox, and receiver operating characteristic curve (ROC) analyses. Also, gene set enrichment analysis (GSEA) and immune infiltrating analyses were conducted to understand function annotation and the role of the signature in the tumor microenvironment. An eight-gene signature was built, which was examined by Kaplan-Meier analysis, revealing that a significant overall survival difference was seen, either in the training or validation cohorts. The eight-gene signature was further proven to be independent of other clinic-pathologic parameters via the Cox regression analyses. Moreover, ROC analysis demonstrated that this signature owned a better predictive power of PBT prognosis. Furthermore, GSEA and immune infiltrating analyses showed that the signature had close interactions with immune-related pathways and was closely related to CD8 T cells and monocytes in the tumor environment. Identifying the eight-gene signature (CBX7, JADE2, IGF2BP3, OR2W6P, PRAME, TICRR, KIF4A, and PIMREG) could accurately identify patients' prognosis and the signature had close interactions with the immunodominant tumor environment, which may provide insight into personalized prognosis prediction and new therapies for PBT patients.
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Affiliation(s)
- Yi Wang
- Department of Neonatology and Neonatal Intensive Care, Zhumadian Central Hospital, Zhumadian, China
| | - Chuan Zhou
- Neonatal Intensive Care Unit, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Huan Luo
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and the Berlin Institute of Health, Berlin, Germany
| | - Jing Cao
- Department of Anatomy, College of Basic Medicine, Zhengzhou University, Zhengzhou, China
| | - Chao Ma
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and the Berlin Institute of Health, Berlin, Germany
| | - Lulu Cheng
- Digital Medical Laboratory, Zhumadian Central Hospital, Zhumadian, China
| | - Yang Yang
- Digital Medical Laboratory, Zhumadian Central Hospital, Zhumadian, China
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28
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Peterson RK, Jones K, Jacobson LA. [Formula: see text]The contribution of sluggish cognitive tempo to processing speed in survivors of pediatric brain tumors. Child Neuropsychol 2021; 27:960-972. [PMID: 33866922 DOI: 10.1080/09297049.2021.1917529] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Sluggish Cognitive Tempo (SCT) describes a pattern of under-activity, poor initiation, and slowness. It was first reported within the Attention Deficit Hyperactivity Disorder (ADHD) literature and found to be positively associated with the inattentive symptoms of ADHD and negatively or not significantly associated with the hyperactivity/impulsivity symptoms of ADHD. SCT has since been considered applicable to the pediatric oncology population given the emergence of inattentive, sluggish symptoms secondary to cancer treatment. The present study examined the unique contribution of SCT to various processing speed skills in a clinical sample of pediatric brain tumor (BT) survivors in order to determine the degree to which SCT explained timed "cognitive" processing components. Measures included speeded naming, graphomotor speed, and speeded inhibition. Hierarchical linear regression analyses were used to predict performance-based measures of processing speed. After controlling for verbal ability and inattention, SCT, particularly Daydreamy SCT (β = -0.698, p = 0.023), explained 28% of variance in speeded inhibition. SCT did not add significantly to the prediction of speeded naming or graphomotor speed. Findings suggest that the "daydreamy" aspect of SCT, rather than "sluggishness" per se, may be related to more complex, cognitively-demanding tasks with greater executive functioning burdens in BT survivors. Implications for intervention for oncology survivors as well as future research directions are discussed.
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Affiliation(s)
- Rachel K Peterson
- Kennedy Krieger Institute Neuropsychology Department.,Johns Hopkins School of Medicine Department of Psychiatry and Behavioral Sciences
| | - Kelly Jones
- Kennedy Krieger Institute Neuropsychology Department
| | - Lisa A Jacobson
- Kennedy Krieger Institute Neuropsychology Department.,Johns Hopkins School of Medicine Department of Psychiatry and Behavioral Sciences
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29
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Willard VW, Tillery R, Harman JL, Long A, Phipps S. The Influence of Early Childhood Temperament on Later Social-Emotional Functioning in Youth with Cancer. J Pediatr Psychol 2021; 46:433-442. [PMID: 33355354 DOI: 10.1093/jpepsy/jsaa120] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 10/20/2020] [Accepted: 11/18/2020] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE One of the peak incidences of childhood cancer is during the early childhood years. This is also an important time for psychosocial and personality development, and it is well known that early childhood temperament influences later psychosocial functioning. However, this association has not been examined in young children with cancer. METHODS Parents of children with cancer (N = 39) and healthy comparisons (N = 35) completed an indicator of temperament (Children's Behavior Questionnaire) when children were young (Mage=4.99 ± 1.05 years). Five years later, parents and youth completed measures of psychosocial functioning (Mage=10.15 ± 1.10 years; Behavior Assessment Scale for Children, 2nd edition and Social Emotional Assets and Resilience Scale). RESULTS Parents of healthy comparisons reported that their children demonstrated greater surgency than youth with cancer; there were no differences in negative affect or effortful control. Children with cancer and healthy comparisons were rated similarly on measures of psychosocial functioning. Health status was not a significant predictor of later functioning, but socioeconomic status and temperament were. The influence of temperament was stronger for strengths-based functioning (e.g., social competence, adaptive functioning) versus distress (internalizing and externalizing problems). CONCLUSIONS Early childhood temperament is a strong predictor of later psychosocial functioning, regardless of health status. Findings highlight the need to consider temperament in the clinical assessment of psychosocial functioning in children with cancer. Additional research is needed to specifically assess how a diagnosis of cancer in early childhood influences temperament over time.
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Affiliation(s)
| | - Rachel Tillery
- Department of Psychology, St. Jude Children's Research Hospital
| | | | - Alanna Long
- Department of Psychology, St. Jude Children's Research Hospital
| | - Sean Phipps
- Department of Psychology, St. Jude Children's Research Hospital
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30
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Puhr A, Ruud E, Anderson V, Due-Tønnessen BJ, Skarbø AB, Finset A, Andersson S. Executive Function and Psychosocial Adjustment in Adolescent Survivors of Pediatric Brain Tumor. Dev Neuropsychol 2021; 46:149-168. [PMID: 33783291 DOI: 10.1080/87565641.2021.1900191] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Adolescent survivors of pediatric brain tumor (PBT) are a sparsely studied subset of childhood cancer survivors. Sustaining a PBT may complicate the development of executive functions (EFs), which play a vital role in long-term psychosocial adjustment. In this study, 48 adolescent survivors and their parents completed questionnaires assessing EF, psychological symptoms, fatigue, and adaptive functioning, and 26 survivors underwent neuropsychological assessment. Survivors reported significantly more problems with adaptive functioning than a healthy control group, and this was most strongly associated to executive dysfunction, compared to psychological symptoms and fatigue. The findings have important implications for long-term follow-ups.
