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Couette M, Roy J, Doglioni DO, Bereznyakova O, Stapf C, Jacquin G, Fraïle V, Desmarais P, Desforges SM, Touma L, Nauche B, Bartolucci P, Kuo KHM, Forté S. Screening for cognitive impairment in adults with sickle cell disease: A systematic review and meta-analysis. Presse Med 2023; 52:104207. [PMID: 37979834 DOI: 10.1016/j.lpm.2023.104207] [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: 08/10/2023] [Accepted: 10/29/2023] [Indexed: 11/20/2023] Open
Abstract
Neurovascular disease such as symptomatic stroke, silent brain infarcts and vascular cognitive impairment are common complications of sickle cell disease (SCD) that can have devastating consequences on quality of life, employment, and social functioning. Early recognition of neurovascular disease is a prerequisite for the timely optimization of medical care and to connect patients to adaptive resources. While cognitive impairment has been well described in children, currently available data are limited in adults. As a result, guidance on the optimal cognitive screening strategies in adults is scarce. We conducted a systematic review to identify the different screening tools that have been evaluated in SCD. A meta-analysis was performed to estimate the prevalence of suspected cognitive impairment in this population. In this qualitative synthesis, we present 8 studies that evaluated 6 different screening tools. Patient characteristics that impacted on cognitive screening performance included age, education level, and a prior history of stroke. We report a pooled prevalence of 38% [14-62%] of suspected cognitive impairment. We discuss the relative benefits and limitations of the different screening tools to help clinicians select an adapted approach tailored to their specific patients' needs. Further studies are needed to establish and validate cognitive screening strategies in patients with diverse cultural and educational backgrounds.
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Affiliation(s)
- Maryline Couette
- Sickle Cell Referral Centre-UMGGR, University of Paris Est Créteil, Henri Mondor APHP, 94010, Créteil, France; CARMAS (Cardiovascular and Respiratory Manifestations of Acute Lung Injury and Sepsis), University of Paris Est Créteil, 94010, Créteil, France; IMRB, INSERM, University of Paris Est Créteil, 94010, Créteil, France
| | - Justine Roy
- Faculté de médecine, Université de Montréal, Montréal, QC, H3C 3J7, Canada
| | - Damien Oudin Doglioni
- Sickle Cell Referral Centre-UMGGR, University of Paris Est Créteil, Henri Mondor APHP, 94010, Créteil, France; Laboratoire Inter-Universitaire de Psychologie-Personnalité, Cognition, Changement Social (LIP/PC2S), Université Grenoble Alpes, 38058, Saint-Martin-d'Hères, France
| | - Olena Bereznyakova
- Axe Neurosciences et Carrefour de l'innovation, Centre de Recherche du CHUM (CRCHUM), Montréal, QC, H2X 0A9, Canada; Division of Neurology, Department of Medicine, Centre hospitalier de l'Université de Montréal (CHUM), Montréal, QC, H2X 0C1, Canada; Department of Neurosciences, Université de Montréal, Montréal, QC, H3C 3J7, Canada
| | - Christian Stapf
- Axe Neurosciences et Carrefour de l'innovation, Centre de Recherche du CHUM (CRCHUM), Montréal, QC, H2X 0A9, Canada; Division of Neurology, Department of Medicine, Centre hospitalier de l'Université de Montréal (CHUM), Montréal, QC, H2X 0C1, Canada; Department of Neurosciences, Université de Montréal, Montréal, QC, H3C 3J7, Canada
| | - Gregory Jacquin
- Axe Neurosciences et Carrefour de l'innovation, Centre de Recherche du CHUM (CRCHUM), Montréal, QC, H2X 0A9, Canada; Division of Neurology, Department of Medicine, Centre hospitalier de l'Université de Montréal (CHUM), Montréal, QC, H2X 0C1, Canada; Department of Neurosciences, Université de Montréal, Montréal, QC, H3C 3J7, Canada
| | - Valérie Fraïle
- Division of Psychology, Centre hospitalier de l'Université de Montréal (CHUM), Montréal, QC, H2X 0C1, Canada
| | - Philippe Desmarais
- Axe Neurosciences et Carrefour de l'innovation, Centre de Recherche du CHUM (CRCHUM), Montréal, QC, H2X 0A9, Canada; Department of Neurosciences, Université de Montréal, Montréal, QC, H3C 3J7, Canada; Division of Geriatrics, Department of Medicine, Centre hospitalier de l'Université de Montréal (CHUM), Montréal, QC, H2X 0C1, Canada
| | - Sara-Maude Desforges
- Faculté de médecine, Université de Montréal, Montréal, QC, H3C 3J7, Canada; Department of Medecine, Centre Hospitalier de l'Université de Montréal, Montréal, QC, H2X 0C1, Canada
| | - Lahoud Touma
- Division of Neurology, Department of Medicine, Centre hospitalier de l'Université de Montréal (CHUM), Montréal, QC, H2X 0C1, Canada; Department of Neurosciences, Université de Montréal, Montréal, QC, H3C 3J7, Canada
| | - Bénédicte Nauche
- Library, Centre Hospitalier de l'Université de Montréal, Montréal, QC, H2X 3E4, Canada
| | - Pablo Bartolucci
- Sickle Cell Referral Centre-UMGGR, University of Paris Est Créteil, Henri Mondor APHP, 94010, Créteil, France; IMRB, INSERM, University of Paris Est Créteil, 94010, Créteil, France; INSERM-U955, Equipe 2, Laboratoire d'Excellence, GRex, Institut Mondor, 94000, Créteil, France
| | - Kevin H M Kuo
- Division of Hematology, Department of Medicine, University of Toronto, Toronto, ON, M5S 1A1, Canada; Division of Medical Oncology and Hematology, Department of Medicine, University Health Network, Toronto, ON, M5G 2N2, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, M5T 3M7, Canada
| | - Stéphanie Forté
- Faculté de médecine, Université de Montréal, Montréal, QC, H3C 3J7, Canada; Department of Medicine, Division of Hematology and Medical Oncology, Centre Hospitalier de l'Université de Montréal, Montréal, QC, H2X 3E4, Canada; Carrefour de l'innovation, Centre de Recherche du CHUM (CRCHUM), Montréal, H2X 0A9, QC, Canada.
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Sunwoo J, Shah P, Thuptimdang W, Khaleel M, Chalacheva P, Kato RM, Coates TD, Khoo MCK. Functional near-infrared spectroscopy-based prefrontal cortex oxygenation during working memory tasks in sickle cell disease. NEUROPHOTONICS 2023; 10:045004. [PMID: 37854507 PMCID: PMC10581024 DOI: 10.1117/1.nph.10.4.045004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 09/25/2023] [Accepted: 10/02/2023] [Indexed: 10/20/2023]
Abstract
Significance Sickle cell disease (SCD), characterized by painful vaso-occlusive crises, is associated with cognitive decline. However, objective quantification of cognitive decline in SCD remains a challenge, and the associated hemodynamics are unknown. Aim To address this, we utilized functional near-infrared spectroscopy (fNIRS) to measure prefrontal cortex (PFC) oxygenation responses to N -back working memory tasks in SCD patients and compared them with healthy controls. Approach We quantified the PFC oxygenation rate as an index of cognitive activity in each group and compared them. In half of the participants, a Stroop test was administered before they started N -back to elevate their baseline stress level. Results In SCD compared to healthy controls, we found that (1) under a high baseline stress level, there were significantly greater oxygenation responses during the 2-back task, further elevated with histories of stroke; (2) there was a marginally slower N -back response time, and it was even slower with a history of stroke; and (3) the task accuracy was not different. Conclusions Additional requirements for processing time, PFC resources, and PFC oxygenation in SCD patients offer an important basis for understanding their cognitive decline and highlight the potential of fNIRS for evaluating cognitive functions.
