1
|
Hagan AJ, Verity SJ. The influence of methylphenidate on sustained attention in paediatric acquired brain injury: a meta-analytical review. Child Neuropsychol 2022:1-32. [PMID: 36000579 DOI: 10.1080/09297049.2022.2112559] [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: 10/15/2022]
Abstract
Impairment in sustained attention is a common consequence of childhood Acquired Brain Injury (ABI). Whilst methylphenidate provides promise in enhancing "attention" as a unitary construct, little work has explored its effectiveness upon individual attentional domains. The current systematic review and meta-analysis evaluates the utility of methylphenidate on sustained attentional performance across childhood ABI groups. Five databases (PsycINFO, MEDLINE, Embase, Scopus & Cochrane Library) were searched for relevant articles from their inception to March 2022. A purpose-developed evaluation tool was used to assess each study's research quality (QuEST:MAP). Nine of the 1600 identified articles were included within this review (n = 259). Meta-analytical findings reported an overall significant benefit of methylphenidate on sustained attention in childhood ABI (g = -0.33, 95% CI: -0.62 to -0.04). Associated summary effect sizes were relatively small, particularly when adjusting for outlier cases. Subgroup analyses identified a significantly greater benefit of methylphenidate in clinical subgroups with comorbid ADHD diagnoses (p < .01). The current evidence base is characterized by small-scale clinical trials with variable research quality and low generalizability. Further robust research is needed to quantify methylphenidate utility upon individual attentional domains in larger and more representative ABI samples.
Collapse
Affiliation(s)
- Alexander J Hagan
- Department of Paediatric Health Psychology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle-Upon-Tyne, UK
| | - Sarah J Verity
- Department of Paediatric Health Psychology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle-Upon-Tyne, UK.,Newcastle University Centre for Cancer, Newcastle University, Newcastle Upon Tyne, UK
| |
Collapse
|
2
|
Hardy SJ, Forman S, Hardy KK, Schatz J. Sluggish Cognitive Tempo in Pediatric Sickle Cell Disease. Front Neurol 2022; 13:867437. [PMID: 35873765 PMCID: PMC9301245 DOI: 10.3389/fneur.2022.867437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 06/13/2022] [Indexed: 11/21/2022] Open
Abstract
Background Sickle cell disease (SCD) imparts risk for a range of neurodevelopmental and neurocognitive disorders. Sluggish cognitive tempo (SCT) is a distinct syndrome that often co-occurs with attention-deficit/hyperactivity disorder (ADHD) but has not been described in SCD. We investigated the reliability and validity of a SCT measure in SCD and examined associations with biopsychosocial risk factors and functional outcomes. Materials and Methods Caregivers (n = 85) of children with SCD ages 7-16 reported on socio-demographics and the Kiddie-Sluggish Cognitive Tempo (K-SCT) measure, Behavior Rating Inventory of Executive Function, and Conners 3. Disease-related characteristics were extracted from health records. Results The K-SCT demonstrated excellent internal consistency (α = 0.92) and test-retest reliability (r = 0.82, p < 0.001). K-SCT scores were correlated with ADHD-Inattention (r = 0.64, p < 0.001) and ADHD-Hyperactive/Impulsive (r = 0.46, p < 0.001) scores, as well as functional outcomes, including learning problems (r = 0.69, p < 0.001). In multivariate analyses controlling for ADHD symptoms, SCT accounted for unique variance in learning (b = 9.67, p < 0.01) and executive functioning (b = 5.93, p < 0.01). Nearly all participants (93%) with elevated levels of co-occurring SCT and ADHD-Inattention symptoms had significant learning problems. Conclusion The K-SCT is a reliable and valid measure of SCT in SCD. SCT symptoms are associated with learning difficulties even after controlling for ADHD symptoms. Further research is needed to understand the biopsychosocial factors that lead to SCT symptoms in SCD and examine long-term implications of SCT.
Collapse
Affiliation(s)
- Steven J. Hardy
- Divisions of Hematology and Oncology, Children's National Hospital, Washington, DC, United States
- Department of Psychiatry and Behavioral Sciences, The George Washington University School of Medicine and Health Sciences, Washington, DC, United States
- *Correspondence: Steven J. Hardy
| | - Sydney Forman
- Divisions of Hematology and Oncology, Children's National Hospital, Washington, DC, United States
| | - Kristina K. Hardy
- Department of Psychiatry and Behavioral Sciences, The George Washington University School of Medicine and Health Sciences, Washington, DC, United States
- Division of Neuropsychology, Children's National Hospital, Washington, DC, United States
| | - Jeffrey Schatz
- Department of Psychology, University of South Carolina, Columbia, SC, United States
| |
Collapse
|
3
|
Hood AM, Crosby LE, Stotesbury H, Kölbel M, Kirkham FJ. Considerations for Selecting Cognitive Endpoints and Psychological Patient-Reported Outcomes for Clinical Trials in Pediatric Patients With Sickle Cell Disease. Front Neurol 2022; 13:835823. [PMID: 35800079 PMCID: PMC9253275 DOI: 10.3389/fneur.2022.835823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 05/20/2022] [Indexed: 12/04/2022] Open
Abstract
Pediatric patients with sickle cell disease (SCD) experience a range of medical complications that result in significant morbidity and mortality. Recent advances in prophylactic and curative treatment approaches have highlighted the need for sensitive and clinically-meaningful trial endpoints. The detrimental effects of cognitive and psychological difficulties on social and economic mobility are well described. Although numerous reviews have assessed cognitive outcomes in other rare genetic disorders, SCD has not received the same focus. This review describes the cognitive (i.e., executive function and processing speed) and psychological domains (i.e., depression and anxiety) that are consistently associated with SCD pathology and, therefore, may be of particular interest as clinical trial endpoints. We then discuss corresponding well-validated and reliable cognitive tests and patient-reported outcomes (PROs) that may be appropriate for clinical trials given their robust psychometric properties, ease of administration, and previous use in the SCD population. Further, we provide a discussion of potential pitfalls and considerations to guide endpoint selection. In line with the move toward patient-centered medicine, we identify specific tests (e.g., NIH Toolbox Cognition Module, Wechsler Cancellation Test) and psychological PROs (e.g., PROMIS depression and anxiety scales) that are sensitive to SCD morbidity and have the potential to capture changes that are clinically meaningful in the context of patients' day to day lives. In particularly vulnerable cognitive domains, such as executive function, we highlight the advantages of composite over single-test scores within the context of trials. We also identify general (i.e., practice effects, disease heterogeneity) and SCD-specific considerations (i.e., genotype, treatment course, and disease course, including degree of neurologic, pain, and sleep morbidity) for trial measures. Executive function composites hold particular promise as trial endpoints that are clinically meaningful, amenable to change, relatively easy to collect, and can be incorporated into the routine care of patients with SCD in various settings and countries.