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Affiliation(s)
- A Puhr
- Dept. of Pediatric Medicine, Oslo University Hospital & Dept. Of Psychology, University of Oslo, Norway
| | - E Ruud
- Dept. of Pediatric Medicine, Oslo University Hospital & Faculty of Medicine, University of Oslo, Norway
| | - V Anderson
- Royal Children's Hospital, Melbourne & Depts of Psychology & Paediatrics, University of Melbourne, Melbourne Australia
| | | | - A B Skarbø
- Dept. of Pediatric Neurology, Oslo University Hospital, Oslo, Norway
| | - A Finset
- Faculty of Medicine, University of Oslo, Oslo Norway
| | - S Andersson
- Dept. of Psychology, University of Oslo, Oslo, Norway
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31
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Neuroimaging Biomarkers and Neurocognitive Outcomes in Pediatric Medulloblastoma Patients: a Systematic Review. THE CEREBELLUM 2021; 20:462-480. [PMID: 33417160 DOI: 10.1007/s12311-020-01225-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/06/2020] [Indexed: 10/22/2022]
Abstract
Medulloblastoma is a malign posterior fossa brain tumor, mostly occurring in childhood. The CNS-directed chemoradiotherapy treatment can be very harmful to the developing brain and functional outcomes of these patients. However, what the underlying neurotoxic mechanisms are remain inconclusive. Hence, this review summarizes the existing literature on the association between advanced neuroimaging and neurocognitive changes in patients that were treated for pediatric medulloblastoma. The PubMed/Medline database was extensively screened for studies investigating the link between cognitive outcomes and multimodal magnetic resonance (MR) imaging in childhood medulloblastoma survivors. A behavioral meta-analysis was performed on the available IQ scores. A total of 649 studies were screened, of which 22 studies were included. Based on this literature review, we conclude medulloblastoma patients to be at risk for white matter volume loss, more frequent white matter lesions, and changes in white matter microstructure. Such microstructural alterations were associated with lower IQ, which reached the clinical cut-off in survivors across studies. Using functional MR scans, changes in activity were observed in cerebellar areas, associated with working memory and processing speed. Finally, cerebral microbleeds were encountered more often, but these were not associated with cognitive outcomes. Regarding intervention studies, computerized cognitive training was associated with changes in prefrontal and cerebellar activation and physical training might result in microstructural and cortical alterations. Hence, to better define the neural targets for interventions in pediatric medulloblastoma patients, this review suggests working towards neuroimaging-based predictions of cognitive outcomes. To reach this goal, large multimodal prospective imaging studies are highly recommended.
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32
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Lönnerblad M, Berglund E, van’t Hooft I, Blomgren K. Can National Tests from the Last Year of Compulsory School Be Used to Obtain More Detailed Information about Academic Performance in Children Treated for Brain Tumours? A Nationwide, Population-Based Study from Sweden. Cancers (Basel) 2021; 13:cancers13010135. [PMID: 33406638 PMCID: PMC7795235 DOI: 10.3390/cancers13010135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 12/22/2020] [Accepted: 12/25/2020] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Children treated for brain tumours often suffer from late-appearing complications, including impaired cognitive performance. In this study, 475 Swedish children diagnosed with a brain tumour before their 15th birthday and 2197 matched controls were included. Data from compulsory national tests performed school year nine in the first foreign language English, the mother tongue Swedish and mathematics were analysed. These tests offered more detailed information on academic strengths and weaknesses than the final grades, as different skill sets were assessed. Cases performed worse than controls in English tests than in Swedish and mathematics tests, and they may have performed better in oral than written tasks. There were larger differences between girls treated for brain tumours and their female controls than between boys treated for brain tumours and their male controls. National tests may be useful to complement neuropsychological follow-ups. Characterising these shortcomings is essential to provide appropriate support and prevent social isolation. Abstract Children treated for brain tumours often have late-appearing complications that may affect their school performance. Uneven skill profiles may help reveal late complications that can be compensated for but otherwise remain undetected. We investigated Swedish national school tests of oral, reading and writing skills in the first foreign language (English), the mother tongue (Swedish) and mathematics. Data were obtained from The Swedish Childhood Cancer Registry and Statistics Sweden. The results from 475 children diagnosed with a brain tumour before their 15th birthday and 2197 matched controls showed that children treated for brain tumours evinced more difficulties with national tests than controls in almost all subtests, especially in the subject English, and that they may perform better on oral than written tasks. There were larger differences between female cases and controls than between male cases and controls; age at diagnosis played a significant role for some subtests, whereas tumour grade did not. Missing information from national tests proved to be a strong predictor of poor academic performance. Our results show that regular educational follow-ups, as a complement to neuropsychological follow-ups, are important for all children treated for brain tumours, regardless of sex, age at diagnosis or tumour grade.
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Affiliation(s)
- Malin Lönnerblad
- Department of Special Education, Stockholm University, 106 91 Stockholm, Sweden;
- Department of Women’s and Children’s Health, Karolinska Institutet, Tomtebodavägen 18 A, 171 77 Stockholm, Sweden;
- Correspondence: (M.L.); (K.B.)
| | - Eva Berglund
- Department of Special Education, Stockholm University, 106 91 Stockholm, Sweden;
| | - Ingrid van’t Hooft
- Department of Women’s and Children’s Health, Karolinska Institutet, Tomtebodavägen 18 A, 171 77 Stockholm, Sweden;
| | - Klas Blomgren
- Department of Women’s and Children’s Health, Karolinska Institutet, Tomtebodavägen 18 A, 171 77 Stockholm, Sweden;
- Paediatric Oncology, Karolinska University Hospital, J9:30, 171 64 Stockholm, Sweden
- Correspondence: (M.L.); (K.B.)