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Affiliation(s)
- John Sunwoo
- University of Southern California, Department of Biomedical Engineering, Los Angeles, California, United States
- Massachusetts General Hospital, Harvard Medical School, Athinoula A. Martinos Center for Biomedical Imaging, Boston, Massachusetts, United States
| | - Payal Shah
- Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Hematology Section of Children’s Center for Cancer, Blood Disease and Bone Marrow Transplantation, Los Angeles, California, United States
| | - Wanwara Thuptimdang
- University of Southern California, Department of Biomedical Engineering, Los Angeles, California, United States
- Prince of Songkla University, Faculty of Medicine, Institute of Biomedical Engineering, Department of Biomedical Sciences and Biomedical Engineering, Hat Yai, Songkhla, Thailand
| | - Maha Khaleel
- Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Hematology Section of Children’s Center for Cancer, Blood Disease and Bone Marrow Transplantation, Los Angeles, California, United States
| | - Patjanaporn Chalacheva
- University of Southern California, Department of Biomedical Engineering, Los Angeles, California, United States
- Carnegie Mellon University, Department of Biomedical Engineering, Pittsburgh, Pennsylvania, United States
| | - Roberta M. Kato
- Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Division of Pediatric Pulmonology, Los Angeles, California, United States
| | - Thomas D. Coates
- Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Hematology Section of Children’s Center for Cancer, Blood Disease and Bone Marrow Transplantation, Los Angeles, California, United States
| | - Michael C. K. Khoo
- University of Southern California, Department of Biomedical Engineering, Los Angeles, California, United States
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Kelleher SC, Kirkham FJ, Hood AM. Executive Function and Processing Speed in Children Living with Sickle Cell Anemia. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1585. [PMID: 37892248 PMCID: PMC10605810 DOI: 10.3390/children10101585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/22/2023] [Accepted: 09/15/2023] [Indexed: 10/29/2023]
Abstract
Executive function and processing speed difficulties are observed in children living with sickle cell anemia (SCA). The influence of processing speed on executive function is not well understood. We recruited 59 children living with SCA and 24 matched controls aged 8-18 years between 2010 and 2016 from clinics in the UK. Children completed tests in processing speed and cognitive flexibility, subdomains of executive function. MRI scans were conducted within one year of testing; oxygen saturation was obtained on the day of testing. Hemoglobin levels were obtained from medical records. Caregivers completed the executive function questionnaire. Hierarchical linear regressions found that hemoglobin, oxygen saturation, age, infarct status, and processing speed were not independent predictors for any model. However, for all cognitive flexibility tests, there was a significant interaction between infarct status and processing speed; children without silent cerebral infarction (SCI) with faster processing speed had better cognitive flexibility. Our findings indicate that, when interpreting executive function difficulties, it is important to account for the relationship between SCI status and processing speed. More research is needed to elucidate the mechanisms, but clinically, including executive function testing as part of clinic visits by embedding psychologists within the healthcare team would appear to be a critical step.
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Affiliation(s)
- Stephanie C. Kelleher
- Developmental Neurosciences Unit and Biomedical Research Centre, UCL Great Ormond Street Institute of Child Health, London WC1N 1EH, UK
| | - Fenella J. Kirkham
- Developmental Neurosciences Unit and Biomedical Research Centre, UCL Great Ormond Street Institute of Child Health, London WC1N 1EH, UK
- Clinical and Experimental Sciences, University of Southampton, Southampton SO17 1BJ, UK
| | - Anna M. Hood
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, University of Manchester, Manchester M13 9PL, UK
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Carlson EJ, Al Ghriwati N, Wolters P, Anne Tamula M, Tisdale J, Fitzhugh C, Hsieh M, Martin S. Longitudinal neurocognitive effects of nonmyeloablative hematopoietic stem cell transplant among older adolescents and adults with sickle cell disease: A description and comparison with sibling donors. Neuropsychol Rehabil 2023:1-20. [PMID: 37540620 DOI: 10.1080/09602011.2023.2238948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 07/13/2023] [Indexed: 08/06/2023]
Abstract
Sickle cell disease (SCD) is associated with increased risk of neurocognitive deficits. However, whether functioning changes following nonmyeloablative hematopoietic stem cell transplant (HSCT) remains unclear. This study aimed to examine changes in neuropsychological functioning pre- to post-transplant among patients with SCD and compare patients and siblings. Adults with SCD (n = 47; Mage = 31.8 ± 8.9) and their sibling stem cell donors (n = 22; Mage = 30.5± 9.2) enrolled on a nonmyeloablative HCST protocol completed cognitive and patient-reported outcome assessments at baseline and 12 months post-transplant. Path analyses were used to assess associations between pre-transplant variables and sibling/patient group status and post-transplant function. Mean patient cognitive scores were average at both timepoints. Patient processing speed and somatic complaints improved from baseline to follow-up. Baseline performance predicted follow-up performance across cognitive variables; patient/sibling status predicted follow-up performance on some processing speed measures. Results suggest that patients with SCD demonstrate slower processing speed than siblings. Processing speed increased pre- to post-HSCT among patients and siblings, and on some measures patients demonstrated greater improvement. Thus, HSCT may improve processing speed in patients, although further confirmation is needed. Findings provide promising evidence that neurocognitive functioning remains stable without detrimental effects from pre- to 12-months post nonmyeloablative HSCT in individuals with SCD.
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Affiliation(s)
- Emily J Carlson
- Department of Psychology, American University, Washington, United States
- Pediatric Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, United States
| | - Nour Al Ghriwati
- Pediatric Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, United States
| | - Pam Wolters
- Pediatric Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, United States
| | - Mary Anne Tamula
- Clinical Research Directorate (CRD), Frederick National Laboratory for Cancer Research, Frederick , USA
| | - John Tisdale
- Cellular and Molecular Therapeutics Branch, National Heart Lung and Blood Institute, Bethesda, United States
| | - Courtney Fitzhugh
- Cellular and Molecular Therapeutics Branch, National Heart Lung and Blood Institute, Bethesda, United States
| | - Matt Hsieh
- Cellular and Molecular Therapeutics Branch, National Heart Lung and Blood Institute, Bethesda, United States
| | - Staci Martin
- Pediatric Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, United States
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Sop D, Steinberg JL, Jordan J, Crouch T, Zhang YM, Smith W. Association of Cerebral Hemodynamics and Anemia on Processing Speed in Adults with Sickle Cell Disease. JOURNAL OF NEUROLOGY AND EXPERIMENTAL NEURAL SCIENCE 2023; 5:150. [PMID: 37645351 PMCID: PMC10464389 DOI: 10.29011/2577-1442.100050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
Background and Purpose Compared to healthy controls, adult patients with Sickle Cell Disease (SCD) are anemic, and therefore have higher cardiac output and Cerebral Blood Flow (CBF) to maintain brain oxygenation. They also demonstrate comparatively more cognitive deficits due to either overt strokes or silent cerebral ischemia. However, there are few correlative studies between CBF and cognitive deficits, specifically processing speed in SCD. Such studies are important to develop biomarkers of central brain processing and ischemia for diagnosis, prognosis, and evaluating the effectiveness of potential interventions. This pilot cross-sectional study tested the hypotheses that adults with SCD and elevated CBF demonstrate lower central brain processing speed than controls on average and that CBF is inversely correlated with processing speed. Methods We conducted a pilot cross-sectional study to assess the relation-ships between CBF, central brain processing speed, and hemoglobin levels in asymptomatic adults with SCD and controls from an urban academic medical center. MRI acquisitions at 3T consisted of 2D phase-contrast quantitative arteriograms (Qflow) of the bilateral internal carotid and vertebral arteries and 3D pseudo-continuous arterial spin labeling (pCASL) of the brain. Participants were patients with SCD (hemoglobin [Hb]SS, [Hb] SBetaThal°, or [Hb]SC) aged 22-52 years of African American descent (N=7) or community controls (Hb AA) (n=3). Processing speed was assessed as an in-direct functional marker of ischemia using a recommended test from the NIH Toolbox for Assessment of Neurological and Behavioral Function, the Pattern Comparison Processing Speed Test. t-tests were used to compare means of CBF, hemoglobin, and cognition between SCD patients and healthy controls. Among SCD patients only multivariate correla-tions were used to evaluate relationships between brain perfusion in specific brain regions vs. processing speed and CBF. The significance level was set at p≤0.05. Results Adults with SCD reported higher CBF compared to healthy con-trols (72.15±28.90 vs. 47.23±12.30 ml/min/100g, p=0.04), and lower hemoglobin concentration (8.64±2.33 vs. 13.33±0.58, p=0.001). Heart rate in SCD patients was higher than in controls (86.29±1.37 vs. 74.00±2.10, p=0.04). Patients with SCD demonstrated lower processing speed (96.14±21.04 vs.123±13.74, p=0.02) than controls. Among adult patients with SCD, perfusion in specific regions of the brain showed an inverse relationship with processing speed, as did whole-brain CBF (p=0.0325). Conclusion These findings, although from a small sample, lend a degree of validity to the claim that processing speed is slower in people with SCD than in controls and that CBF is significantly higher in SCD patients com-pared to controls. The results also lend credence to the finding that the degree of processing speed deficiencies among adults with SCD is correlated with the degree of elevated CBF, which is known to correspond with the degree of anemia associated with SCD.