Collapse
Affiliation(s)
- Anna M. Hood
- Division of Psychology and Mental Health, Manchester Centre for Health Psychology, University of Manchester, Manchester, United Kingdom
| | - Lori E. Crosby
- Division of Behavioral Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Hanne Stotesbury
- Developmental Neurosciences Unit and Biomedical Research Centre, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Melanie Kölbel
- Developmental Neurosciences Unit and Biomedical Research Centre, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Fenella J. Kirkham
- Developmental Neurosciences Unit and Biomedical Research Centre, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| |
Collapse
|
4
|
Longoria JN, Heitzer AM, Hankins JS, Trpchevska A, Porter JS. Neurocognitive risk in sickle cell disease: Utilizing neuropsychology services to manage cognitive symptoms and functional limitations. Br J Haematol 2022; 197:260-270. [PMID: 35118643 DOI: 10.1111/bjh.18041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 12/10/2021] [Accepted: 12/31/2021] [Indexed: 11/28/2022]
Abstract
Sickle cell disease (SCD) is an inherited blood disorder that is associated with developmental delays and neurocognitive deficits. This review details key findings related to neurocognitive outcomes for children and adults with emphasis on the impact of neurological correlates and disease severity. Associations between neurocognition, demographic factors and social determinants of health are also reviewed. Emerging literature has reported on the neurocognitive impact of SCD in children and adolescents in Africa and Europe, including children from immigrant communities. Neurocognitive deficits are linked to poor functional outcomes, including transition from paediatric to adult care, medication adherence and unemployment. Integrating neuropsychology into multidisciplinary care for individuals with SCD can assist with identification and management of neurocognitive concerns, intervention development, individualized care plan development and continued multidisciplinary research.
Collapse
Affiliation(s)
- Jennifer N Longoria
- Department of Psychology, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Andrew M Heitzer
- Department of Psychology, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Jane S Hankins
- Department of Hematology, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Ana Trpchevska
- Department of Psychology, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Jerlym S Porter
- Department of Psychology, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| |
Collapse
|
5
|
Hood AM, Stotesbury H, Kölbel M, DeHaan M, Downes M, Kawadler JM, Sahota S, Dimitriou D, Inusa B, Wilkey O, Pelidis M, Trompeter S, Leigh A, Younis J, Drasar E, Chakravorty S, Rees DC, Height S, Lawson S, Gavlak J, Gupta A, Ridout D, Clark CA, Kirkham FJ. Study of montelukast in children with sickle cell disease (SMILES): a study protocol for a randomised controlled trial. Trials 2021; 22:690. [PMID: 34629091 PMCID: PMC8502503 DOI: 10.1186/s13063-021-05626-6] [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: 03/07/2021] [Accepted: 09/14/2021] [Indexed: 01/20/2023] Open
Abstract
Background Young children with sickle cell anaemia (SCA) often have slowed processing speed associated with reduced brain white matter integrity, low oxygen saturation, and sleep-disordered breathing (SDB), related in part to enlarged adenoids and tonsils. Common treatments for SDB include adenotonsillectomy and nocturnal continuous positive airway pressure (CPAP), but adenotonsillectomy is an invasive surgical procedure, and CPAP is rarely well-tolerated. Further, there is no current consensus on the ability of these treatments to improve cognitive function. Several double-blind, randomised controlled trials (RCTs) have demonstrated the efficacy of montelukast, a safe, well-tolerated anti-inflammatory agent, as a treatment for airway obstruction and reducing adenoid size for children who do not have SCA. However, we do not yet know whether montelukast reduces adenoid size and improves cognition function in young children with SCA. Methods The Study of Montelukast In Children with Sickle Cell Disease (SMILES) is a 12-week multicentre, double-blind, RCT. SMILES aims to recruit 200 paediatric patients with SCA and SDB aged 3–7.99 years to assess the extent to which montelukast can improve cognitive function (i.e. processing speed) and sleep and reduce adenoidal size and white matter damage compared to placebo. Patients will be randomised to either montelukast or placebo for 12 weeks. The primary objective of the SMILES trial is to assess the effect of montelukast on processing speed in young children with SCA. At baseline and post-treatment, we will administer a cognitive evaluation; caregivers will complete questionnaires (e.g. sleep, pain) and measures of demographics. Laboratory values will be obtained from medical records collected as part of standard care. If a family agrees, patients will undergo brain MRIs for adenoid size and other structural and haemodynamic quantitative measures at baseline and post-treatment, and we will obtain overnight oximetry. Discussion Findings from this study will increase our understanding of whether montelukast is an effective treatment for young children with SCA. Using cognitive testing and MRI, the SMILES trial hopes to gain critical knowledge to help develop targeted interventions to improve the outcomes of young children with SCA. Trial registration ClinicalTrials.govNCT04351698. Registered on April 17, 2020. European Clinical Trials Database (EudraCT No. 2017-004539-36). Registered on May 19, 2020
Collapse
Affiliation(s)
- Anna M Hood
- Developmental Neurosciences Unit and Biomedical Research Centre, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK.