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Predictors of cognitive function in pediatric brain tumor patients: Pre-surgery through 24-month follow-up. APPLIED NEUROPSYCHOLOGY. CHILD 2021; 10:340-347. [PMID: 31887256 PMCID: PMC7326643 DOI: 10.1080/21622965.2019.1706179] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The aim of this study was to examine the feasibility of cognitive assessment from pre-surgery through 2-year follow-up in a sample of pediatric brain tumor (BT) patients. We sought to investigate cognitive function over the course of diagnosis and treatment, and as a function of presenting problems, tumor location, treatment type, and tumor severity. Using a prospective, longitudinal design, standardized IQ measures were administered to pediatric BT patients (ages 6-16) prior to surgery (n = 25), 6 months post-diagnosis (n = 24), and 24 months post-diagnosis (n = 23). Group differences emerged based on tumor severity and treatment type at multiple time points, including prior to surgical intervention; children with high grade tumors performed more poorly than children with low grade tumors, and children receiving surgery plus adjuvant therapy performed more poorly than children who received surgery only. When considered together, an analysis of covariance demonstrated that tumor grade significantly accounted for variability in cognitive functioning, while treatment type did not. Although there is overlap clinically between tumor severity and treatment received, results suggest that tumor severity is an important factor contributing to variability in cognitive functioning and should also be considered when monitoring risk for cognitive deficits in children diagnosed with BT.
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34
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Semmel ES, Quadri TR, King TZ. Oral processing speed as a key mechanism in the relationship between neurological risk and adaptive functioning in survivors of pediatric brain tumors. Pediatr Blood Cancer 2020; 67:e28575. [PMID: 32813316 DOI: 10.1002/pbc.28575] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/25/2020] [Accepted: 06/26/2020] [Indexed: 11/11/2022]
Abstract
PURPOSE Brain tumor (BT) survivors are at risk for difficulties with adaptive functioning (AF). Recent work has associated neurological risk with poorer AF outcomes using the Neurological Predictor Scale (NPS), a quantification of neurological risk factors. Survivors also have poorer attention, processing speed, and working memory, which are all important for AF. The current study examined whether these cognitive constructs explain the relationship between the NPS and AF in survivors. METHODS Ninety-five adult BT survivors and 135 healthy controls were recruited from the Atlanta area. The Oral Symbol Digits Modalities test was used to measure processing speed, Digit Span Backward assessed working memory, and Digit Span Forward measured attention. Informants completed the Scales of Independent Behavior (SIB-R) to measure AF. Group differences and correlations were assessed, and the PROCESS macro for SPSS tested indirect effects. RESULTS Survivors were significantly lower on AF and cognitive measures compared with controls. Attention span and processing speed had significant indirect effects in relationship between NPS and AF individually, but processing speed was the only variable with a significant indirect effect when all cognitive variables were included in the model. The NPS and processing speed together account for approximately 39% of variance in AF outcomes. CONCLUSIONS BT survivors in our sample have lower AF than controls, and processing speed appears to be particularly important in explaining the relationship between neurological risk and AF. In the future, the development of interventions aimed at increasing young adult independence should target both cognitive processing speed and AF skills.
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Affiliation(s)
- Eric S Semmel
- Department of Psychology and Neuroscience Institute, Georgia State University, Atlanta, Georgia
| | - Tobiloba R Quadri
- Department of Psychology and Neuroscience Institute, Georgia State University, Atlanta, Georgia
| | - Tricia Z King
- Department of Psychology and Neuroscience Institute, Georgia State University, Atlanta, Georgia
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Double Dissociation of Auditory Attention Span and Visual Attention in Long-Term Survivors of Childhood Cerebellar Tumor: A Deterministic Tractography Study of the Cerebellar-Frontal and the Superior Longitudinal Fasciculus Pathways. J Int Neuropsychol Soc 2020; 26:939-953. [PMID: 32342828 DOI: 10.1017/s1355617720000417] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Right cerebellar-left frontal (RC-LF) white matter integrity (WMI) has been associated with working memory. However, prior studies have employed measures of working memory that include processing speed and attention. We examined the relationships between the RC-LF WMI and processing speed, attention, and working memory to clarify the relationship of RC-LF WMI with a specific cognitive function. Right superior longitudinal fasciculus II (SLF II) WMI and visual attention were included as a negative control tract and task to demonstrate a double dissociation. METHODS Adult survivors of childhood brain tumors [n = 29, age: M = 22 years (SD = 5), 45% female] and demographically matched controls were recruited (n = 29). Tests of auditory attention span, working memory, and visual attention served as cognitive measures. Participants completed a 3-T MRI diffusion-weighted imaging scan. Fractional anisotropy (FA) and radial diffusivity (RD) served as WMI measures. Partial correlations between WMI and cognitive scores included controlling for type of treatment. RESULTS A correlational double dissociation was found. RC-LF WMI was associated with auditory attention (FA: r = .42, p = .03; RD: r = -.50, p = .01) and was not associated with visual attention (FA: r = -.11, p = .59; RD: r = -.11, p = .57). SLF II FA WMI was associated with visual attention (FA: r = .44, p = .02; RD: r = -.17, p = .40) and was not associated with auditory attention (FA: r = .24, p = .22; RD: r = -.10, p = .62). CONCLUSIONS The results show that RC-LF WMI is associated with auditory attention span rather than working memory per se and provides evidence for a specificity based on the correlational double dissociation.
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Attina G, Ariano A, Maurizi P, Triarico S, Capozza MA, Coccia P, Rizzo D, Mastrangelo S, Ruggiero A. Treatment and Long-Term Sequelae in Childhood Brain Tumors. Open Neurol J 2020. [DOI: 10.2174/1874205x02014010079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
In children treated for brain tumors, important deficits in cognitive development have been described. The reduction of Intelligence Quotient (IQ) is correlated with multiple conditions such as tumor location, obstructive hydrocephalus, surgical intervention, and above all, the use of radiotherapy, especially in young children. Demyelinization represents the most striking microscopic alteration following radiation: cerebral white matter’s loss and failure to white matter development could partly account for changes in IQ score.Recently, combined chemo-radiotherapeutic approaches and the improvement of radiotherapy techniques have enabled the reduction of neurocognitive symptoms and improved the standard of life of childhood brain tumor survivors.
