Visual Attention and Math Performance in Survivors of Childhood Acute Lymphoblastic Leukemia

Association of markers of inflammation on attention and neurobehavioral outcomes in survivors of childhood acute lymphoblastic leukemia

Background

Survivors of childhood acute lymphoblastic leukemia (ALL) are at-risk of developing cognitive impairment and neurobehavioral symptoms. Inflammation induced by a compromised health status during cancer survivorship is proposed as a pathophysiological mechanism underlying cognitive impairment in cancer survivors.

Objectives

To evaluate the associations of biomarkers of inflammation with attention and neurobehavioral outcomes in survivors of childhood ALL, and to identify clinical factors associated with biomarkers of inflammation in this cohort.

Methods

We recruited patients who were diagnosed with ALL at ≤ 18 years old and were currently ≥5 years post-cancer diagnosis. The study outcomes were attention (Conners Continuous Performance Test) and self-reported behavioral symptoms (Adult Self-Report [ASR] checklist). Using a commercial screening kit, survivors' plasma (5ml) was assayed for 17 cytokines/chemokine cell-signaling molecules that are associated with neurodegenerative diseases. The final panel of the targeted markers included interleukin (IL)-8, IL-13, interferon-gamma (IFN-γ), monocyte chemoattractant protein-1 (MCP-1), macrophage inflammatory protein-1β, and tumor necrosis factor-α. Biomarker levels were rank-ordered into tertiles based on the sample distribution. Multivariable general linear modeling was used to test for associations between biomarkers and study outcomes in the overall cohort and stratified by gender.

Results

This study included 102 survivors (55.9% males, mean[SD] age 26.2[5.9] years; 19.3[7.1] years post-diagnosis). Survivors within top tertiles of IFN-γ (Estimate =6.74, SE=2.26; P=0.0037) and IL-13 (Estimate =5.10, SE=2.27; P=0.027) demonstrated more inattentiveness. Adjusting for age, gender and treatment, more self-reported thought (Estimate=3.53, SE=1.78; P=0.050) and internalizing problems (Estimate =6.52, SE=2.91; P=0.027) correlated with higher IL-8. Higher levels of IL-13 (RR = 4.58, 95% CI: 1.01-11.10) and TNF-α (RR = 1.44, 95% CI: 1.03-4.07) were observed in survivors had developed chronic health conditions (n=26, 25.5%). The stratified analysis showed that association of IFN-γ with attention was stronger in male survivors than in female survivors.

Conclusion

Inflammation due to cancer-related late effects may potentially be mechanistic mediators of neurobehavioral problems in pediatric ALL survivors. Markers of inflammation can potentially be applied to assess or monitor the effectiveness of interventions, particularly behavioral interventions, in improving cognitive outcomes in survivors. Future work includes understanding the underlying gender-specific pathophysiology behind functional outcomes in the population.

Working Memory and Processing Speed Predict Math Skills in Pediatric Brain Tumor Survivors

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.

Patterns of Attention and Anxiety in Predicting Arithmetic Fluency among School-Aged Children

Although the interaction between anxiety and attention is considered crucial for learning and performance in mathematics, few studies have examined these cognitive and affective predictors in a single framework or explored the role of sustained attention in promoting children’s arithmetic performance, using traditional linear analyses and latent profile analysis (LPA). In this paper, state anxieties (in a math test and in an attention test situation), general anxiety traits, sustained attention (performance-based test and attention deficit/hyperactivity disorder (ADHD) self-ratings) and math achievement of 403 fourth and fifth graders (55.8% girls) were assessed. A negative correlation between state anxiety prior to the math test and arithmetic achievements was identified, even when controlling for other non-math related state anxieties and general anxiety. Sustained attention was a strong predictor of arithmetic achievement and functioned as a moderator in the anxiety-performance link. LPA identified six distinct profiles that revealed a complex relationship with arithmetic fluency. The weakest achievement was found for a specific math anxiety subgroup. The findings highlight the important role of the interaction of anxiety and sustained attention in children’s ability to perform math and enable new conclusions about the specific nature of math anxiety. Implications for future research are discussed.

Cognitive Correlates of Math Performance in School-Aged Children with Sickle Cell Disease and Silent Cerebral Infarcts

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.

Psychometric evaluation of the pediatric applied cognition scale in pediatric hematology/oncology

Pediatric patients with hematology and oncology conditions often experience disease- and treatment-related neurocognitive deficits. Well-validated screening tools are critical for identifying patients experiencing cognitive impairments. The Pediatric Applied Cognition scale (PAC) Short Form, developed by the National Institutes of Health, assesses attention and memory concerns. The current study is the first to examine the psychometrics of the PAC in pediatric patients with hematology/oncology conditions. Pediatric patients (n = 222) and caregivers completed the PAC and self-report measures of psychosocial and academic functioning. Results revealed strong internal consistency for the Child (α = 0.81-0.89) and Parent (α = 0.92-0.95) PAC. More cognitive concerns on the Child/Parent PAC were associated with greater psychosocial concerns (e.g. anxiety, depression, and fatigue) and lower reported school grades. The Parent PAC incrementally predicted child reported symptoms of depression, mobility concerns, and school grades beyond the Child PAC. Overall, the PAC Short Form may be useful as an indicator of general academic and psychosocial concerns. Further research validating the PAC in relation to performance-based neurocognitive outcomes and academic achievement is needed in children treated for hematology/oncology conditions.