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Affiliation(s)
- Daniel Sop
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, VA USA
- Department of Internal Medicine, Virginia Commonwealth University Health System, Richmond, VA USA
| | - Joel L Steinberg
- Department of Psychiatry, Virginia Commonwealth University Health System, Richmond, VA USA
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, VA USA
| | - Jennifer Jordan
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, VA USA
- Pauley Heart Center, Virginia Commonwealth University Health System, Richmond, VA USA
| | - Taylor Crouch
- Department of Psychiatry, Virginia Commonwealth University Health System, Richmond, VA USA
| | - Yue May Zhang
- Department of Internal Medicine, Virginia Commonwealth University Health System, Richmond, VA USA
| | - Wally Smith
- Department of Internal Medicine, Virginia Commonwealth University Health System, Richmond, VA USA
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Portela GT, Butters MA, Brooks MM, Candra L, Rosano C, Novelli EM. Comprehensive assessment of cognitive function in adults with moderate and severe sickle cell disease. Am J Hematol 2022; 97:E344-E346. [PMID: 35749262 PMCID: PMC9378513 DOI: 10.1002/ajh.26643] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 05/19/2022] [Accepted: 06/18/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Gerard T. Portela
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh
| | - Meryl A. Butters
- Department of Psychiatry, School of Medicine, University of Pittsburgh
| | - Maria M. Brooks
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh
| | - Leticia Candra
- Department of Medicine, School of Medicine, University of Pittsburgh
| | - Caterina Rosano
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh
| | - Enrico M. Novelli
- Department of Medicine, School of Medicine, University of Pittsburgh
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Ampomah MA, Drake JA, Anum A, Amponsah B, Dei-Adomakoh Y, Anie K, Mate-Kole CC, Jonassaint CR, Kirkham FJ. A case-control and seven-year longitudinal neurocognitive study of adults with sickle cell disease in Ghana. Br J Haematol 2022; 199:411-426. [PMID: 36017640 DOI: 10.1111/bjh.18386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 07/13/2022] [Accepted: 07/17/2022] [Indexed: 11/28/2022]
Abstract
Ageing in sickle cell disease (SCD) is associated with a myriad of end-organ complications, including cerebrovascular damage and cognitive impairment (CI). Although CI is very common in SCD, little is known about cognitive functioning and how it changes with age. This study examines cognitive patterns of 63 adults with SCD and 60 non-SCD, age- and education-matched controls in Ghana. Of those adults with SCD, 34 completed the neuropsychological battery at baseline and again seven years later. In cross-sectional data, adults with SCD performed worse than controls in all cognitive test domains (p < 0.01 for all). The seven-year follow-up data showed that the group exhibited a significant decline in visuospatial abilities (ranging from Cohen's d = 1.40 to 2.38), and to a lesser extent, in processing speed and executive functioning. Exploratory analyses showed a significant time-by-education interaction, indicating that education may be protective from decline in cognitive performance. These findings have implications for clinical practice. Early neuropsychological surveillance coupled with early assessment and remedial programmes will provide avenues for enhancing the quality of life of adults living with SCD in Ghana.
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Affiliation(s)
- Mary A Ampomah
- Family and Community Health, School of Public Health, University of Health and Allied Sciences, Ho, Ghana
| | - Jermon A Drake
- Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Adote Anum
- Department of Psychology, School of Social Sciences, University of Ghana, Legon, Ghana
| | - Benjamin Amponsah
- Department of Psychology, School of Social Sciences, University of Ghana, Legon, Ghana
| | - Yvonne Dei-Adomakoh
- Department of Haematology, School of Medicine and Dentistry, University of Ghana Medical School, Ghana Institute of Clinical Genetics, Accra, Ghana
| | - Kofi Anie
- School of Public Health, Imperial College London, London, UK.,London North West University Healthcare NHS Trust, London, UK
| | - Christopher C Mate-Kole
- Department of Psychology, School of Social Sciences, University of Ghana, Legon, Ghana.,Centre for Ageing Studies, College of Humanities, University of Ghana, Legon, Ghana
| | | | - Fenella J Kirkham
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, London, UK.,Clinical and Experimental Sciences, University of Southampton, Southampton, UK
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Kölbel M, Kirkham F, Iles RK, Stotesbury H, Halstead E, Brenchley C, Sahota S, Dimitriou D. Exploring the relationship of sleep, cognition, and cortisol in sickle cell disease. COMPREHENSIVE PSYCHONEUROENDOCRINOLOGY 2022; 10:100128. [PMID: 35755206 PMCID: PMC9216257 DOI: 10.1016/j.cpnec.2022.100128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 02/22/2022] [Indexed: 12/03/2022] Open
Abstract
Background Neurocognitive impairment is common in people with Sickle Cell Disease (SCD) and evidence is accumulating that sleep disturbances play a role. The interaction between cortisol and sleep in the general population is associated with cognition as well as general wellbeing but there are few data in SCD. We aimed to understand the relationship between cortisol and sleep in individuals with SCD and explored associations with cognition. Methods Forty-five participants of black heritage (SCD: N = 27, 9–29 years, 16 females; Controls: N = 18, 11–25 years, 13 females) were recruited from the community between 2018 - 2020. Participants completed standardized questionnaires about their sleep behaviour and wore actigraphy MotionWatch8 for 7 nights to assess nocturnal sleep patterns. Salivary cortisol samples were taken on wakening and 3 times after 14:00. Cognition was assessed using the Wechsler Intelligence Scales for children and adults. Results People with SCD took longer to fall asleep and experienced greater wake bouts, mobile minutes and fragmented sleep compared to controls. Although non-significant, people with SCD experienced lower morning cortisol, with a flattened diurnal cortisol ratio compared to controls. Interestingly, SCD participants, but not controls, with low diurnal variation scored lowest on processing speed (PSI) and perceptual reasoning index (PRI). A moderator analysis revealed that the effect of morning cortisol and diurnal cortisol ratio on PRI by group health (i.e., SCD and healthy controls) depended on sleep quality. Discussion Sleep and cortisol may play a crucial role in the expression of cognitive difficulties seen in SCD. This should be considered for the development of interventions to optimise cognitive functioning and sleep. This, in turn, could positively impact on secretion of cortisol and general health in SCD. We examined sleep patterns, cortisol and cognition in 27 participants with Sickle Cell Disease (SCD) and 18 healthy controls. People with SCD had lower cognitive scores compared to healthy controls. People with SCD took longer to fall asleep, had greater wake bouts, mobile minutes, and fragmented sleep. People with SCD experienced a flattened diurnal cortisol profile. Sleep disturbances might interfere with diurnal cortisol rhythm and contribute to lower cognitive scores .
