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Mavrea K, Efthymiou V, Katsibardi K, Tsarouhas K, Kanaka-Gantenbein C, Spandidos DA, Chrousos G, Kattamis A, Bacopoulou F. Cognitive function of children and adolescent survivors of acute lymphoblastic leukemia: A meta-analysis. Oncol Lett 2021; 21:262. [PMID: 33664825 PMCID: PMC7882890 DOI: 10.3892/ol.2021.12523] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 01/14/2021] [Indexed: 11/05/2022] Open
Abstract
Pediatric cancer and its treatment may have an impact on the neurocognitive functions of childhood cancer survivors (CCS). The aim of the present meta-analysis was to compare the intelligence quotient (IQ) scores between CCS of acute lymphoblastic leukemia (ALL) and controls. A comprehensive electronic search identified original research articles that reported scores of the Wechsler Intelligence Scale (WISC; WISC-III, WISC-IV and WISC-R) for children and adolescents, aged 6-16 years at evaluation, survivors of ALL and healthy controls. The included CCS had completed anticancer treatment and were in remission at the time of assessment. A total of 16 studies were included in the meta-analysis, out of 128 extracted studies, and involved a total of 1,676 children and adolescents: 991 CCS (ALL) and 685 healthy controls. Among the studies, a random effects model revealed a moderate estimate of effect size [standardized mean difference (SMD), -0.78; 95% CI, -1.05 to -0.50], indicating that the WISC scores for total IQ were significantly lower in the CCS than in the controls. The mean total IQ range was 85.2-107.2 in the CCS and 88.4-114.1 in the controls. The difference in the mean total IQ between controls and CCS ranged from -13.8 to 20.6. As regards the WISC scores for verbal IQ, 11 studies were included. A random effects model revealed a moderate estimate of effect size (SMD, -0.71; 95% CI, -1.05 to -0.38), indicating that the WISC scores for verbal IQ were significantly lower in the CCS than in the controls. Among the 9 studies that had available data for performance IQ scores, a fixed effect model revealed a moderate estimate of effect size (SMD, -0.80; 95% CI, -1.09 to -0.52), indicating that the WISC scores for performance IQ were significantly lower in the CCS than in the controls. As the survival rates of children and adolescents with ALL are steadily increasing, regular, lifelong follow-up for neurocognitive late effects is imperative in order to improve their education and employment prospects and overall, their quality of life.
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Affiliation(s)
- Kalliopi Mavrea
- Clinic for Assessment of Adolescent Learning Difficulties, Center for Adolescent Medicine and UNESCO Chair on Adolescent Health Care, First Department of Pediatrics, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Athens 11527, Greece
| | - Vasiliki Efthymiou
- University Research Institute of Maternal and Child Health and Precision Medicine, and UNESCO Chair on Adolescent Health Care, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Athens 11527, Greece
| | - Katerina Katsibardi
- Pediatric Hematology-Oncology Unit, First Department of Pediatrics, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Athens 11527, Greece
| | | | - Christina Kanaka-Gantenbein
- Clinic for Assessment of Adolescent Learning Difficulties, Center for Adolescent Medicine and UNESCO Chair on Adolescent Health Care, First Department of Pediatrics, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Athens 11527, Greece.,University Research Institute of Maternal and Child Health and Precision Medicine, and UNESCO Chair on Adolescent Health Care, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Athens 11527, Greece
| | - Demetrios A Spandidos
- Laboratory of Clinical Virology, School of Medicine, University of Crete, Heraklion 71409, Greece
| | - George Chrousos
- University Research Institute of Maternal and Child Health and Precision Medicine, and UNESCO Chair on Adolescent Health Care, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Athens 11527, Greece
| | - Antonis Kattamis
- Pediatric Hematology-Oncology Unit, First Department of Pediatrics, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Athens 11527, Greece
| | - Flora Bacopoulou
- Clinic for Assessment of Adolescent Learning Difficulties, Center for Adolescent Medicine and UNESCO Chair on Adolescent Health Care, First Department of Pediatrics, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Athens 11527, Greece.,University Research Institute of Maternal and Child Health and Precision Medicine, and UNESCO Chair on Adolescent Health Care, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Athens 11527, Greece