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Stadskleiv K, Stensvold E, Stokka K, Bechensteen AG, Brandal P. Neuropsychological functioning in survivors of childhood medulloblastoma/CNS-PNET: The role of secondary medical complications. Clin Neuropsychol 2020; 36:600-625. [PMID: 32729777 DOI: 10.1080/13854046.2020.1794045] [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: 10/23/2022]
Abstract
OBJECTIVE To investigate the long-term cognitive consequences of malignant pediatric brain tumor and its treatment, and factors explaining variability in cognitive functioning among survivors. Method: A geographical cohort of survivors of pediatric medulloblastoma (MB) and supratentorial primitive neuroectodermal tumor (CNS-PNET), treated between 1974 and 2013, was invited to participate. Of the 63 surviving patients, 50 (79%) consented to participation. The participants were tested with a battery of neuropsychological tests covering a wide age range. Verbal cognition, nonverbal cognition, processing speed, attention, memory, executive functioning, and manual dexterity were assessed. The participants were between 5:5 and 51:11 years of age at time of assessment. Assessments took place on average 19 years after primary tumor resective surgery. Results: One participant had a severe intellectual disability. For the rest, IQ varied from 52 to 125, with a mean score of 88.0 (SD 19.7). Twenty-eight (56%) of the participants had full-scale IQ scores in the age-average range or above. Gender, age at operation, time since operation, the presence of secondary medical complications, and treatment variables explained 46% of the variability in IQ scores, F(4,44) = 9.5, p<.001. The presence of endocrine insufficiency in combination with either epilepsy and/or hydrocephalus was associated with lowered IQ, lowered processing speed, and memory impairments. Conclusion: Patients treated for childhood MB and CNS-PNET have a lifelong risk of medical sequelae, including impaired cognitive functioning. This study adds to the literature by demonstrating the importance of following neuropsychological functioning closely, especially processing speed, learning, and memory, in survivors who have multiple secondary medical complications.
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Affiliation(s)
- Kristine Stadskleiv
- Department of Special Needs Education, University of Oslo, Oslo, Norway.,Department of Clinical Neurosciences for Children, Oslo University Hospital, Oslo, Norway
| | - Einar Stensvold
- The Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Pediatric Research, Oslo University Hospital, Oslo, Norway.,Department of Pediatrics, Oslo University Hospital, Oslo, Norway
| | - Kjersti Stokka
- Department of Psychology, University of Oslo, Oslo, Norway
| | | | - Petter Brandal
- Department of Oncology, Oslo University Hospital, Oslo, Norway.,Section for Cancer Cytogenetics, Institute for Cancer Genetics and Informatics, Oslo University Hospital, Oslo, Norway.,Centre for Cancer Biomedicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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38
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Lee JW, Lim DH, Sung KW, Cho HW, Ju HY, Hyun JK, Yoo KH, Koo HH, Suh YL, Joung YS, Shin HJ. Promising survival rate but high incidence of treatment-related mortality after reduced-dose craniospinal radiotherapy and tandem high-dose chemotherapy in patients with high-risk medulloblastoma. Cancer Med 2020; 9:5807-5818. [PMID: 32608158 PMCID: PMC7433836 DOI: 10.1002/cam4.3199] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 05/20/2020] [Accepted: 05/20/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND In this study, we report the follow-up results of reduced dose of craniospinal radiotherapy (CSRT) followed by tandem high-dose chemotherapy (HDCT) in patients with high-risk medulloblastoma (MB). METHODS Newly diagnosed high-risk MB patients (metastatic disease, postoperative residual tumor >1.5 cm2 , or large cell/anaplastic histology) over 3 years of age were enrolled in this study. Two cycles of pre-RT chemotherapy, radiotherapy (RT) including reduced-dose CSRT (23.4 or 30.6 Gy), four cycles of post-RT chemotherapy, and tandem HDCT were administered. NanoString and DNA sequencing were performed using archival tissues. RESULTS In all, 40 patients were enrolled, and molecular subgrouping was possible in 21 patients (2 wingless, 3 sonic hedgehog, 8 Group 3, and 8 group 4). All patients including two patients who experienced progression during the induction chemotherapy underwent HDCT. Relapse/progression occurred only in four patients (5-year cumulative incidence [CI] 10.4 ± 0.3%). However, six patients died from treatment-related mortality (TRM) (four acute TRMs and two late TRMs) resulting in 18.5 ± 0.5% of 5-year CI. Taken together, the 5-year event-free survival and overall survival were 71.1 ± 8.0% and 73.2 ± 7.9%, respectively. Late effects were evaluated in 25 patients and high-tone hearing loss, endocrine dysfunction, dyslipidemia, and growth retardation were common. CONCLUSIONS The strategy using tandem HDCT following reduced-dose CSRT showed promising results in terms of low relapse/progression rate; however, the high TRM rate indicates that modification of HDCT regimen and careful selection of patients who can benefit from HDCT will be needed in the future study.
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Affiliation(s)
- Ji Won Lee
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Do Hoon Lim
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ki Woong Sung
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hee Won Cho
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hee Young Ju
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ju Kyung Hyun
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Keon Hee Yoo
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hong Hoe Koo
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yeon-Lim Suh
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yoo-Sook Joung
- Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyung Jin Shin
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Meoded A, Goldenberg NA, Huisman TAGM. Structural Connectomics: State of the Art and Applications in Pediatric Neurodevelopmental Disorders, Neuro-Oncology, and Arterial Ischemic Stroke. J Pediatr 2020; 221S:S37-S42. [PMID: 32482233 DOI: 10.1016/j.jpeds.2020.01.056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 01/20/2020] [Accepted: 01/27/2020] [Indexed: 02/06/2023]
Affiliation(s)
- Avner Meoded
- Edward B. Singleton Department of Radiology, Section of Pediatric Neuroradiology, Texas Children's Hospital, Houston, TX.