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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
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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
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10
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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.
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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
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11
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Saulsberry-Abate AC, Partanen M, Porter JS, Podila PSB, Hodges JR, King AA, Wang WC, Schreiber JE, Zhao X, Kang G, Jacola LM, Hankins JS. Cognitive performance as a predictor of healthcare transition in sickle cell disease. Br J Haematol 2021; 192:1082-1091. [PMID: 33570182 DOI: 10.1111/bjh.17351] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 01/06/2021] [Indexed: 12/21/2022]
Abstract
Neurocognitive deficits in sickle cell disease (SCD) may impair adult care engagement. We investigated the relationship between neurocognitive functioning and socio-environmental factors with healthcare transition outcomes. Adolescents aged 15-18 years who had neurocognitive testing and completed a visit with an adult provider were included. Transition outcomes included transfer interval from paediatric to adult care and retention in adult care at 12 and 24 months. Eighty adolescents (59% male, 64% HbSS/HbSβ0 -thalassaemia) were included. Mean age at adult care transfer was 18·0 (±0·3) years and transfer interval was 2·0 (±2·3) months. Higher IQ (P = 0·02; PFDR = 0·05) and higher verbal comprehension (P = 0·008; PFDR = 0·024) were associated with <2 and <6 month transfer intervals respectively. Better performance on measures of attention was associated with higher adult care retention at 12 and 24 months (P = 0·009; PFDR = 0·05 and P = 0·04; PFDR = 0·12 respectively). Transfer intervals <6 months were associated with smaller households (P = 0·02; PFDR = 0·06) and households with fewer children (P = 0·02; PFDR = 0·06). Having a working parent was associated with less retention in adult care at 12 and 24 months (P = 0·01; P = 0·02 respectively). Lower IQ, verbal comprehension, attention difficulties and environmental factors may negatively impact transition outcomes. Neurocognitive function should be considered in transition planning for youth with SCD.
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Affiliation(s)
| | - Marita Partanen
- Princess Maxima Center for Pediatric Oncology, Heidelberglaan, The Netherlands
| | - Jerlym S Porter
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Pradeep S B Podila
- Methodist Comprehensive Sickle Cell Center, Methodist University Hospital, Memphis, TN, USA
| | - Jason R Hodges
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Allison A King
- Program in Occupational Therapy and Departments of Pediatrics and Medicine, Washington University, St. Louis, MO, USA
| | - Winfred C Wang
- Department of 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
| | - Xiwen Zhao
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Guolian Kang
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Lisa M Jacola
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Jane S Hankins
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, TN, USA
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12
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Martin S, Roderick MC, Abel C, Wolters P, Tamula MA, Fitzhugh C, Hsieh M, Tisdale J. Neurocognitive functioning in symptomatic adults with sickle cell disease: A description and comparison with unaffected siblings. Neuropsychol Rehabil 2020; 30:1666-1681. [PMID: 30924397 PMCID: PMC8493482 DOI: 10.1080/09602011.2019.1598876] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 03/19/2019] [Indexed: 10/27/2022]
Abstract
Children and adults with sickle cell disease (SCD) are at risk for neuropsychological deficits; however, the neurocognitive functioning of adults with SCD and related comorbidities has not been widely reported in the literature. We examined specific cognitive domains in symptomatic adults with SCD and compared them with their unaffected siblings. We also examined relationships between cognitive scores, patient-reported outcomes (PROs), and medical/laboratory values. Thirty patient-sibling pairs (M patient age = 32.5 years, M sibling age = 32.1 years) completed evaluations as part of a medical clinical trial (NCT00061568). All patient and sibling neurocognitive test scores were within normal limits. Patients scored significantly lower (M = 91.0 ± 11.3) than their siblings (M = 100.6 ± 12.3; t = -3.5, p < .01) on the Wechsler Processing Speed Index. They also indicated more problems than siblings on an executive functioning questionnaire, although these differences were nonsignificant after accounting for depressive symptoms. Higher fetal hemoglobin and lower creatinine correlated with better scores on particular cognitive and PRO measures. In summary, our sample of adults with symptomatic SCD demonstrated worse processing speed and experience more executive challenges than their siblings, despite treatment with hydroxyurea. These relative weakness likely relate to disease processes but the specific physiological mechanism is unclear.
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Affiliation(s)
- Staci Martin
- Pediatric Oncology Branch, National Cancer Institute, 9030 Old Georgetown Road, Bldg 82, Bethesda, MD, USA
| | - Marie Claire Roderick
- Pediatric Oncology Branch, National Cancer Institute, 9030 Old Georgetown Road, Bldg 82, Bethesda, MD, USA
| | - Cristina Abel
- Pediatric Oncology Branch, National Cancer Institute, 9030 Old Georgetown Road, Bldg 82, Bethesda, MD, USA
| | - Pamela Wolters
- Pediatric Oncology Branch, National Cancer Institute, 9030 Old Georgetown Road, Bldg 82, Bethesda, MD, USA
| | - Mary Anne Tamula
- Clinical Research Directorate/Clinical Monitoring Research Program, Leidos Biomedical Research Inc., NCI Campus at Frederick, Frederick, MD 21702
| | - Courtney Fitzhugh
- Molecular and Clinical Hematology Branch, National Heart Lung and Blood Institute, 9000 Rockville Pike, Bldg 10, Bethesda, MD 20892, USA
- Hematology Branch, National Heart Lung and Blood Institute, 9000 Rockville Pike, Bldg 10, Bethesda, MD 20892, USA
| | - Matthew Hsieh
- Molecular and Clinical Hematology Branch, National Heart Lung and Blood Institute, 9000 Rockville Pike, Bldg 10, Bethesda, MD 20892, USA
| | - John Tisdale
- Molecular and Clinical Hematology Branch, National Heart Lung and Blood Institute, 9000 Rockville Pike, Bldg 10, Bethesda, MD 20892, USA
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13
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Stotesbury H, Kirkham FJ, Kölbel M, Balfour P, Clayden JD, Sahota S, Sakaria S, Saunders DE, Howard J, Kesse-Adu R, Inusa B, Pelidis M, Chakravorty S, Rees DC, Awogbade M, Wilkey O, Layton M, Clark CA, Kawadler JM. White matter integrity and processing speed in sickle cell anemia. Neurology 2018; 90:e2042-e2050. [PMID: 29752305 PMCID: PMC5993179 DOI: 10.1212/wnl.0000000000005644] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 03/14/2018] [Indexed: 11/15/2022] Open
Abstract
Objective The purpose of this retrospective cross-sectional study was to investigate whether changes in white matter integrity are related to slower processing speed in sickle cell anemia. Methods Thirty-seven patients with silent cerebral infarction, 46 patients with normal MRI, and 32 sibling controls (age range 8–37 years) underwent cognitive assessment using the Wechsler scales and 3-tesla MRI. Tract-based spatial statistics analyses of diffusion tensor imaging (DTI) and neurite orientation dispersion and density imaging (NODDI) parameters were performed. Results Processing speed index (PSI) was lower in patients than controls by 9.34 points (95% confidence interval: 4.635–14.855, p = 0.0003). Full Scale IQ was lower by 4.14 scaled points (95% confidence interval: −1.066 to 9.551, p = 0.1), but this difference was abolished when PSI was included as a covariate (p = 0.18). There were no differences in cognition between patients with and without silent cerebral infarction, and both groups had lower PSI than controls (both p < 0.001). In patients, arterial oxygen content, socioeconomic status, age, and male sex were identified as predictors of PSI, and correlations were found between PSI and DTI scalars (fractional anisotropy r = 0.614, p < 0.00001; r = −0.457, p < 0.00001; mean diffusivity r = −0.341, p = 0.0016; radial diffusivity r = −0.457, p < 0.00001) and NODDI parameters (intracellular volume fraction r = 0.364, p = 0.0007) in widespread regions. Conclusion Our results extend previous reports of impairment that is independent of presence of infarction and may worsen with age. We identify processing speed as a vulnerable domain, with deficits potentially mediating difficulties across other domains, and provide evidence that reduced processing speed is related to the integrity of normal-appearing white matter using microstructure parameters from DTI and NODDI.