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Jirayucharoensak S, Israsena P, Pan-Ngum S, Hemrungrojn S, Maes M. A game-based neurofeedback training system to enhance cognitive performance in healthy elderly subjects and in patients with amnestic mild cognitive impairment. Clin Interv Aging 2019; 14:347-360. [PMID: 30863028 PMCID: PMC6388796 DOI: 10.2147/cia.s189047] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION This study examines the clinical efficacy of a game-based neurofeedback training (NFT) system to enhance cognitive performance in patients with amnestic mild cognitive impairment (aMCI) and healthy elderly subjects. The NFT system includes five games designed to improve attention span and cognitive performance. The system estimates attention levels by investigating the power spectrum of Beta and Alpha bands. METHODS We recruited 65 women with aMCI and 54 healthy elderly women. All participants were treated with care as usual (CAU); 58 were treated with CAU + NFT (20 sessions of 30 minutes each, 2-3 sessions per week), 36 with CAU + exergame-based training, while 25 patients had only CAU. Cognitive functions were assessed using the Cambridge Neuropsychological Test Automated Battery both before and after treatment. RESULTS NFT significantly improved rapid visual processing and spatial working memory (SWM), including strategy, when compared with exergame training and no active treatment. aMCI was characterized by impairments in SWM (including strategy), pattern recognition memory, and delayed matching to samples. CONCLUSION In conclusion, treatment with NFT improves sustained attention and SWM. Nevertheless, NFT had no significant effect on pattern recognition memory and short-term visual memory, which are the other hallmarks of aMCI. The NFT system used here may selectively improve sustained attention, strategy, and executive functions, but not other cognitive impairments, which characterize aMCI in women.
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Affiliation(s)
- Suwicha Jirayucharoensak
- Neural Signal Processing Research Team, Artificial Intelligence Research Unit, National Electronics and Computer Technology Center, Pathum Thani 12120, Thailand,
- Department of Computer Engineering, Faculty of Engineering, Chulalongkorn University, Bangkok 10330, Thailand
| | - Pasin Israsena
- Neural Signal Processing Research Team, Artificial Intelligence Research Unit, National Electronics and Computer Technology Center, Pathum Thani 12120, Thailand,
| | - Setha Pan-Ngum
- Department of Computer Engineering, Faculty of Engineering, Chulalongkorn University, Bangkok 10330, Thailand
| | - Solaphat Hemrungrojn
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Michael Maes
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
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Stout NL, Silver JK, Raj VS, Rowland J, Gerber L, Cheville A, Ness KK, Radomski M, Nitkin R, Stubblefield MD, Morris GS, Acevedo A, Brandon Z, Braveman B, Cunningham S, Gilchrist L, Jones L, Padgett L, Wolf T, Winters-Stone K, Campbell G, Hendricks J, Perkin K, Chan L. Toward a National Initiative in Cancer Rehabilitation: Recommendations From a Subject Matter Expert Group. Arch Phys Med Rehabil 2016; 97:2006-2015. [DOI: 10.1016/j.apmr.2016.05.002] [Citation(s) in RCA: 122] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 05/17/2016] [Accepted: 05/18/2016] [Indexed: 11/29/2022]
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Neurofeedback ineffective in paediatric brain tumour survivors: Results of a double-blind randomised placebo-controlled trial. Eur J Cancer 2016; 64:62-73. [DOI: 10.1016/j.ejca.2016.04.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 03/23/2016] [Accepted: 04/24/2016] [Indexed: 11/20/2022]
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de Ruiter MA, Schouten-van Meeteren AYN, van Vuurden DG, Maurice-Stam H, Gidding C, Beek LR, Granzen B, Oosterlaan J, Grootenhuis MA. Psychosocial profile of pediatric brain tumor survivors with neurocognitive complaints. Qual Life Res 2016; 25:435-446. [PMID: 26289022 PMCID: PMC4722086 DOI: 10.1007/s11136-015-1091-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2015] [Indexed: 10/25/2022]
Abstract