| | - Neil A Goldenberg
- Department of Pediatrics and Medicine, Johns Hopkins University School of Medicine, Baltimore, MD; Stroke Program, Johns Hopkins Institute for Brain Protection Sciences, Johns Hopkins All Children's Hospital, St Petersburg, FL
| | - Thierry A G M Huisman
- Edward B. Singleton Department of Radiology, Section of Pediatric Neuroradiology, Texas Children's Hospital, Houston, TX
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Cox E, Bells S, Timmons BW, Laughlin S, Bouffet E, de Medeiros C, Beera K, Harasym D, Mabbott DJ. A controlled clinical crossover trial of exercise training to improve cognition and neural communication in pediatric brain tumor survivors. Clin Neurophysiol 2020; 131:1533-1547. [PMID: 32403066 DOI: 10.1016/j.clinph.2020.03.027] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 12/10/2019] [Accepted: 03/21/2020] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To assess the efficacy of aerobic exercise training to improve controlled attention, information processing speed and neural communication during increasing task load and rest in pediatric brain tumor survivors (PBTS) treated with cranial radiation. METHODS Participants completed visual-motor Go and Go/No-Go tasks during magnetoencephalography recording prior to and following the completion of 12-weeks of exercise training. Exercise-related changes in response accuracy and visual-motor latency were evaluated with Linear Mixed models. The Phase Lag Index (PLI) was used to estimate functional connectivity during task performance and rest. Changes in PLI values after exercise training were assessed using Partial Least Squares analysis. RESULTS Exercise training predicted sustained (12-weeks) improvement in response accuracy (p<0.05) during No-Go trials. Altered functional connectivity was detected in theta (4-7Hz) alpha (8-12Hz) and high gamma (60-100Hz) frequency bands (p<0.001) during Go and Go/No-Go trials. Significant changes in response latency and resting state connectivity were not detected. CONCLUSION These findings support the efficacy of aerobic exercise to improve controlled attention and enhance functional mechanisms under increasing task load in participants. SIGNIFICANCE It may be possible to harness the beneficial effects of exercise as therapy to promote cognitive recovery and enhance brain function in PBTS.
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Affiliation(s)
- Elizabeth Cox
- Neurosciences & Mental Health, SickKids, 686 Bay Street, Toronto, ON M5G 0A4, Canada; Department of Psychology, University of Toronto, 100 St. George Street, Toronto, ON M5S 3G3, Canada.
| | - Sonya Bells
- Neurosciences & Mental Health, SickKids, 686 Bay Street, Toronto, ON M5G 0A4, Canada.
| | - Brian W Timmons
- Department of Pediatrics, McMaster University, 1200 Main Street W., Hamilton, ON L8N 3Z5, Canada.
| | - Suzanne Laughlin
- Diagnostic Imaging, SickKids, 555 University Avenue, Toronto, ON M5G 1X8, Canada.
| | - Eric Bouffet
- Neurosciences & Mental Health, SickKids, 686 Bay Street, Toronto, ON M5G 0A4, Canada.
| | - Cynthia de Medeiros
- Neurosciences & Mental Health, SickKids, 686 Bay Street, Toronto, ON M5G 0A4, Canada.
| | - Kiran Beera
- Neurosciences & Mental Health, SickKids, 686 Bay Street, Toronto, ON M5G 0A4, Canada.
| | - Diana Harasym
- Neurosciences & Mental Health, SickKids, 686 Bay Street, Toronto, ON M5G 0A4, Canada.
| | - Donald J Mabbott
- Neurosciences & Mental Health, SickKids, 686 Bay Street, Toronto, ON M5G 0A4, Canada; Department of Psychology, University of Toronto, 100 St. George Street, Toronto, ON M5S 3G3, Canada.
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41
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Karlson CW, Sarver DE, Raiker JS, Espil FM, Cox AD, Elkin TD, Annett RD. The contribution of neurocognitive functions to academic and psychological outcomes in pediatric cancer: A latent profile analysis. Child Neuropsychol 2020; 26:881-899. [PMID: 32157961 DOI: 10.1080/09297049.2020.1734553] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
This study aimed to identify the impact of neurocognitive functioning on academic and psychological domains using a novel person-centered latent profile analysis approach. We further examined the contribution of identified risk factors (e.g., age at diagnosis, treatment) on latent class membership. 101 pediatric oncology patients and survivors (M age = 11.2, 35.6% female; 47.5% African American; M time since diagnosis = 3.4 years) completed neuropsychological evaluations at a university medical center between February 2004 and June 2017. Neurocognitive, academic, and emotional-behavioral functioning were examined using validated measures. Discreet, homogenous neurocognitive subgroups (latent classes) were identified using latent profile analysis. Demographic and medical factors were evaluated as predictors of latent class. A 3-class model indicated excellent class separation (range: .00-.04) and homogeneity (range: .94-.99). Classes were distinguished by differential cognitive patterns. Class 2 (52%) and Class 3 (25%) displayed overall normative functioning; however, Class 3 displayed significantly poorer attention than the other two classes. Class 1 (23%) demonstrated Borderline neurocognitive, low average academic, and poorer emotional-behavioral and inhibition/executive control functioning. Class membership was predicted by race and whole brain radiation dose. Latent profile analysis identified discrete groups in neurocognitive functioning in this heterogeneous pediatric cancer population. Class membership was predicted by race, whole brain radiation dose, and referral source. Other medical variables (e.g., diagnosis, age at diagnosis) were not significant predictors of neurocognitive function in our sample.