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Affiliation(s)
- Hanne Stotesbury
- From Developmental Neurosciences (H.S., F.J.K., M.K., P.B., J.D.C., S. Sahota, S. Sakaria, C.A.C., J.M.K.), UCL Great Ormond Street Institute of Child Health, London; University Hospital Southampton NHS Foundation Trust (F.J.K.); Clinical and Experimental Sciences (F.J.K.), University of Southampton; Department of Radiology (D.E.S.), Great Ormond Street Hospital NHS Foundation Trust, London; Department of Haematology and Evelina Children's Hospital (J.H., R.K.-A., B.I., M.P.), Guy's and St Thomas' NHS Foundation Trust, London; King's College Hospital NHS Foundation Trust (S.C., D.C.R., M.A.), London; North Middlesex University Hospital NHS Foundation Trust (O.W.), London; and Department of Haematology (M.L.), Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Fenella J Kirkham
- From Developmental Neurosciences (H.S., F.J.K., M.K., P.B., J.D.C., S. Sahota, S. Sakaria, C.A.C., J.M.K.), UCL Great Ormond Street Institute of Child Health, London; University Hospital Southampton NHS Foundation Trust (F.J.K.); Clinical and Experimental Sciences (F.J.K.), University of Southampton; Department of Radiology (D.E.S.), Great Ormond Street Hospital NHS Foundation Trust, London; Department of Haematology and Evelina Children's Hospital (J.H., R.K.-A., B.I., M.P.), Guy's and St Thomas' NHS Foundation Trust, London; King's College Hospital NHS Foundation Trust (S.C., D.C.R., M.A.), London; North Middlesex University Hospital NHS Foundation Trust (O.W.), London; and Department of Haematology (M.L.), Imperial College Healthcare NHS Foundation Trust, London, UK.
| | - Melanie Kölbel
- From Developmental Neurosciences (H.S., F.J.K., M.K., P.B., J.D.C., S. Sahota, S. Sakaria, C.A.C., J.M.K.), UCL Great Ormond Street Institute of Child Health, London; University Hospital Southampton NHS Foundation Trust (F.J.K.); Clinical and Experimental Sciences (F.J.K.), University of Southampton; Department of Radiology (D.E.S.), Great Ormond Street Hospital NHS Foundation Trust, London; Department of Haematology and Evelina Children's Hospital (J.H., R.K.-A., B.I., M.P.), Guy's and St Thomas' NHS Foundation Trust, London; King's College Hospital NHS Foundation Trust (S.C., D.C.R., M.A.), London; North Middlesex University Hospital NHS Foundation Trust (O.W.), London; and Department of Haematology (M.L.), Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Philippa Balfour
- From Developmental Neurosciences (H.S., F.J.K., M.K., P.B., J.D.C., S. Sahota, S. Sakaria, C.A.C., J.M.K.), UCL Great Ormond Street Institute of Child Health, London; University Hospital Southampton NHS Foundation Trust (F.J.K.); Clinical and Experimental Sciences (F.J.K.), University of Southampton; Department of Radiology (D.E.S.), Great Ormond Street Hospital NHS Foundation Trust, London; Department of Haematology and Evelina Children's Hospital (J.H., R.K.-A., B.I., M.P.), Guy's and St Thomas' NHS Foundation Trust, London; King's College Hospital NHS Foundation Trust (S.C., D.C.R., M.A.), London; North Middlesex University Hospital NHS Foundation Trust (O.W.), London; and Department of Haematology (M.L.), Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Jonathan D Clayden
- From Developmental Neurosciences (H.S., F.J.K., M.K., P.B., J.D.C., S. Sahota, S. Sakaria, C.A.C., J.M.K.), UCL Great Ormond Street Institute of Child Health, London; University Hospital Southampton NHS Foundation Trust (F.J.K.); Clinical and Experimental Sciences (F.J.K.), University of Southampton; Department of Radiology (D.E.S.), Great Ormond Street Hospital NHS Foundation Trust, London; Department of Haematology and Evelina Children's Hospital (J.H., R.K.-A., B.I., M.P.), Guy's and St Thomas' NHS Foundation Trust, London; King's College Hospital NHS Foundation Trust (S.C., D.C.R., M.A.), London; North Middlesex University Hospital NHS Foundation Trust (O.W.), London; and Department of Haematology (M.L.), Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Sati Sahota
- From Developmental Neurosciences (H.S., F.J.K., M.K., P.B., J.D.C., S. Sahota, S. Sakaria, C.A.C., J.M.K.), UCL Great Ormond Street Institute of Child Health, London; University Hospital Southampton NHS Foundation Trust (F.J.K.); Clinical and Experimental Sciences (F.J.K.), University of Southampton; Department of Radiology (D.E.S.), Great Ormond Street Hospital NHS Foundation Trust, London; Department of Haematology and Evelina Children's Hospital (J.H., R.K.-A., B.I., M.P.), Guy's and St Thomas' NHS Foundation Trust, London; King's College Hospital NHS Foundation Trust (S.C., D.C.R., M.A.), London; North Middlesex University Hospital NHS Foundation Trust (O.W.), London; and Department of Haematology (M.L.), Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Simrat Sakaria
- From Developmental Neurosciences (H.S., F.J.K., M.K., P.B., J.D.C., S. Sahota, S. Sakaria, C.A.C., J.M.K.), UCL Great Ormond Street Institute of Child Health, London; University Hospital Southampton NHS Foundation Trust (F.J.K.); Clinical and Experimental Sciences (F.J.K.), University of Southampton; Department of Radiology (D.E.S.), Great Ormond Street Hospital NHS Foundation Trust, London; Department of Haematology and Evelina Children's Hospital (J.H., R.K.-A., B.I., M.P.), Guy's and St Thomas' NHS Foundation Trust, London; King's College Hospital NHS Foundation Trust (S.C., D.C.R., M.A.), London; North Middlesex University Hospital NHS Foundation Trust (O.W.), London; and Department of Haematology (M.L.), Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Dawn E Saunders
- From Developmental Neurosciences (H.S., F.J.K., M.K., P.B., J.D.C., S. Sahota, S. Sakaria, C.A.C., J.M.K.), UCL Great Ormond Street Institute of Child Health, London; University Hospital Southampton NHS Foundation Trust (F.J.K.); Clinical and Experimental Sciences (F.J.K.), University of Southampton; Department of Radiology (D.E.S.), Great Ormond Street Hospital NHS Foundation Trust, London; Department of Haematology and Evelina Children's Hospital (J.H., R.K.-A., B.I., M.P.), Guy's and St Thomas' NHS Foundation Trust, London; King's College Hospital NHS Foundation Trust (S.C., D.C.R., M.A.), London; North Middlesex University Hospital NHS Foundation Trust (O.W.), London; and Department of Haematology (M.L.), Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Jo Howard
- From Developmental Neurosciences (H.S., F.J.K., M.K., P.B., J.D.C., S. Sahota, S. Sakaria, C.A.C., J.M.K.), UCL Great Ormond Street Institute of Child Health, London; University Hospital Southampton NHS Foundation Trust (F.J.K.); Clinical and Experimental Sciences (F.J.K.), University of Southampton; Department of Radiology (D.E.S.), Great Ormond Street Hospital NHS Foundation Trust, London; Department of Haematology and Evelina Children's Hospital (J.H., R.K.-A., B.I., M.P.), Guy's and St Thomas' NHS Foundation Trust, London; King's College Hospital NHS Foundation Trust (S.C., D.C.R., M.A.), London; North Middlesex University Hospital NHS Foundation Trust (O.W.), London; and Department of Haematology (M.L.), Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Rachel Kesse-Adu