| | - Hanne Stotesbury
- Developmental Neurosciences Unit and Biomedical Research Centre, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Melanie Kölbel
- Developmental Neurosciences Unit and Biomedical Research Centre, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Michelle DeHaan
- Developmental Neurosciences Unit and Biomedical Research Centre, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Michelle Downes
- School of Psychology, University College Dublin, Dublin, Ireland
| | - Jamie M Kawadler
- Developmental Neurosciences Unit and Biomedical Research Centre, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Satwinder Sahota
- Developmental Neurosciences Unit and Biomedical Research Centre, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Dagmara Dimitriou
- Department of Psychology and Human Development, UCL Institute of Education, London, UK
| | - Baba Inusa
- Children's Sickle Cell and Thalassaemia Centre, Evelina London Children's Hospital, Guy's and St Thomas' NHS Trust, London, UK
| | - Olu Wilkey
- North Middlesex Hospital National Health Service Trust, London, UK
| | - Maria Pelidis
- Department of Paediatric Haematology, Evelina London Children's Hospital, Guy's and St Thomas' NHS Trust, London, UK
| | - Sara Trompeter
- University College London Hospitals NHS Foundation Trust, London, UK.,NHS Blood and Transplant, London, UK
| | - Andrea Leigh
- University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Emma Drasar
- Whittington Health NHS Trust, London, UK.,Department of Clinical Haematology, University College London Hospitals NHS Foundation Trust, London, UK
| | | | - David C Rees
- Department of Haematological Medicine, King's College Hospital NHS Trust, London, UK
| | - Sue Height
- Paediatric Haematology, King's College Hospital NHS Trust, London, UK
| | - Sarah Lawson
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Johanna Gavlak
- Department of Child Health, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Atul Gupta
- Department of Paediatric Respiratory Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - Deborah Ridout
- Population, Policy and Practice Programme, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Christopher A Clark
- Developmental Neurosciences Unit and Biomedical Research Centre, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Fenella J Kirkham
- Developmental Neurosciences Unit and Biomedical Research Centre, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK.,Department of Clinical Haematology, University College London Hospitals NHS Foundation Trust, London, UK.,Department of Child Health, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,Clinical and Experimental Sciences, University of Southampton, Southampton, UK
| |
Collapse
|
6
|
Hood AM, Kölbel M, Stotesbury H, Kawadler J, Slee A, Inusa B, Pelidis M, Howard J, Chakravorty S, Height S, Awogbade M, Kirkham FJ, Liossi C. Biopsychosocial Predictors of Quality of Life in Paediatric Patients With Sickle Cell Disease. Front Psychol 2021; 12:681137. [PMID: 34594262 PMCID: PMC8476744 DOI: 10.3389/fpsyg.2021.681137] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 08/18/2021] [Indexed: 11/13/2022] Open
Abstract
Sickle cell disease (SCD) refers to a group of inherited blood disorders with considerable morbidity that causes severe pain, reduces life expectancy, and requires significant self-management. Acute painful episodes are the hallmark of SCD, but persistent daily pain is also highly prevalent in this population. Characterising the impact and experience of SCD-related morbidity (i.e., sleep disruption, frequent emergency department visits, cognitive dysfunction) on health-related quality of life (HRQOL) requires multiple assessment methods to best capture the underlying mechanisms. To gain a greater understanding of the effect of common symptom categories on HRQOL and to determine potential pain coping targets, the present study investigated whether demographic, socioeconomic, sleepiness, pain burden, frequency of emergency department (ED) visits, and cognition predicted HRQOL in a paediatric sample of patients with SCD. Our study was a secondary analysis of baseline assessment data of children with SCD aged 8-15 years (n = 30) in the Prevention of Morbidity in Sickle Cell Anaemia Phase 2b (POMSb2) randomised controlled clinical trial of auto-adjusting continuous positive airways pressure. Patients completed cognitive testing (IQ, Processing Speed Index, Delis-Kaplan Executive Function Scale (DKEFS) Tower, Conner's Continuous Performance Test), sleepiness (Epworth Sleepiness Scale), and HRQOL (PedsQL Sickle Cell Module) at baseline. Patients reported pain burden (Sickle Cell Pain Burden Inventory-Youth) each month over 8 visits. Caregivers provided demographic information and reported their child's executive function (Behavioural Rating Inventory of Executive Function) at baseline. Data from our analysis demonstrated that demographic factors (i.e., age, gender, level of neighbourhood deprivation) and treatment variables (i.e., hydroxyurea use) did not independently predict HRQOL, and laboratory values (i.e., haemoglobin, haematocrit, mean oxygen saturation) were not significantly correlated with HRQOL (ps > 0.05). However, sleepiness, pain burden, ED visits, and executive dysfunction independently predicted HRQOL (R 2 = 0.66) with large effects (η2 = 0.16 to 0.32). These findings identify specific, measurable symptom categories that may serve as targets to improve HRQOL that are responsive to change. This knowledge will be useful for multimodal interventions for paediatric patients with SCD that include sleep management, pain coping strategies, and executive function training.
Collapse
Affiliation(s)
- Anna M Hood
- Developmental Neurosciences Unit and Biomedical Research Centre, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Melanie Kölbel
- Developmental Neurosciences Unit and Biomedical Research Centre, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Hanne Stotesbury
- Developmental Neurosciences Unit and Biomedical Research Centre, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Jamie Kawadler
- Developmental Neurosciences Unit and Biomedical Research Centre, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - April Slee
- Department of Primary Care and Population Health, University College London, London, United Kingdom
| | - Baba Inusa
- Department of Paediatric Haematology, Evelina London Children's Hospital, Guy's and St Thomas' NHS Trust, London, United Kingdom
| | - Maria Pelidis
- Department of Paediatric Haematology, Evelina London Children's Hospital, Guy's and St Thomas' NHS Trust, London, United Kingdom
| | - Jo Howard
- Department of Haematological Medicine, King's College London, London, United Kingdom.,Department of Haematology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Subarna Chakravorty
- Paediatric Haematology, King's College Hospital NHS Trust, London, United Kingdom
| | - Sue Height
- Paediatric Haematology, King's College Hospital NHS Trust, London, United Kingdom
| | - Moji Awogbade
- Department of Haematological Medicine, King's College Hospital NHS Trust, London, United Kingdom
| | - Fenella J Kirkham
- Developmental Neurosciences Unit and Biomedical Research Centre, University College London Great Ormond Street Institute of Child Health, London, United Kingdom.,Department of Clinical Haematology, University College London Hospitals NHS Foundation Trust, London, United Kingdom.,Department of Child Health, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.,Clinical and Experimental Sciences, University of Southampton, Southampton, United Kingdom
| | - Christina Liossi
- Department of Psychology, University of Southampton, Southampton, United Kingdom.,Paediatric Psychology, Great Ormond Hospital for Children NHS Foundation Trust, London, United Kingdom
| |
Collapse
|
7
|
Lance EI, Cannon AD, Shapiro BK, Lee LC, Johnston MV, Casella JF. Co-Occurrence of Neurodevelopmental Disorders in Pediatric Sickle Cell Disease. J Dev Behav Pediatr 2021; 42:463-471. [PMID: 34397573 PMCID: PMC8369039 DOI: 10.1097/dbp.0000000000000914] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 12/01/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The objective of this study is to retrospectively determine the co-occurrence, associated characteristics, and risk factors for neurodevelopmental disorders (NDD) in a pediatric sickle cell disease (SCD) clinic population. METHOD We investigated the co-occurrence and features of NDD in pediatric SCD through a retrospective cohort study conducted between July 2017 and January 2019. The participants were patients with SCD younger than 18 years of age identified from our institutions' clinic rosters and medical records databases. RESULTS A total of 276 participants were eligible for study inclusion, and 65 participants were found to have various NDD. Children with SCD and NDD were more likely to have a history of multiple SCD-related complications in comparison to children with SCD without NDD. Children with SCD and NDD were more likely to use disease-modifying therapies in comparison to children with SCD without NDD (χ2 27.2, p < 0.001). CONCLUSION Children with SCD and NDD have higher odds of having certain disease-related complications and higher use of disease-modifying treatments than children with SCD who do not have NDD. Screening and diagnoses of NDD may be relevant to clinical management of pediatric SCD.