PURPOSE With more children surviving a brain tumor, neurocognitive consequences of the tumor and its treatment become apparent, which could affect psychosocial functioning. The present study therefore aimed to assess psychosocial functioning of pediatric brain tumor survivors (PBTS) in detail. METHODS Psychosocial functioning of PBTS (8-18 years) with parent-reported neurocognitive complaints was compared to normative data on health-related quality of life (HRQOL), self-esteem, psychosocial adjustment, and executive functioning (one-sample t tests) and to a sibling control group on fatigue (independent-samples t test). Self-, parent-, and teacher-report questionnaires were included, where appropriate, providing complementary information. RESULTS Eighty-two PBTS (mean age 13.4 years, SD 3.2, 49 % males) and 43 healthy siblings (mean age 14.3, SD 2.4, 40 % males) were included. As compared to the normative population, PBTS themselves reported decreased physical, psychological, and generic HRQOL (d = 0.39-0.62, p < 0.008). Compared to siblings, increased fatigue-related concentration problems (d = 0.57, p < 0.01) were reported, although self-reported self-esteem and psychosocial adjustment seemed not to be affected. Parents of PBTS reported more psychosocial (d = 0.81, p < 0.000) and executive problems (d = 0.35-0.43, p < 0.016) in their child than parents of children in the normative population. Teachers indicated more psychosocial adjustment problems for female PBTS aged 8-11 years than for the female normative population (d = 0.69, p < 0.025), but they reported no more executive problems. CONCLUSIONS PBTS with parent-reported neurocognitive complaints showed increased psychosocial problems, as reported by PBTS, parents, and teachers. IMPLICATIONS FOR CANCER SURVIVORS Systematic screening of psychosocial functioning is necessary so that tailored support from professionals can be offered to PBTS with neurocognitive complaints.
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Affiliation(s)
- Marieke Anna de Ruiter
- />Pediatric Psychosocial Department, Emma Children’s Hospital AMC, Meibergdreef 9, Room A3-241, 1105 AZ Amsterdam, The Netherlands
| | | | | | - Heleen Maurice-Stam
- />Pediatric Psychosocial Department, Emma Children’s Hospital AMC, Meibergdreef 9, Room A3-241, 1105 AZ Amsterdam, The Netherlands
| | - Corrie Gidding
- />Department of Pediatric Oncology/Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Laura Rachel Beek
- />Department of Medical Psychology, Wilhelmina Children’s Hospital UMC, Utrecht, The Netherlands
| | - Bernd Granzen
- />Department of Pediatrics, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jaap Oosterlaan
- />Department of Clinical Neuropsychology, VU University Amsterdam, Amsterdam, The Netherlands
| | - Martha Alexandra Grootenhuis
- />Pediatric Psychosocial Department, Emma Children’s Hospital AMC, Meibergdreef 9, Room A3-241, 1105 AZ Amsterdam, The Netherlands
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Myers JS. Review complementary and integrative interventions for cancer-related cognitive changes. Asia Pac J Oncol Nurs 2015; 2:215-226. [PMID: 26719850 PMCID: PMC4692461 DOI: 10.4103/2347-5625.162825] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Cognitive sequelae from a diagnosis of cancer and the subsequent treatment impact survivors’ quality of life and can interfere with both social relationships and employment. The search for evidence-based prevention and intervention strategies continues for both central nervous system (CNS) and non-CNS cancer-related cognitive changes. Complementary therapies in conjunction with conventional medicine are being included in integrative programs designed to maximize symptom management in cancer treatment centers providing survivorship care. The purpose of this article is to review the existing evidence for the use of complementary and integrative interventions to prevent or treat cancer-related cognitive changes and to discuss the rationale for current and future research. Search terminology included: Complementary, alternative, and integrative medicine, cognition, cognitive function, and cancer, and yielded 20 studies that met criteria for inclusion. Preliminary results published to date indicate that some complementary therapies may be beneficial to cancer survivors experiencing cognitive concerns. A number of gaps in the literature remain primarily due to preliminary study designs, small sample sizes, lack of objective cognitive testing, and cognitive function not being a primary endpoint for much of the published work.