- From Developmental Neurosciences (H.S., F.J.K., M.K., P.B., J.D.C., S. Sahota, S. Sakaria, C.A.C., J.M.K.), UCL Great Ormond Street Institute of Child Health, London; University Hospital Southampton NHS Foundation Trust (F.J.K.); Clinical and Experimental Sciences (F.J.K.), University of Southampton; Department of Radiology (D.E.S.), Great Ormond Street Hospital NHS Foundation Trust, London; Department of Haematology and Evelina Children's Hospital (J.H., R.K.-A., B.I., M.P.), Guy's and St Thomas' NHS Foundation Trust, London; King's College Hospital NHS Foundation Trust (S.C., D.C.R., M.A.), London; North Middlesex University Hospital NHS Foundation Trust (O.W.), London; and Department of Haematology (M.L.), Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Baba Inusa
- From Developmental Neurosciences (H.S., F.J.K., M.K., P.B., J.D.C., S. Sahota, S. Sakaria, C.A.C., J.M.K.), UCL Great Ormond Street Institute of Child Health, London; University Hospital Southampton NHS Foundation Trust (F.J.K.); Clinical and Experimental Sciences (F.J.K.), University of Southampton; Department of Radiology (D.E.S.), Great Ormond Street Hospital NHS Foundation Trust, London; Department of Haematology and Evelina Children's Hospital (J.H., R.K.-A., B.I., M.P.), Guy's and St Thomas' NHS Foundation Trust, London; King's College Hospital NHS Foundation Trust (S.C., D.C.R., M.A.), London; North Middlesex University Hospital NHS Foundation Trust (O.W.), London; and Department of Haematology (M.L.), Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Maria Pelidis
- From Developmental Neurosciences (H.S., F.J.K., M.K., P.B., J.D.C., S. Sahota, S. Sakaria, C.A.C., J.M.K.), UCL Great Ormond Street Institute of Child Health, London; University Hospital Southampton NHS Foundation Trust (F.J.K.); Clinical and Experimental Sciences (F.J.K.), University of Southampton; Department of Radiology (D.E.S.), Great Ormond Street Hospital NHS Foundation Trust, London; Department of Haematology and Evelina Children's Hospital (J.H., R.K.-A., B.I., M.P.), Guy's and St Thomas' NHS Foundation Trust, London; King's College Hospital NHS Foundation Trust (S.C., D.C.R., M.A.), London; North Middlesex University Hospital NHS Foundation Trust (O.W.), London; and Department of Haematology (M.L.), Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Subarna Chakravorty
- From Developmental Neurosciences (H.S., F.J.K., M.K., P.B., J.D.C., S. Sahota, S. Sakaria, C.A.C., J.M.K.), UCL Great Ormond Street Institute of Child Health, London; University Hospital Southampton NHS Foundation Trust (F.J.K.); Clinical and Experimental Sciences (F.J.K.), University of Southampton; Department of Radiology (D.E.S.), Great Ormond Street Hospital NHS Foundation Trust, London; Department of Haematology and Evelina Children's Hospital (J.H., R.K.-A., B.I., M.P.), Guy's and St Thomas' NHS Foundation Trust, London; King's College Hospital NHS Foundation Trust (S.C., D.C.R., M.A.), London; North Middlesex University Hospital NHS Foundation Trust (O.W.), London; and Department of Haematology (M.L.), Imperial College Healthcare NHS Foundation Trust, London, UK
| | - David C Rees
- From Developmental Neurosciences (H.S., F.J.K., M.K., P.B., J.D.C., S. Sahota, S. Sakaria, C.A.C., J.M.K.), UCL Great Ormond Street Institute of Child Health, London; University Hospital Southampton NHS Foundation Trust (F.J.K.); Clinical and Experimental Sciences (F.J.K.), University of Southampton; Department of Radiology (D.E.S.), Great Ormond Street Hospital NHS Foundation Trust, London; Department of Haematology and Evelina Children's Hospital (J.H., R.K.-A., B.I., M.P.), Guy's and St Thomas' NHS Foundation Trust, London; King's College Hospital NHS Foundation Trust (S.C., D.C.R., M.A.), London; North Middlesex University Hospital NHS Foundation Trust (O.W.), London; and Department of Haematology (M.L.), Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Moji Awogbade
- From Developmental Neurosciences (H.S., F.J.K., M.K., P.B., J.D.C., S. Sahota, S. Sakaria, C.A.C., J.M.K.), UCL Great Ormond Street Institute of Child Health, London; University Hospital Southampton NHS Foundation Trust (F.J.K.); Clinical and Experimental Sciences (F.J.K.), University of Southampton; Department of Radiology (D.E.S.), Great Ormond Street Hospital NHS Foundation Trust, London; Department of Haematology and Evelina Children's Hospital (J.H., R.K.-A., B.I., M.P.), Guy's and St Thomas' NHS Foundation Trust, London; King's College Hospital NHS Foundation Trust (S.C., D.C.R., M.A.), London; North Middlesex University Hospital NHS Foundation Trust (O.W.), London; and Department of Haematology (M.L.), Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Olu Wilkey
- From Developmental Neurosciences (H.S., F.J.K., M.K., P.B., J.D.C., S. Sahota, S. Sakaria, C.A.C., J.M.K.), UCL Great Ormond Street Institute of Child Health, London; University Hospital Southampton NHS Foundation Trust (F.J.K.); Clinical and Experimental Sciences (F.J.K.), University of Southampton; Department of Radiology (D.E.S.), Great Ormond Street Hospital NHS Foundation Trust, London; Department of Haematology and Evelina Children's Hospital (J.H., R.K.-A., B.I., M.P.), Guy's and St Thomas' NHS Foundation Trust, London; King's College Hospital NHS Foundation Trust (S.C., D.C.R., M.A.), London; North Middlesex University Hospital NHS Foundation Trust (O.W.), London; and Department of Haematology (M.L.), Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Mark Layton
- From Developmental Neurosciences (H.S., F.J.K., M.K., P.B., J.D.C., S. Sahota, S. Sakaria, C.A.C., J.M.K.), UCL Great Ormond Street Institute of Child Health, London; University Hospital Southampton NHS Foundation Trust (F.J.K.); Clinical and Experimental Sciences (F.J.K.), University of Southampton; Department of Radiology (D.E.S.), Great Ormond Street Hospital NHS Foundation Trust, London; Department of Haematology and Evelina Children's Hospital (J.H., R.K.-A., B.I., M.P.), Guy's and St Thomas' NHS Foundation Trust, London; King's College Hospital NHS Foundation Trust (S.C., D.C.R., M.A.), London; North Middlesex University Hospital NHS Foundation Trust (O.W.), London; and Department of Haematology (M.L.), Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Christopher A Clark
- From Developmental Neurosciences (H.S., F.J.K., M.K., P.B., J.D.C., S. Sahota, S. Sakaria, C.A.C., J.M.K.), UCL Great Ormond Street Institute of Child Health, London; University Hospital Southampton NHS Foundation Trust (F.J.K.); Clinical and Experimental Sciences (F.J.K.), University of Southampton; Department of Radiology (D.E.S.), Great Ormond Street Hospital NHS Foundation Trust, London; Department of Haematology and Evelina Children's Hospital (J.H., R.K.-A., B.I., M.P.), Guy's and St Thomas' NHS Foundation Trust, London; King's College Hospital NHS Foundation Trust (S.C., D.C.R., M.A.), London; North Middlesex University Hospital NHS Foundation Trust (O.W.), London; and Department of Haematology (M.L.), Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Jamie M Kawadler