Collapse
Affiliation(s)
- Eboni I. Lance
- Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, MD
- Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Bruce K. Shapiro
- Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, MD
- Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Li-Ching Lee
- Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Michael V. Johnston
- Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, MD
- Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - James F. Casella
- Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
| |
Collapse
|
8
|
Coris EE, Moran B, Sneed K, Del Rossi G, Bindas B, Mehta S, Narducci D. Stimulant Therapy Utilization for Neurocognitive Deficits in Mild Traumatic Brain Injury. Sports Health 2021; 14:538-548. [PMID: 34292098 DOI: 10.1177/19417381211031842] [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: 11/16/2022] Open
Abstract
CONTEXT There are 3.8 million mild traumatic brain injuries (mTBIs) that occur each year in the United States. Many are left with prolonged life-altering neurocognitive deficits, including difficulties in attention, concentration, mental fatigue, and distractibility. With extensive data on the safety and efficacy of stimulant medications in treating attention deficit, concentration difficulties and distractibility seen with attention deficit disorder, it is not surprising that interest continues regarding the application of stimulant medications for the persistent neurocognitive deficits in some mTBIs. EVIDENCE ACQUISITION Studies were extracted from PubMed based on the topics of neurocognitive impairment, mTBI, stimulant use in mTBI, stimulants, and the association between attention deficit/hyperactivity disorder and mTBI. The search criteria included a date range of 1999 to 2020 in the English language. STUDY DESIGN Literature review. LEVEL OF EVIDENCE Level 4. RESULTS Currently, there is very limited literature, and no guidelines for evaluating the use of stimulant medication for the treatment of prolonged neurocognitive impairments due to mTBI. However, a limited number of studies have demonstrated efficacy and safety of stimulants in the treatment of neurocognitive sequelae of mTBI in the adult, pediatric, military, and athletic populations. CONCLUSION There is limited evidence to suggest stimulant medication may be beneficial in patients with mTBI with persistent neurocognitive symtpoms. The decision to utilize stimulant medication for mTBI patients remains physician and patient preference dependent. Given the limited encouraging data currently available, physicians may consider stimulant medication in appropriate patients to facilitate the recovery of prolonged neurocognitive deficits, while remaining cognizant of potential adverse effects.
Collapse
Affiliation(s)
- Eric E Coris
- USF Morsani College of Medicine, Department of Family Medicine, Tampa, Florida.,USF Morsani College of Medicine, Department of Orthopedics and Sports Medicine, Tampa, Florida
| | - Byron Moran
- USF Morsani College of Medicine, Department of Family Medicine, Tampa, Florida.,USF Morsani College of Medicine, Department of Orthopedics and Sports Medicine, Tampa, Florida
| | | | - Gianluca Del Rossi
- USF Morsani College of Medicine, Department of Orthopedics and Sports Medicine, Tampa, Florida
| | - Bradford Bindas
- USF Morsani College of Medicine, Department of Family Medicine, Tampa, Florida
| | - Shaan Mehta
- USF Morsani College of Medicine, Department of Family Medicine, Tampa, Florida
| | - Dusty Narducci
- USF Morsani College of Medicine, Department of Family Medicine, Tampa, Florida.,USF Morsani College of Medicine, Department of Orthopedics and Sports Medicine, Tampa, Florida
| |
Collapse
|
9
|
Hardy SJ, Bills SE, Meier ER, Schatz JC, Keridan KJ, Wise S, Hardy KK. A Randomized Controlled Trial of Working Memory Training in Pediatric Sickle Cell Disease. J Pediatr Psychol 2021; 46:1001-1014. [PMID: 33824980 DOI: 10.1093/jpepsy/jsab030] [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] [Received: 06/10/2020] [Revised: 02/25/2021] [Accepted: 03/02/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Youth with sickle cell disease (SCD) are at risk for neurocognitive deficits including problems with working memory (WM), but few interventions to improve functioning exist. This study sought to determine the feasibility and efficacy of home-based, digital WM training on short-term memory and WM, behavioral outcomes, and academic fluency using a parallel group randomized controlled trial design. METHODS 47 children (7-16 years) with SCD and short-term memory or WM difficulties were randomized to Cogmed Working Memory Training at home on a tablet device (N = 24) or to a standard care Waitlist group (N = 23) that used Cogmed after the waiting period. Primary outcomes assessed in clinic included performance on verbal and nonverbal short-term memory and WM tasks. Secondary outcomes included parent-rated executive functioning and tests of math and reading fluency. RESULTS In the evaluable sample, the Cogmed group (N = 21) showed greater improvement in visual WM compared with the Waitlist group (N = 22; p = .03, d = 0.70 [CI95 = 0.08, 1.31]). When examining a combined sample of participants, those who completed ≥10 training sessions exhibited significant improvements in verbal short-term memory, visual WM, and math fluency. Adherence to Cogmed was lower than expected (M = 9.07 sessions, SD = 7.77), with 19 participants (41%) completing at least 10 sessions. Conclusions: Visual WM, an ability commonly affected by SCD, is modifiable with cognitive training. Benefits extended to verbal short-term memory and math fluency when patients completed a sufficient training dose. Additional research is needed to identify ideal candidates for training and determine whether training gains are sustainable and generalize to real-world outcomes.
Collapse
Affiliation(s)
- Steven J Hardy
- Division of Hematology, Children's National Hospital.,Department of Psychiatry and Behavioral Sciences, George Washington University School of Medicine and Health Sciences
| | - Sarah E Bills
- Division of Hematology, Children's National Hospital
| | | | | | | | - Shane Wise
- Division of Hematology, Children's National Hospital
| | - Kristina K Hardy
- Department of Psychiatry and Behavioral Sciences, George Washington University School of Medicine and Health Sciences.,Division of Neuropsychology, Children's National Hospital
| |
Collapse
|
10
|
Chai Y, Ji C, Coloigner J, Choi S, Balderrama M, Vu C, Tamrazi B, Coates T, Wood JC, O'Neil SH, Lepore N. Tract-specific analysis and neurocognitive functioning in sickle cell patients without history of overt stroke. Brain Behav 2021; 11:e01978. [PMID: 33434353 PMCID: PMC7994688 DOI: 10.1002/brb3.1978] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 10/05/2020] [Accepted: 10/27/2020] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Sickle cell disease (SCD) is a hereditary blood disorder in which the oxygen-carrying hemoglobin molecule in red blood cells is abnormal. SCD patients are at increased risks for strokes and neurocognitive deficit, even though neurovascular screening and treatments have lowered the rate of overt strokes. Tract-specific analysis (TSA) is a statistical method to evaluate microstructural WM damage in neurodegenerative disorders, using diffusion tensor imaging (DTI). METHODS We utilized TSA and compared 11 major brain WM tracts between SCD patients with no history of overt stroke, anemic controls, and healthy controls. We additionally examined the relationship between the most commonly used DTI metric of WM tracts and neurocognitive performance in the SCD patients and healthy controls. RESULTS Disruption of WM microstructure orientation-dependent metrics for the SCD patients was found in the genu of the corpus callosum (CC), cortico-spinal tract, inferior fronto-occipital fasciculus, right inferior longitudinal fasciculus, superior longitudinal fasciculus, and left uncinate fasciculus. Neurocognitive performance indicated slower processing speed and lower response inhibition skills in SCD patients compared to controls. TSA abnormalities in the CC were significantly associated with measures of processing speed, working memory, and executive functions. CONCLUSION Decreased DTI-derived metrics were observed on six tracts in chronically anemic patients, regardless of anemia subtype, while two tracks with decreased measures were unique to SCD patients. Patients with WMHs had more significant FA abnormalities. Decreased FA values in the CC significantly correlated with all nine neurocognitive tests, suggesting a critical importance for CC in core neurocognitive processes.