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Affiliation(s)
- Cynthia W Karlson
- Division of Hematology/Oncology, Department of Pediatrics, University of Mississippi Medical Center , Jackson, MS, USA.,Center for Advancement of Youth, Department of Pediatrics, University of Mississippi Medical Center , Jackson, MS, USA
| | - Dustin E Sarver
- Center for Advancement of Youth, Department of Pediatrics, University of Mississippi Medical Center , Jackson, MS, USA.,Department of Psychiatry and Human Behavior, University of Mississippi Medical Center , Jackson, MS, USA
| | - Joseph S Raiker
- Department of Psychology, Florida International University , Miami, FL, USA
| | - Flint M Espil
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine , Stanford, CA, USA
| | - Amanda D Cox
- Center for Advancement of Youth, Department of Pediatrics, University of Mississippi Medical Center , Jackson, MS, USA
| | - T David Elkin
- Center for Advancement of Youth, Department of Pediatrics, University of Mississippi Medical Center , Jackson, MS, USA.,Department of Psychiatry and Human Behavior, University of Mississippi Medical Center , Jackson, MS, USA
| | - Robert D Annett
- Center for Advancement of Youth, Department of Pediatrics, University of Mississippi Medical Center , Jackson, MS, USA
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Papini C, Dineen RA, Walker DA, Thomas S, Pitchford NJ. Neuropsychological outcomes of children with Optic Pathway Glioma. Sci Rep 2020; 10:3344. [PMID: 32094393 PMCID: PMC7039908 DOI: 10.1038/s41598-020-59896-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 02/03/2020] [Indexed: 11/09/2022] Open
Abstract
Optic Pathway Glioma (OPG) is a relatively common brain tumour in childhood; however, there is scarce understanding of neuropsychological sequelae in these survivors. In this study, 12 children with diagnosis of OPG before 6 years of age received a comprehensive standardised assessment of visual perception, general intelligence and academic achievement, using adjustments to visual materials of the tests, to examine the extent of concurrent impairment in these functional domains. Information about vision, clinical and socio-demographic factors were extracted from medical records to assess the associations of neuropsychological outcomes with clinical and socio-demographic factors. Children with OPG exhibited high within-patient variability and moderate group-level impairment compared to test norms. Visual perception was the most impaired domain, while scholastic progression was age-appropriate overall. For cognition, core verbal and visuo-spatial reasoning skills were intact, whereas deficits were found in working memory and processing speed. Visual function was associated with tasks that rely on visual input. Children with OPG are at moderate risk of neuropsychological impairment, especially for visual perception and cognitive proficiency. Future research should elucidate further the relative contribution of vision loss and neurofibromatosis type 1 co-diagnosis within a large sample.
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Affiliation(s)
- Chiara Papini
- School of Psychology, University of Nottingham, Nottingham, UK.,Children's Brain Tumour Research Centre, University of Nottingham, Nottingham, UK
| | - Robert A Dineen
- Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK.,Sir Peter Mansfield Imaging Centre, School of Medicine, University of Nottingham, Nottingham, UK.,NIHR Nottingham Biomedical Research Centre, Queen's Medical Centre, University of Nottingham, Nottingham, UK
| | - David A Walker
- Children's Brain Tumour Research Centre, University of Nottingham, Nottingham, UK.,Division of Child Health, Obstetrics and Gynaecology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Shery Thomas
- Ophthalmology Department, Nottingham University Hospitals, Nottingham, UK
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Roche J, Câmara-Costa H, Roulin JL, Chevignard M, Frappaz D, Guichardet K, Benkhaled O, Kerrouche B, Prodhomme J, Kieffer-Renaux V, Le Gall D, Fournet N, Roy A. Assessment of everyday executive functioning using the BRIEF in children and adolescents treated for brain tumor. Brain Inj 2020; 34:583-590. [DOI: 10.1080/02699052.2020.1725982] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Jeanne Roche
- Laboratory of Psychology Pays de la Loire, EA4638, UBL, Angers University, Angers, France
- SMAEC, Resource Centre for Children, Adolescents, Young Adults with Acquired Neurological Injury, Miribel, France
| | - Hugo Câmara-Costa
- Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, INSERM, Villejuif, France
- Laboratoire d’Imagerie Biomédicale, LIB, Sorbonne Université, Paris, France
| | - Jean-Luc Roulin
- University Grenoble Alpes, University Savoie Mont Blanc, CNRS, LPNC, Grenoble, France
| | - Mathilde Chevignard
- Laboratoire d’Imagerie Biomédicale, LIB, Sorbonne Université, Paris, France
- Rehabilitation Department for children with acquired neurological injury, and Outreach team for children and adolescents with acquired brain injury, Saint Maurice Hospitals, Saint Maurice, France
- GRC 24 HaMCRe, Handicap Moteur et Cognitif et Réadaptation, Sorbonne Université, Paris, France
| | - Didier Frappaz
- Institut d’Hématologie et d’Oncologie Pédiatrique, Lyon, France
| | - Karine Guichardet
- Medical Clinic of Paediatrics, HCE, CHU de Grenoble Alpes, Grenoble, France
| | - Ouarda Benkhaled
- Rehabilitation Department for children with acquired neurological injury, and Outreach team for children and adolescents with acquired brain injury, Saint Maurice Hospitals, Saint Maurice, France
| | - Bernadette Kerrouche
- Rehabilitation Department for children with acquired neurological injury, and Outreach team for children and adolescents with acquired brain injury, Saint Maurice Hospitals, Saint Maurice, France
| | - Julie Prodhomme
- Rehabilitation Department for children with acquired neurological injury, and Outreach team for children and adolescents with acquired brain injury, Saint Maurice Hospitals, Saint Maurice, France
| | - Virginie Kieffer-Renaux
- Rehabilitation Department for children with acquired neurological injury, and Outreach team for children and adolescents with acquired brain injury, Saint Maurice Hospitals, Saint Maurice, France
| | - Didier Le Gall
- Laboratory of Psychology Pays de la Loire, EA4638, UBL, Angers University, Angers, France
- Département de neurologie, CHU d’Angers, Université Bretagne Loire, France
| | - Nathalie Fournet
- University Grenoble Alpes, University Savoie Mont Blanc, CNRS, LPNC, Grenoble, France
| | - Arnaud Roy
- Laboratory of Psychology Pays de la Loire, EA4638, UBL, Angers University, Angers, France
- Centre Référent des Troubles d’Apprentissage, Centre de Compétence Nantais de Neurofibromatose, Hôpital Femme-Enfant-Adolescent, CHU de Nantes, Nantes, France
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Lönnerblad M, Van't Hooft I, Blomgren K, Berglund E. A nationwide, population-based study of school grades, delayed graduation, and qualification for school years 10-12, in children with brain tumors in Sweden. Pediatr Blood Cancer 2020; 67:e28014. [PMID: 31595683 DOI: 10.1002/pbc.28014] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 08/28/2019] [Accepted: 09/06/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND As many as 95.7% of children diagnosed with a brain tumor will experience persistent late effects as adults. These include difficulties with general executive functions, lower IQ, and mental fatigue, which may negatively affect school performance. METHODS Through the Swedish Childhood Cancer Registry, we identified 475 children born between 1988 and 1996, diagnosed with a brain tumor before their 15th birthday. School grades in "Swedish," "mathematics," and "English," if their graduation was delayed, and qualification for school years 10-12 were compared with 2197 matched controls. Furthermore, we checked for interaction effects between sex and age at diagnosis, and possible effects of tumor grade (high or low) as well as parents' education. RESULTS Children treated for a brain tumor performed worse in the subjects compared to controls and also had delayed graduation to a greater extent. Fewer children treated for a brain tumor than controls qualified for school years 10-12. Children treated at a young age, especially females, and children whose parents have low education seem to be at particular risk. Unexpectedly, there were no differences in outcomes between survivors with high- and low-grade tumors. CONCLUSIONS It is important that schools provide regular pedagogical assessment and individualized support to meet the different needs of children treated for a brain tumor. Children treated for low-grade tumors do not perform better than children treated for high-grade tumors, despite the lighter treatment, and hence require the same attention and support.