- From Developmental Neurosciences (H.S., F.J.K., M.K., P.B., J.D.C., S. Sahota, S. Sakaria, C.A.C., J.M.K.), UCL Great Ormond Street Institute of Child Health, London; University Hospital Southampton NHS Foundation Trust (F.J.K.); Clinical and Experimental Sciences (F.J.K.), University of Southampton; Department of Radiology (D.E.S.), Great Ormond Street Hospital NHS Foundation Trust, London; Department of Haematology and Evelina Children's Hospital (J.H., R.K.-A., B.I., M.P.), Guy's and St Thomas' NHS Foundation Trust, London; King's College Hospital NHS Foundation Trust (S.C., D.C.R., M.A.), London; North Middlesex University Hospital NHS Foundation Trust (O.W.), London; and Department of Haematology (M.L.), Imperial College Healthcare NHS Foundation Trust, London, UK
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14
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Howard J, Slee AE, Skene S, Inusa B, Kawadler J, Downes M, Gavlak J, Koelbel M, Stotesbury H, Chorozoglou M, Tebbs S, Chakravorty S, Awogbade M, Rees DC, Gupta A, Murphy PB, Hart N, Sahota S, Nwosu C, Gwam M, Saunders D, Muthurangu V, Barber N, Ako E, Thein SL, Marshall M, Reading IC, Cheng MYE, Kirkham FJ, Liossi C. Overnight auto-adjusting continuous airway pressure + standard care compared with standard care alone in the prevention of morbidity in sickle cell disease phase II (POMS2b): study protocol for a randomised controlled trial. Trials 2018; 19:55. [PMID: 29357947 PMCID: PMC5778753 DOI: 10.1186/s13063-017-2419-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 12/14/2017] [Indexed: 11/29/2022] Open
Abstract
Background In addition to pain, sickle cell anaemia (HbSS) complications include neurocognitive difficulties in attention and processing speed associated with low daytime and night-time oxygen saturation compounded by obstructive sleep apnoea (OSA). In the general population OSA is treated with continuous positive airways pressure (CPAP). The aim of this single-blind, randomised, controlled phase II trial is to compare auto-adjusting CPAP (APAP) with standard care to standard care alone in individuals with HbSS to determine whether the intervention improves attention and processing speed, brain structure, pain and quality of life. Methods/Design Eligibility criteria include: ability to provide informed consent; age > 8 years; diagnosis of HbSS; and mean overnight saturation of < 90% for < 30% of the night (i.e. not meeting current criteria for overnight oxygen therapy). Key exclusion criteria are: overnight respiratory support; respiratory or decompensated cardiac failure; chronic transfusion; or contraindications to APAP therapy or magnetic resonance imaging (MRI). Sixty individuals with HbSS (30 children and 30 adults) will be randomised to standard care + APAP or standard care alone for six months. Minimisation factors are: age group (8–11, 12–15, 16–22 and > 23 years); silent infarction on MRI; minimum overnight oxygen saturation > 90% or < 90%; and hydroxyurea use. For APAP individuals, the intervention is administered at home. Adherence and effectiveness are recorded using software documenting hours of use each night and overnight oximetry. Participant support in terms of appropriate facemask and facilitating adherence are provided by an unblinded sleep physiologist. The primary outcome is change in the cancellation subtest from the Wechsler scales. Secondary outcomes include general cognitive functioning, quantitative brain MRI, blood and urine chemistry, quality of life and daily pain via a smartphone App (GoMedSolutions, Inc) and, where possible MRI heart, echocardiography, and 6-min walk. These outcomes will be assessed at baseline and after six months of treatment by assessors blind to treatment assignment. Discussion Altering oxygen saturation in HbSS may lead to bone marrow suppression. This risk will be reduced by monitoring full blood counts at baseline, two weeks, three months and six months, providing treatment as appropriate and reporting as safety events. Trial registration ISRCTN46012373. Registered on 10 July 2015. Protocol Version: 6.0 Date: 24th December 2015 Sponsor: University Hospital Southampton. Sponsor’s protocol code: RHMCHIOT53
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Affiliation(s)
- Jo Howard
- Department of Haematology, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK
| | - April E Slee
- Comprehensive Clinical Trials Unit at UCL, London, UK
| | - Simon Skene
- Comprehensive Clinical Trials Unit at UCL, London, UK
| | - Baba Inusa
- Evelina Children's Hospital, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK
| | - Jamie Kawadler
- London, UCL GOSH Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Michelle Downes
- London, UCL GOSH Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Johanna Gavlak
- London, UCL GOSH Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK.,Department of Child Health, University Hospital Southampton, Tremona Road, Southampton, SO16 6YD, UK
| | - Melanie Koelbel
- London, UCL GOSH Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Hanne Stotesbury
- London, UCL GOSH Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | | | - Susan Tebbs
- Comprehensive Clinical Trials Unit at UCL, London, UK
| | | | | | - David C Rees
- King's College Hospital, London, UK.,King's College London, London, UK
| | - Atul Gupta
- Evelina Children's Hospital, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK.,King's College Hospital, London, UK.,King's College London, London, UK
| | - Patrick B Murphy
- King's College London, London, UK.,Lane Fox Respiratory Unit, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK
| | - Nicholas Hart
- King's College London, London, UK.,Lane Fox Respiratory Unit, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK
| | - Sati Sahota
- London, UCL GOSH Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Carol Nwosu
- Sickle Cell and Young Stroke Survivors Charity, London, UK
| | - Maureen Gwam
- Sickle Cell and Young Stroke Survivors Charity, London, UK
| | - Dawn Saunders
- London, UCL GOSH Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Vivek Muthurangu
- London, UCL GOSH Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK.,Centre for Translational Cardiovascular Imaging, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Nathaniel Barber
- London, UCL GOSH Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK.,Centre for Translational Cardiovascular Imaging, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Emmanuel Ako
- London, UCL GOSH Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK.,Centre for Translational Cardiovascular Imaging, UCL Great Ormond Street Institute of Child Health, London, UK
| | | | | | - Isabel C Reading
- University of Southampton, Southampton, UK.,Research Design Service, University Hospital Southampton, Southampton, UK
| | - Man Ying Edith Cheng
- University of Southampton, Southampton, UK.,Research Design Service, University Hospital Southampton, Southampton, UK
| | - Fenella J Kirkham
- London, UCL GOSH Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK. .,Department of Child Health, University Hospital Southampton, Tremona Road, Southampton, SO16 6YD, UK. .,University of Southampton, Southampton, UK.