Collapse
Affiliation(s)
- Yaqiong Chai
- CIBORG LaboratoryDepartment of RadiologyChildren's Hospital Los AngelesLos AngelesCAUSA
- Department of RadiologyChildren's Hospital Los AngelesLos AngelesCAUSA
- Department of Biomedical EngineeringUniversity of Southern CaliforniaLos AngelesCAUSA
| | - Chaoran Ji
- CIBORG LaboratoryDepartment of RadiologyChildren's Hospital Los AngelesLos AngelesCAUSA
- Department of RadiologyChildren's Hospital Los AngelesLos AngelesCAUSA
- Department of Electrical EngineeringUniversity of Southern CaliforniaLos AngelesCAUSA
| | - Julie Coloigner
- CIBORG LaboratoryDepartment of RadiologyChildren's Hospital Los AngelesLos AngelesCAUSA
- Division of CardiologyChildren's Hospital Los AngelesLos AngelesCAUSA
| | - Soyoung Choi
- Neuroscience Graduate ProgramUniversity of Southern CaliforniaLos AngelesCAUSA
| | - Melissa Balderrama
- Department of PediatricsKeck School of MedicineUniversity of Southern CaliforniaLos AngelesCAUSA
- Division of Hematology, Oncology, and Blood and Marrow TransplantationChildren's Hospital Los AngelesLos AngelesCAUSA
| | - Chau Vu
- Department of Biomedical EngineeringUniversity of Southern CaliforniaLos AngelesCAUSA
| | - Benita Tamrazi
- Department of RadiologyChildren's Hospital Los AngelesLos AngelesCAUSA
| | - Thomas Coates
- Department of PediatricsKeck School of MedicineUniversity of Southern CaliforniaLos AngelesCAUSA
- Division of Hematology, Oncology, and Blood and Marrow TransplantationChildren's Hospital Los AngelesLos AngelesCAUSA
| | - John C. Wood
- Division of CardiologyChildren's Hospital Los AngelesLos AngelesCAUSA
- Department of PediatricsKeck School of MedicineUniversity of Southern CaliforniaLos AngelesCAUSA
| | - Sharon H. O'Neil
- Department of PediatricsKeck School of MedicineUniversity of Southern CaliforniaLos AngelesCAUSA
- Division of NeurologyChildren's Hospital Los AngelesLos AngelesCAUSA
- The Saban Research InstituteChildren's Hospital Los AngelesLos AngelesCAUSA
| | - Natasha Lepore
- CIBORG LaboratoryDepartment of RadiologyChildren's Hospital Los AngelesLos AngelesCAUSA
- Department of RadiologyChildren's Hospital Los AngelesLos AngelesCAUSA
- Department of Biomedical EngineeringUniversity of Southern CaliforniaLos AngelesCAUSA
- Department of PediatricsKeck School of MedicineUniversity of Southern CaliforniaLos AngelesCAUSA
| |
Collapse
|
11
|
Do chronic pain and comorbidities affect brain function in sickle cell patients? A systematic review of neuroimaging and treatment approaches. Pain 2020; 160:1933-1945. [PMID: 31045749 DOI: 10.1097/j.pain.0000000000001591] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Sickle cell disease (SCD) is a medical condition in which chronic pain is common and negatively impacts psychosocial function and quality of life. Although the brain mechanisms underlying chronic pain are well studied in other painful conditions, the brain mechanisms underlying chronic pain and the associated psychosocial comorbidities are not well established in SCD. A growing literature demonstrates the effect of treatment of chronic pain, including pharmacological and nonpharmacological treatments, on brain function. The present systematic review aimed to (1) determine the effects of chronic pain and psychosocial comorbidities on brain function of patients with SCD; (2) summarize pharmacological and nonpharmacological approaches to treat these symptoms; and (3) identify areas for further investigation of potential beneficial effects of treatments on brain function. Titles were screened using predefined criteria, including SCD, and abstracts and full texts were reviewed by 2 independent reviewers. A total of 1167 SCD articles were identified, and 86 full articles were included covering 3 sections: chronic pain (4 studies), psychosocial comorbidities (11 studies), and pharmacological and nonpharmacological treatments (71 studies). Neuroimaging evidence demonstrates aberrant neural processing related to chronic pain and psychosocial comorbidities in SCD beyond ischemic stroke and cerebral hemorrhage. Although neuroimaging studies show an important role for psychological factors, pain management is nearly exclusively based on opioids. Behavior therapy seems useful to improve psychological symptoms as well as chronic pain and quality of life. Further investigation is required with larger cohorts, matched controls, and examination of treatment-related neural mechanisms.