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Affiliation(s)
- Malin Lönnerblad
- Department of Special Education, Stockholm University, Stockholm, Sweden.,Neuropediatric Unit, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Ingrid Van't Hooft
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Klas Blomgren
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Pediatric Oncology, Karolinska University Hospital, Stockholm, Sweden
| | - Eva Berglund
- Department of Special Education, Stockholm University, Stockholm, Sweden
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Kok TB, Koerts J, Lemiere J, Post WJ, de Bont ESJM, Gidding C, Happé F, Jacobs S, Oostrom K, Schieving J, Tucha O, Kingma A. Social competence in newly diagnosed pediatric brain tumor patients. Pediatr Hematol Oncol 2020; 37:41-57. [PMID: 31682775 DOI: 10.1080/08880018.2019.1682089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Brain tumors (BTs) are a common pediatric malignancy. Improved treatment has resulted in higher survival rates. There is, however, increasing concern about adverse effects of the disease and its treatment, including effects on social competence (i.e. effective social functioning in everyday life). The aim of this study is to examine multiple levels of social competence (i.e. social skills and social adjustment) in newly diagnosed pediatric BT patients. Thirty newly diagnosed BT patients aged 5-12 years were assessed shortly after diagnosis with a neuropsychological test battery focusing on social competence, including tests for IQ, social skills (i.e. social-affective and executive functioning) and social adjustment (rated by parents and teachers). Their performance was compared to 95 healthy controls who completed the same assessment. Patients and healthy controls were largely comparable with regard to demographic and environmental factors and did not differ on measures of IQ, social skills and social adjustment. Furthermore, age was found to have a positive significant effect on social skills independent of group. Shortly after diagnosis, pediatric BT patients did not perform different from healthy controls on IQ and measures of social skills and social adjustment. This is an encouraging finding. However, because of potentially neurotoxic adjuvant therapy and the ongoing development of social skills, longitudinal follow-up studies are needed to investigate long-term outcome regarding social competence in BT survivors.
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Affiliation(s)
- Tessa B Kok
- Department of Pediatric Oncology/Hematology, University of Groningen, Groningen, The Netherlands.,Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, The Netherlands
| | - Janneke Koerts
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, The Netherlands
| | - Jurgen Lemiere
- Department of Pediatric Oncology/Hematology, University Hospitals Leuven, Leuven, Belgium.,Department of Oncology, KU Leuven, Leuven, Belgium
| | - Wendy J Post
- Department of Orthopedagogy, University of Groningen, Groningen, The Netherlands
| | - Eveline S J M de Bont
- Department of Pediatric Oncology/Hematology, University of Groningen, Groningen, The Netherlands
| | - Corrie Gidding
- Department of Pediatric Oncology/Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Franscesca Happé
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Sandra Jacobs
- Department of Pediatric Oncology/Hematology, University Hospitals Leuven, Leuven, Belgium.,Department of Oncology, KU Leuven, Leuven, Belgium
| | - Kim Oostrom
- Department of Psychology, Vrije Universiteit Medical Center, Amsterdam, The Netherlands
| | - Jolanda Schieving
- Department of Neurology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Oliver Tucha
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, The Netherlands
| | - Annette Kingma
- Department of Pediatric Oncology/Hematology, University of Groningen, Groningen, The Netherlands
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Schepke E, Tisell M, Kennedy C, Puget S, Ferroli P, Chevignard M, Doz F, Pizer B, Rutkowski S, Massimino M, Navajas A, Schwalbe E, Hicks D, Clifford SC, Pietsch T, Lannering B. Effects of the growth pattern of medulloblastoma on short-term neurological impairments after surgery: results from the prospective multicenter HIT-SIOP PNET 4 study. J Neurosurg Pediatr 2020; 25:425-433. [PMID: 31952041 DOI: 10.3171/2019.11.peds19349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 11/01/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Extensive resection of a tumor in the posterior fossa in children is associated with the risk of neurological deficits. The objective of this study was to prospectively evaluate the short-term neurological morbidity in children after medulloblastoma surgery and relate this to the tumor's growth pattern and to the extent of resection. METHODS In 160 patients taking part in the HIT-SIOP PNET 4 (Hyperfractionated Versus Conventionally Fractionated Radiotherapy in Standard Risk Medulloblastoma) trial, neurosurgeons prospectively responded to questions concerning the growth pattern of the tumor they had resected. The extent of resection (gross, near, or subtotal) was evaluated using MRI. The patients' neurological status before resection and around 30 days after resection was recorded. RESULTS Invasive tumor growth, defined as local invasion in the brain or meninges, cranial nerve, or major vessel, was reported in 58% of the patients. After surgery almost 70% of all patients were affected by one or several neurological impairments (e.g., impaired vision, impaired extraocular movements, and ataxia). However, this figure was very similar to the preoperative findings. Invasive tumor growth implied a significantly higher number of impairments after surgery (p = 0.03) and greater deterioration regarding extraocular movements (p = 0.012), facial weakness (p = 0.048), and ataxia in the arms (p = 0.014) and trunk (p = 0.025) compared with noninvasive tumor growth. This deterioration was not dependent on the extent of resection performed. Progression-free survival (PFS) at 5 years was 80% ± 4% and 76% ± 5% for patients with invasive and noninvasive tumor growth, respectively, with no difference in the 5-year PFS for extent of resection. CONCLUSIONS Preoperative neurological impairments and invasive tumor growth were strong predictors of deterioration in short-term neurological outcome after medulloblastoma neurosurgery, whereas the extent of resection was not. Neither tumor invasiveness nor extent of resection influenced PFS. These findings support the continuation of maximal safe resection in medulloblastoma surgery where functional risks are not taken in areas with tumor invasion.