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15
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Disease severity and slower psychomotor speed in adults with sickle cell disease. Blood Adv 2017; 1:1790-1795. [PMID: 29296825 DOI: 10.1182/bloodadvances.2017008219] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 08/16/2017] [Indexed: 11/20/2022] Open
Abstract
Psychomotor slowing is common in children with sickle cell disease (SCD), but little is known about its severity in adults. We conducted a cross-sectional study to quantify psychomotor speed, measured with the digit symbol substitution test (DSST), in relationship with disease severity in adults with SCD attending an outpatient clinic (n = 88, age 36.3 years). Genotype was used to group patients in "severe" (homozygous for hemoglobin S or compound heterozygous with β0 thalassemia) or "moderate" groups (compound heterozygous for HbS, with either HbC or β+ thalassemia). Analyses were repeated after exclusion of patients with a history of stroke (n = 11). Mild impairment in processing speed was detectable in both the "severe" and the "moderate" group (30% and 9%, respectively; age-adjusted P = .14). Compared with the "moderate" group, those in the "severe" group had significantly lower standardized DSST scores (P = .004), independent of adjustment for factors that differed between the groups: hemoglobin, ferritin, hydroxyurea use, blood pressure parameters, and stroke history. Results were similar after excluding patients with stroke. Psychomotor slowing in SCD differs in relationship to genotype; this difference appears unrelated to history of stroke or severity of anemia and other risk factors examined cross-sectionally. Although less prevalent, mild cognitive impairment was also detectable in patients with a less severe genotype. Longitudinal studies of SCD should include all diseases genotypes and examine factors that would reduce the risk of slow processing speed and perhaps more general cognitive impairment in each subgroup.
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16
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Lyon DE, Cohen R, Chen H, Kelly DL, McCain NL, Starkweather A, Ahn H, Sturgill J, Jackson-Cook CK. Relationship of systemic cytokine concentrations to cognitive function over two years in women with early stage breast cancer. J Neuroimmunol 2016; 301:74-82. [PMID: 27890459 PMCID: PMC5181109 DOI: 10.1016/j.jneuroim.2016.11.002] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 11/04/2016] [Accepted: 11/11/2016] [Indexed: 12/12/2022]
Abstract
Cancer and its treatment are frequently associated with cancer-related cognitive impairment (CRCI). While CRCI has been associated with linked to chemotherapy, there is increasing evidence that the condition may start prior to treatment and for some, remain unresolved after active treatment and into survivorship. Although the pathophysiology of the condition is complex, alterations in systemic cytokines, signaling molecules activated in response to infection or injury that trigger inflammation, are a possible mechanism linked to cognitive dysfunction in breast cancer and other conditions. Given the conflicting results in the literature, the lack of focus on domain specific cognitive testing, and the need for a longer time period given the multiple modalities of standard treatments for early-stage breast cancer, this longitudinal study was conducted to address these gaps. METHODS We assessed 75 women with early-stage breast cancer at five points over two years, starting prior to the initial chemotherapy through 24months after chemotherapy initiation. Measures included a validated computerized evaluation of domain-specific cognitive functioning and a 17-plex panel of plasma cytokines. Linear mixed-effects models were applied to test the relationships of clinical variables and cytokine concentrations to each cognitive domain. RESULTS Levels and patterns of cytokine concentrations varied over time: six of the 17 cytokines (IL-6, IL-12, IL-17, G-CSF, MIPS-1β, and MCP-1) had the most variability. Some cytokine levels (e.g., IL-6) increased during chemotherapy but then decreased subsequently, while others (e.g., IL-17) consistently declined from baseline over time. There were multiple relationships among cytokines and cognition, which varied over time. At baseline, elevated concentrations of G-CSF and reduced concentrations of IL-17 were associated with faster psychomotor speed. At the second time-point (prior to the mid-chemotherapy), multiple cytokines had significant associations with psychomotor speed, complex attention, executive function, verbal memory, cognitive flexibility, composite memory and visual memory. Six months after chemotherapy initiation and at the one-year point, there were multiple, significant relationships among cytokines and multiple cognitive. At two years, fewer significant relationships were noted; however, lower concentrations of IL-7, a hematopoietic cytokine, were associated with better psychomotor speed, complex attention, and memory (composite, verbal and visual). MCP-1 was inversely associated with psychomotor speed and complex attention and higher levels of MIP-1β were related to better complex attention. CONCLUSION Levels and patterns of cytokines changed over time and demonstrated associations with domain-specific cognitive functioning that varied over time. The observed associations between cytokines and cognitive performance provides evidence that not only prototypical cytokines (i.e., IL-6, TNF-α, and IL1-β) but also cytokines from multiple classes may contribute to the inflammatory environment that is associated with cognitive dysfunction. Future studies to better delineate the cytokine changes, both individually and in networks, are needed to precisely assess a mechanistic link between cytokines and cognitive function in women receiving treatments for breast cancer.
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Affiliation(s)
- Debra E Lyon
- University of Florida, College of Nursing, United States.
| | - Ronald Cohen
- Center for Cognitive Aging and Memory, University of Florida, Institute on Aging, United States.
| | - Huaihou Chen
- College of Public Health & Health Professions, College of Medicine, University of Florida, United States.
| | - Debra L Kelly
- University of Florida, College of Nursing, United States.
| | - Nancy L McCain
- Adult Health and Nursing Systems, Virginia Commonwealth University, United States.
| | - Angela Starkweather
- Center for Advancement in Managing Pain, University of Connecticut, School of Nursing, United States.
| | - Hyochol Ahn
- University of Texas Health Science Center at Houston, United States
| | - Jamie Sturgill
- Biobehavioral Laboratory Services, Department of Family and Community Health Nursing, Virginia Commonwealth University, United States.
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17
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Lyon DE, Cohen R, Chen H, Kelly DL, Starkweather A, Ahn HC, Jackson-Cook CK. The relationship of cognitive performance to concurrent symptoms, cancer- and cancer-treatment-related variables in women with early-stage breast cancer: a 2-year longitudinal study. J Cancer Res Clin Oncol 2016; 142:1461-74. [PMID: 27102492 DOI: 10.1007/s00432-016-2163-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 04/11/2016] [Indexed: 12/30/2022]
Abstract
PURPOSE Cognitive dysfunction in women with breast cancer continues to be an area of intense research interest. The prevalence, severity, timing, and cognitive domains that are most affected, as well as the contribution of cancer and its treatments to cognition, remain unresolved. Thus, longitudinal studies are needed that examine cognitive function during different stages of breast cancer treatment and survivorship. This longitudinal trial followed women with early-stage breast cancer, prior to chemotherapy through 2 years survivorship. METHODS In women with early-stage breast cancer (N = -75), performance-based assessment of nine cognitive domains was performed at five time points beginning prior to chemotherapy and finishing 24 months after initial chemotherapy. Linear mixed effects models were used to examine the temporal changes in cognitive performance domains, while adjusting for cofactors, including those related to individuals, tumor attributes, chemotherapy (adjuvant or neoadjuvant), radiation, endocrine therapy, and concurrent symptoms. RESULTS At baseline, scores on reaction time, complex attention, cognitive flexibility, executive function, and visual memory were lower than 90. At 2 years, all domains improved except for the memory domains (verbal, visual, and composite). Scores on six domains (psychomotor speed, reaction time, complex attention, cognitive flexibility, and visual memory) remained lower than 100 at 2 years. Neoadjuvant chemotherapy and fatigue had strong inverse relationship with cognitive functioning at multiple time points. CONCLUSION The low performance-based cognitive scores at baseline and over time warrant further study. Although most scores improved over time, memory did not improve. In all, the level of cognitive function is lower than expected for a majority college-educated sample. Thus, future studies are warranted to replicate these findings and to develop methods for identifying women with cognitive dysfunction pretreatment and into survivorship.
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Affiliation(s)
| | | | | | | | - Angela Starkweather
- University of Connecticut, Storrs Hall, Room 112B, 231 Glenbrook Road, Unit 4026, Storrs, CT, 06269, USA
| | | | - Colleen K Jackson-Cook
- School of Medicine, Virginia Commonwealth University, 1101 E. Marshall Street, Richmond, VA, 23298-0662, USA
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18
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Wilkie DJ. Research to advance health and health care for individuals with sickle cell disease: a drop in the bucket of needed research. J Adv Nurs 2016; 72:1396-7. [PMID: 27062162 DOI: 10.1111/jan.12972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Diana J Wilkie
- Center of Excellence in Palliative Care Research, Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, Florida, USA.
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