Collapse
|
12
|
Wu CYC, Lopez-Toledano MA, Daak AA, Clemons GA, Citadin CT, Sancilio FD, Rabinowicz AL, Minagar A, Neumann JT, Lee RHC, Lin HW. SC411 treatment can enhance survival in a mouse model of sickle cell disease. Prostaglandins Leukot Essent Fatty Acids 2020; 158:102110. [PMID: 32447175 DOI: 10.1016/j.plefa.2020.102110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 04/10/2020] [Accepted: 04/14/2020] [Indexed: 02/02/2023]
Abstract
Sickle cell disease (SCD) is one of the most common inherited blood disorder among African Americans affecting 70,000-100,000 individuals in the United States. It is characterized by abnormal hemoglobin (HbS) which develops into severe hemolytic anemia and vaso-occlusive crisis. Therefore, patients with SCD suffer from a chronic state of inflammation, which is responsible for multiple organ damage, ischemic attacks, and premature death. Another major hallmark of SCD patients is the abnormally low levels of omega-3 fatty acids, especially docosahexaenoic acid (DHA) in their red blood cell membranes. Treatment with DHA can reduce red blood cell adhesion and enhance cerebral blood flow, thus, our main goal is to investigate the effect of SC411, which is a novel, highly purified DHA ethyl ester formulation with a proprietary delivery platform in SCD. Utilizing a transgenic mouse model of SCD (HbSS-Townes) and recurrent hypoxic challenges (10%O2, 0.5% CO2 and balance N2 for 3 h) to mimic ischemic-like conditions, our data suggest that SC411 can elevate blood DHA and eicosapentaenoic acid (EPA) levels after 8 weeks of treatment. SC411 can also decrease arachidonic acid (AA) and sickling of red blood cells. In addition, SC411-treated SCD mice showed presented with cerebral blood flow, alleviated neuroinflammation, and revived working memory which ultimately enhanced overall survival. In summary, this study suggests that treatment with SC411 improves cellular and functional outcomes in SCD mice. This finding may provide novel therapeutic opportunities in the treatment against ischemic injury elicited by SCD.
Collapse
Affiliation(s)
- Celeste Y C Wu
- Department of Neurology, Louisiana State University Health Sciences Center, 1501 Kings Hwy Shreveport, LA, USA
| | - Miguel A Lopez-Toledano
- Sancilio & Company, Inc, Stuart, FL, USA; Center of Molecular Biology and Biotechnology (CMBB), Florida Atlantic University, USA
| | - Ahmed A Daak
- Sancilio & Company, Inc, Stuart, FL, USA; Center of Molecular Biology and Biotechnology (CMBB), Florida Atlantic University, USA
| | - Garrett A Clemons
- Department of Cellular Biology and Anatomy, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - Cristiane T Citadin
- Department of Cellular Biology and Anatomy, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - Frederick D Sancilio
- Sancilio & Company, Inc, Stuart, FL, USA; Center of Molecular Biology and Biotechnology (CMBB), Florida Atlantic University, USA
| | - Adrian L Rabinowicz
- Sancilio & Company, Inc, Stuart, FL, USA; Center of Molecular Biology and Biotechnology (CMBB), Florida Atlantic University, USA
| | - Alireza Minagar
- Department of Neurology, Louisiana State University Health Sciences Center, 1501 Kings Hwy Shreveport, LA, USA
| | - Jake T Neumann
- Deaprtment of Biomedical Sciences, West Virginia School of Osteopathic Medicine, Lewisburg, WV, USA
| | - Reggie H C Lee
- Department of Neurology, Louisiana State University Health Sciences Center, 1501 Kings Hwy Shreveport, LA, USA
| | - Hung Wen Lin
- Department of Neurology, Louisiana State University Health Sciences Center, 1501 Kings Hwy Shreveport, LA, USA; Department of Cellular Biology and Anatomy, Louisiana State University Health Sciences Center, Shreveport, LA, USA.
| |
Collapse
|
13
|
Ali JS, Andrasik F, Berlin KS, Porter J, Hankins J, Anderson S, Schreiber JE. Attention difficulties are associated with lower engagement in adult care amongst youth with sickle cell disease. Br J Haematol 2020; 189:e27-e30. [PMID: 32103490 DOI: 10.1111/bjh.16421] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Jeanelle S Ali
- Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | | | | | - Jerlym Porter
- Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Jane Hankins
- Hematology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Sheila Anderson
- Hematology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Jane E Schreiber
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
14
|
Bluschke A, von der Hagen M, Novotna B, Roessner V, Beste C. Executive Function Deficits in Seriously Ill Children-Emerging Challenges and Possibilities for Clinical Care. Front Pediatr 2018; 6:92. [PMID: 29721487 PMCID: PMC5915456 DOI: 10.3389/fped.2018.00092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 03/23/2018] [Indexed: 12/26/2022] Open
Abstract
The past years have seen an incredible increase in the quality and success rates of treatments in pediatric medicine. One of the resulting major challenges refers to the management of primary or secondary residual executive function deficits in affected children. These deficits lead to problems in the ability to acquire, understand, and apply abstract and complex knowledge and to plan, direct, and control actions. Executive functions deficits are important to consider because they are highly predictive of functioning in social and academic aspects of daily life. We argue that current clinical practice does not sufficiently account for the complex cognitive processes in this population. This is because widely applied pharmacological interventions only rarely account for the complexity of the underlying neuronal mechanisms and do not fit well into possibly powerful "individualized medicine" approaches. Novel treatment approaches targeting deficits in executive functions in seriously ill children could focus on neuronal oscillations, as these have some specific relations to different aspects of executive function. Importantly, such treatment approaches can be individually tailored to the individuals' deficits and can be transferred into home-treatment or e-health solutions. These approaches are easy-to-use, can be easily integrated into daily life, and are becoming increasingly cost-effective.
Collapse
Affiliation(s)
- Annet Bluschke
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Maja von der Hagen
- Abteilung Neuropädiatrie, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Barbara Novotna
- Abteilung Neuropädiatrie, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Veit Roessner
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Christian Beste
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany.,Experimental Neurobiology, National Institute of Mental Health, Prague, Czechia.,Institute of Psychology, Technische Universität Dresden, Dresden, Germany
| |
Collapse
|
15
|
Attention Deficit Hyperactivity Disorder in Children With Sickle Cell Disease Referred for an Evaluation. J Pediatr Hematol Oncol 2017; 39:350-354. [PMID: 28538513 DOI: 10.1097/mph.0000000000000847] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Neuropsychological deficits, including difficulties with attention, are well described in children with sickle cell disease (SCD). Very little is known about attention deficit hyperactivity disorder (ADHD) in children with SCD. The objective of this study was to determine the proportion of ADHD in children with SCD referred for neuropsychological evaluation. This prospective, cross-sectional study included patients (age, 4 to 18 y) with SCD and completion of a neuropsychological evaluation between December 2013 and March 2016. Patients were referred for neuropsychological evaluation because of concern regarding school performance, development, and/or behavior. The diagnosis of ADHD was made by a neuropsychologist on the basis of the diagnostic criteria in the Diagnostic Statistical Manual-Fourth or Fifth Editions. ADHD medication usage rate was obtained by medical record review. Of the 89 patients with SCD referred for neuropsychological evaluation, 25% (95% confidence interval, 16%-35%) met diagnostic criteria for ADHD. Only 21% of the patients with SCD and ADHD were prescribed an ADHD medication. Our study supports routine ADHD screening in children with SCD who have poor school performance or behavioral concerns. Despite the benefits of pharmacologic treatment, the majority of patients with SCD and ADHD did not receive a medication for management of their ADHD.