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Affiliation(s)
- Elizabeth Schepke
- 1Sahlgrenska Cancer Center, Department of Laboratory Medicine, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg
- 2Department of Pediatrics, Sahlgrenska University Hospital, Gothenburg
| | - Magnus Tisell
- 3Department of Neurosurgery, Sahlgrenska University Hospital and
- 4Institute of Neuroscience and Physiology, Department of Neuroscience, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Colin Kennedy
- 5University of Southampton Faculty of Medicine and University Hospital Southampton National Health Service Foundation Trust, Southampton, United Kingdom
| | - Stephanie Puget
- 6Département de Neurochirurgie Pédiatrique, Hôpital Necker-Enfants Malades, Université, Paris, France
| | - Paolo Ferroli
- 7Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Mathilde Chevignard
- 8Rehabilitation Department for Children with Acquired Neurological Injury, Saint Maurice Hospitals, Saint Maurice
- 9Laboratoire d'Imagerie Biomédicale and
- 10GRC 24 HaMCRe, Sorbonne Université, Paris
| | - François Doz
- 11SIREDO Cancer Center (Care, Innovation & Research, in Childhood, Adolescent and Young-Adult Oncology), Institut Curie Paris
- 12Department of Pediatrics, University Paris Descartes, Paris, France
| | - Barry Pizer
- 13Department of Oncology, Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom
| | - Stefan Rutkowski
- 14Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Maura Massimino
- 15Fondazione Istituto di Ricovero e Cura a Carattere Scientifico IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Edward Schwalbe
- 17Wolfson Childhood Cancer Research Centre, Northern Institute for Cancer Research, Newcastle University, Newcastle-upon-Tyne
- 18Department of Applied Sciences, Northumbria University, Newcastle-upon-Tyne, United Kingdom
| | - Debbie Hicks
- 17Wolfson Childhood Cancer Research Centre, Northern Institute for Cancer Research, Newcastle University, Newcastle-upon-Tyne
| | - Steven C Clifford
- 17Wolfson Childhood Cancer Research Centre, Northern Institute for Cancer Research, Newcastle University, Newcastle-upon-Tyne
| | - Torsten Pietsch
- 19Institute of Neuropathology, DGNN Brain Tumour Reference Center, University of Bonn, Germany; and
| | - Birgitta Lannering
- 20Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Germany
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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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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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Abstract
PURPOSE OF REVIEW Adverse late effects of pediatric brain tumors can be numerous and complex and potentially alter the life trajectories of survivors in a multitude of ways. We review these inter-related late effects that compromise neurocognitive function, general health, social and psychological adjustment, and overall adaptive and vocational outcomes, and threaten to undermine the ability of survivors to transition independently into adulthood and effectively manage their care. Intervention/prevention strategies and advances in treatment that may reduce such late effects are discussed. RECENT FINDINGS Studies of neuropsychological late effects have revealed specific deficits in core cognitive functions of attention, working memory and processing speed, with many survivors demonstrating decline in working memory and processing speed over time, irrespective of tumor type or treatment. This in turn affects the ongoing development of higher order neurocognitive skills. Research also highlights the increasing burden of health-related, neuropsychological and psychosocial late effects into adulthood and impact across life outcomes. SUMMARY Pediatric brain tumor survivors require coordinated interdisciplinary care, ongoing evaluation and management of late effects, and timely interventions focused on mitigating the impact of late effects. The transition to adulthood can be especially vulnerable and addressing barriers to care is of paramount importance.
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Affiliation(s)
- Celiane Rey-Casserly
- Department of Psychiatry, Boston Children's Hospital
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Tanya Diver
- Department of Psychiatry, Boston Children's Hospital
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
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50
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Semmel ES, Fox ME, Na SD, Kautiainen R, Latzman RD, King TZ. Caregiver- and Clinician-Reported Adaptive Functioning in Rett Syndrome: a Systematic Review and Evaluation of Measurement Strategies. Neuropsychol Rev 2019; 29:465-483. [PMID: 31748842 DOI: 10.1007/s11065-019-09420-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 11/06/2019] [Indexed: 01/03/2023]
Abstract
Rett syndrome is the second most common cause of intellectual disability in females worldwide. The severity of many individuals' impairment limits the effectiveness of traditional assessment. However, clinician and parent reports of adaptive functioning may provide insight into these patients' abilities. This review aims to synthesize the current literature assessing adaptive functioning in Rett syndrome and evaluate existing measurement tools in this population. A search was conducted on PubMed using the search term "Rett syndrome." Studies that quantitatively assessed adaptive functioning outcomes in Rett syndrome with published and normed questionnaire measures were included. Twenty-three studies met inclusion criteria. Overall results indicate that the population of people with Rett syndrome is highly impaired, both in overall adaptive functioning as well as in specific subdomains (e.g., mobility, activities of daily living). Atypical Rett syndrome groups performed better on measures of adaptive functioning relative to patients with classic Rett syndrome. Our findings identified measurement weaknesses, as many of the studies found floor effects and therefore were unable to capture meaningful variability in outcomes. Individuals with Rett syndrome are highly reliant on caregivers due to disrupted adaptive functioning abilities. Optimizing measurement of adaptive skills in Rett syndrome will facilitate the quantification of meaningful change in skills and the identification of efficacious interventions aimed at improving outcomes and quality of life.
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Affiliation(s)
- Eric S Semmel
- Department of Psychology and Neuroscience Institute, Georgia State University, P.O. Box 5010, Atlanta, GA, 30302-5010, USA
| | - Michelle E Fox
- Department of Psychology and Neuroscience Institute, Georgia State University, P.O. Box 5010, Atlanta, GA, 30302-5010, USA
| | - Sabrina D Na
- Department of Psychology and Neuroscience Institute, Georgia State University, P.O. Box 5010, Atlanta, GA, 30302-5010, USA
| | - Rella Kautiainen
- Department of Psychology and Neuroscience Institute, Georgia State University, P.O. Box 5010, Atlanta, GA, 30302-5010, USA
| | - Robert D Latzman
- Department of Psychology and Neuroscience Institute, Georgia State University, P.O. Box 5010, Atlanta, GA, 30302-5010, USA
| | - Tricia Z King
- Department of Psychology and Neuroscience Institute, Georgia State University, P.O. Box 5010, Atlanta, GA, 30302-5010, USA.
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