Collapse
|
16
|
Burkhardt L, Lobitz S, Koustenis E, Rueckriegel SM, Hernáiz Driever P. Cognitive and fine motor deficits in a pediatric sickle cell disease cohort of mixed ethnic origin. Ann Hematol 2016; 96:199-213. [DOI: 10.1007/s00277-016-2861-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 10/18/2016] [Indexed: 11/24/2022]
|
17
|
Asnani MR, Quimby KR, Bennett NR, Francis DK. Interventions for patients and caregivers to improve knowledge of sickle cell disease and recognition of its related complications. Cochrane Database Syst Rev 2016; 10:CD011175. [PMID: 27711980 PMCID: PMC6457882 DOI: 10.1002/14651858.cd011175.pub2] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Sickle cell disease is a group of genetic diseases which is especially prevalent in tropical and subtropical regions; however, forced migration and ongoing population movement have spread it throughout the world, with estimated birth rates reaching 0.49 per 1000 in the Americas, 0.07 per 1000 in Europe, 0.68 per 1000 in South and Southeast Asia, and 10.68 per 1000 in Africa. Life for individuals with sickle cell disease can be affected by repeated acute complications and compounded by progressive organ damage. Studies reveal that when people with chronic illness learn self-management, their clinical outcomes and quality of life improves; and they show lower dependence on healthcare services. There are, however, no reviews identifying which interventions improve knowledge and little is known about the impact of patient or care-giver knowledge on clinical and psychosocial outcomes in people with sickle cell disease. OBJECTIVES 1. To determine the effectiveness of patient- and caregiver-centred educational interventions for changing knowledge and understanding of sickle cell disease among patients as well as caregivers of people with the disease.2. To assess the effectiveness and safety of patient- and caregiver-centred educational interventions and programs for the recognition of signs and symptoms of disease-related morbidity, adherence to treatment and healthcare utilization in patients with sickle cell disease. SEARCH METHODS The authors searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Haemoglobinopathies Trials Register, compiled from electronic database searches and handsearching of journals and conference abstract books. Additional trials were sought from the reference lists of the trials and reviews identified by the search strategy.Date of last search: 11 April 2016. SELECTION CRITERIA Randomized and quasi-randomized controlled trials which evaluate the effectiveness of individual- and group-based interventions for either the patient with sickle cell disease or their caregivers, or both. Eligible interventions will aim to change knowledge, attitudes or skills, improve psychosocial aspects of the disease as well as treatment adherence and healthcare utilization. Trials evaluating the intervention versus no program, comparing two interventions and those which are part of a multi-faceted intervention to improve a range of sickle cell-related health outcomes are all eligible for inclusion. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials based on stated inclusion criteria and thereafter examined each selected report to extract data using a prepared, piloted, data collection form. A third author assisted in reaching consensus if there were any discrepancies. Similarly, risk of bias was assessed by two authors and verified by a third author. MAIN RESULTS A total of 12 trials (11 randomized controlled trials and one quasi-randomized trial) of 563 people with HbSS, HbSC or HbSβthal, aged six to 35 years old, were included in the review; the majority of participants were African-American. Interventions ranged from a total of one hour to weekly sessions for eight weeks and the post-intervention assessments ranged from the end of the intervention period to 12 months after completion. The heterogeneity of the included trials, which encompasses setting, inclusion and exclusion criteria, interventional method and time of assessment, ranged from 'not important' to 'moderate to substantial' for different review outcomes. The overall risk of bias was low for selective reporting, unclear for random sequence generation, allocation concealment, blinding of participants and blinding of outcome assessment. Incomplete outcome reporting and blinding of personnel showed mixed bias representations.Patient knowledge was assessed by four trials (160 participants) with moderate to substantial heterogeneity. There was evidence that educational programs improved patient knowledge, standardised mean difference 0.87 points (95% confidence interval 0.28 to 1.45, moderate quality evidence), which improved further when a trial with high bias was removed in a sensitivity analysis. Caregiver knowledge, reported in a single trial of 20 families, also showed an improvement, standardised mean difference 0.52 points (95% confidence interval 0.03 to 1.00, moderate quality evidence). The effect on patient knowledge was sustained at longer follow-up periods, whereas the effect on caregiver knowledge was not sustained.There were two primary outcomes related to the effectiveness of educational programs on the recognition of signs and symptoms of disease-related morbidity. No comparative data were reported for patients or caregivers (or both) recognising signs and symptoms leading to self-management. Data from two trials were analysed for the utilization of health services and showed no evidence of an effect, mean difference 0.33 (95% confidence interval -0.57 to 1.23, moderate quality evidence).With regard to the review's secondary outcomes, depression showed a statistically significant decline in intervention groups, standardised mean difference -0.66 points (95% confidence interval -1.18, to -0.14, moderate quality evidence). Adherence to treatment was not assessed in any of the identified trials. No effects of interventions were seen on coping, family relationships or health-related quality of life of patients.The quality of evidence was low for positive coping and moderate for child knowledge, healthcare utilization and depression. This suggests that further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimates. AUTHORS' CONCLUSIONS This review identifies important positive effects of educational interventions on improving patient knowledge of sickle cell disease and depression. Effects on patients' knowledge were maintained for longer than for caregivers. The effect on knowledge was significant but small and whether it offers any clinical benefit is uncertain. Significant factors limiting these effects could be trials being under powered as well as attrition rates. Effects were not statistically significant in assessments of secondary outcomes, possibly due to the paucity of the number of trials and patients and caregivers. Trials showed moderate to high heterogeneity which might impact the results. To better study effects on outcomes, further controlled trials are needed with rigorous attention given to improve recruitment and retention and to decrease bias. Predetermined protocols using similar measurements should be used across multiple sites.
Collapse
Affiliation(s)
- Monika R Asnani
- Caribbean Institute for Health Research, University of the West IndiesSickle Cell Unit7 Ring Road, Mona CampusKingston 7Jamaica
| | - Kim R Quimby
- Caribbean Institute for Health Research, The University of the West IndiesChronic Disease Research CentreJermott's LaneBridgetownSt MichaelBarbadosBB11110
| | - Nadia R Bennett
- Caribbean Institute for Health Research, The University of the West Indies, MonaEpidemiology Research Unit7 Ring RoadKingstonJamaica
| | - Damian K Francis
- Caribbean Institute for Health Research, The University of the West Indies, MonaEpidemiology Research Unit7 Ring RoadKingstonJamaica
| | | |
Collapse
|
18
|
Hardy SJ, Hardy KK, Schatz JC, Thompson AL, Meier ER. Feasibility of Home-Based Computerized Working Memory Training With Children and Adolescents With Sickle Cell Disease. Pediatr Blood Cancer 2016; 63:1578-85. [PMID: 27227457 DOI: 10.1002/pbc.26019] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 03/03/2016] [Accepted: 03/25/2016] [Indexed: 11/09/2022]
Abstract
BACKGROUND Children with sickle cell disease (SCD) are at increased risk for neurocognitive deficits, yet the literature describing interventions to ameliorate these problems and promote academic achievement is limited. We evaluated the feasibility and preliminary efficacy of a home-based computerized working memory (WM) training intervention (Cogmed) in children with SCD. PROCEDURE Youth with SCD between the age of 7 and 16 years completed an initial neuropsychological assessment; those with WM deficits were loaned an iPad on which they accessed Cogmed at home. Participants were instructed to work on Cogmed 5 days each week for 5 weeks (25 training sessions). We examined Cogmed usage characteristics and change on WM assessment scores following the intervention. RESULTS Of the 21 participants (M age = 11.38, SD = 2.78; Mdn age = 10.00, interquartile range [IQR] = 5.00; 52% female) screened, 60% exhibited WM deficits (n = 12) and received the intervention and 50% (n = 6) completed Cogmed. The mean number of sessions completed was 15.83 (SD = 7.73; Mdn = 17.00, IQR = 16.00); females were more likely to complete Cogmed, χ(2) (1) = 6.00, P = 0.01. Participants who reported lower SCD-related pain impact completed more sessions (r = 0.71, P = 0.01). Children who completed Cogmed exhibited improvements in verbal WM, visuospatial short-term memory, and visuospatial WM. CONCLUSIONS Initial findings suggest Cogmed is associated with WM improvement in youth with SCD; however, adherence was lower than expected. Home-based WM interventions may ameliorate SCD-related WM deficits but strategies are needed to address barriers to program completion.
Collapse
Affiliation(s)
- Steven J Hardy
- Departments of Pediatrics and Psychiatry & Behavioral Sciences, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Kristina K Hardy
- Children's National Health System, Washington, District of Columbia.,Departments of Pediatrics and Psychiatry & Behavioral Sciences, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Jeffrey C Schatz
- Department of Psychology, University of South Carolina, Columbia, South Carolina
| | - Amanda L Thompson
- Children's National Health System, Washington, District of Columbia.,Departments of Pediatrics and Psychiatry & Behavioral Sciences, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Emily R Meier
- Children's National Health System, Washington, District of Columbia.,Departments of Pediatrics and Psychiatry & Behavioral Sciences, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| |
Collapse
|
19
|
Lance EI, Lanier KE, Zabel TA, Comi AM. Stimulant use in patients with sturge-weber syndrome: safety and efficacy. Pediatr Neurol 2014; 51:675-80. [PMID: 25439578 PMCID: PMC4392725 DOI: 10.1016/j.pediatrneurol.2013.11.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Revised: 11/11/2013] [Accepted: 11/13/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Sturge-Weber syndrome is characterized by a facial port-wine birthmark, vascular eye abnormalities, and a leptomeningeal angioma. Attention and behavioral issues are common in Sturge-Weber syndrome. However, literature evidence for stimulant treatment is minimal. This study evaluates stimulant medication safety and efficacy in individuals with Sturge-Weber syndrome. METHODS The research database of the Hunter Nelson Sturge-Weber Center (n = 210 subjects in the database) was reviewed for stimulant use. Twelve patients (mean age 10.5 years, age range 4 to 21 years) on stimulants were seen between 2003 and 2012. A retrospective chart review obtained comorbid diagnoses, stimulant type and dosage, medication side effects, vital signs, and medication efficacy. RESULTS All 12 patients had brain involvement (unilateral, nine; bilateral, three). Additional comorbidities included epilepsy (twelve), hemiparesis (eight), headaches (eight), and vision deficits (six). Eight patients reported side effects, primarily appetite suppression (four) and headaches (three). There were no statistically significant changes in weight or blood pressure 6 months after medication initiation. Medication efficacy was subjectively reported in 11 patients. Seven patients remained on stimulants at their most recent follow-up visit. CONCLUSIONS This study preliminarily evaluates stimulant medication use in a small group of Sturge-Weber syndrome patients. Stimulants were tolerated and effective in most subjects. Side effects were mostly minor and medication did not negatively affect growth or vital signs. Stimulant medication may be a safe and effective intervention for Sturge-Weber syndrome children with attention issues/attention deficit hyperactivity disorder. Further studies with larger sample sizes are needed.
Collapse
Affiliation(s)
- Eboni I. Lance
- Department of Neurodevelopmental Medicine, Kennedy Krieger Institute, Baltimore, MD,Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD,Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD
| | - Kira E. Lanier
- Department of Neurodevelopmental Medicine, Kennedy Krieger Institute, Baltimore, MD
| | - T. Andrew Zabel
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD
| | - Anne M. Comi
- Department of Neurodevelopmental Medicine, Kennedy Krieger Institute, Baltimore, MD,Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD,Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD
| |
Collapse
|
20
|
Nicholls E, Hildenbrand AK, Aggarwal R, McCarthy L, Daly B. The use of stimulant medication to treat neurocognitive deficits in patients with pediatric cancer, traumatic brain injury, and sickle cell disease: a review. Postgrad Med 2013; 124:78-90. [PMID: 23095428 DOI: 10.3810/pgm.2012.09.2596] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Several chronic health conditions of childhood, including pediatric cancers, traumatic brain injury (TBI), and sickle cell disease (SCD) are associated with significant neurocognitive impairments that can compromise educational attainment and future vocational opportunities. The prominence of attentional deficits as part of the neurocognitive sequelae associated with each of these conditions has led some researchers to draw parallels with another chronic condition that manifests in childhood, specifically the inattentive subtype of attention-deficit/hyperactivity disorder (ADHD). Because ADHD shares similar neurocognitive and symptomatological features with pediatric cancer, TBI, and SCD, stimulant medications may be indicated to treat associated deficits in each condition. However, relatively few studies have investigated the safety and effectiveness of stimulant medications in treating neurocognitive sequelae in children with cancer, TBI, or SCD. Thus, clinicians have received little guidance regarding a potentially useful treatment modality for ameliorating the neurocognitive deficits that can profoundly impact the educational, psychosocial, and vocational development of youth with these chronic health conditions. We provide a review of the literature and synthesize current developments in research regarding treatment with stimulant medication for children with cancer, TBI, and SCD, as well as discuss special considerations for each condition.
Collapse
|