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Affiliation(s)
- Jamie S Myers
- School of Nursing, University of Pittsburgh, Pittsburgh, PA ; School of Nursing, University of Kansas, Kansas City, KS, USA
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de Ruiter MA, Grootenhuis MA, van Mourik R, Maurice-Stam H, Breteler MHM, Gidding C, Beek LR, Granzen B, van Vuurden DG, Schouten-van Meeteren AYN, Oosterlaan J. Timed performance weaknesses on computerized tasks in pediatric brain tumor survivors: A comparison with sibling controls. Child Neuropsychol 2015; 23:208-227. [DOI: 10.1080/09297049.2015.1108395] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Karch S, Keeser D, Hümmer S, Paolini M, Kirsch V, Karali T, Kupka M, Rauchmann BS, Chrobok A, Blautzik J, Koller G, Ertl-Wagner B, Pogarell O. Modulation of Craving Related Brain Responses Using Real-Time fMRI in Patients with Alcohol Use Disorder. PLoS One 2015. [PMID: 26204262 PMCID: PMC4512680 DOI: 10.1371/journal.pone.0133034] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
LITERATURE One prominent symptom in addiction disorders is the strong desire to consume a particular substance or to display a certain behaviour (craving). Especially the strong association between craving and the probability of relapse emphasises the importance of craving in the therapeutic process. Neuroimaging studies have shown that craving is associated with increased responses, predominantly in fronto-striatal areas. AIM AND METHODS The aim of the present study is the modification of craving-related neuronal responses in patients with alcohol addiction using fMRI real-time neurofeedback. For that purpose, patients with alcohol use disorder and healthy controls participated once in neurofeedback training; during the sessions neuronal activity within an individualized cortical region of interest (ROI) (anterior cingulate cortex, insula, dorsolateral prefrontal cortex) was evaluated. In addition, variations regarding the connectivity between brain regions were assessed in the resting state. RESULTS AND DISCUSSION The results showed a significant reduction of neuronal activity in patients at the end of the training compared to the beginning, especially in the anterior cingulate cortex, the insula, the inferior temporal gyrus and the medial frontal gyrus. Furthermore, the results show that patients were able to regulate their neuronal activities in the ROI, whereas healthy subjects achieved no significant reduction. However, there was a wide variability regarding the effects of the training within the group of patients. After the neurofeedback-sessions, individual craving was slightly reduced compared to baseline. The results demonstrate that it seems feasible for patients with alcohol dependency to reduce their neuronal activity using rtfMRI neurofeedback. In addition, there is some evidence that craving can be influenced with the help of this technique. FUTURE PROSPECTS In future, real-time fMRI might be a complementary neurophysiological-based strategy for the psychotherapy of patients with psychiatric or psychosomatic diseases. For that purpose, the stability of this effect and the generalizability needs to be assessed.
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Affiliation(s)
- Susanne Karch
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Munich, Germany
- * E-mail:
| | - Daniel Keeser
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Munich, Germany
- Institute for Clinical Radiology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Sebastian Hümmer
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Marco Paolini
- Institute for Clinical Radiology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Valerie Kirsch
- Department of Neurology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Temmuz Karali
- Institute for Clinical Radiology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Michael Kupka
- Institute for Clinical Radiology, Ludwig-Maximilians-University Munich, Munich, Germany
| | | | - Agnieszka Chrobok
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Janusch Blautzik
- Institute for Clinical Radiology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Gabi Koller
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Birgit Ertl-Wagner
- Institute for Clinical Radiology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Oliver Pogarell
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Munich, Germany
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Luctkar-Flude M, Groll D. A Systematic Review of the Safety and Effect of Neurofeedback on Fatigue and Cognition. Integr Cancer Ther 2015; 14:318-40. [PMID: 25716351 DOI: 10.1177/1534735415572886] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Many cancer survivors continue to experience ongoing symptoms, such as fatigue and cognitive impairment, which are poorly managed and have few effective, evidence-based treatment options. Neurofeedback is a noninvasive, drug-free form of brain training that may alleviate long-term symptoms reported by cancer patients. OBJECTIVE The purpose of this systematic review of the literature was to describe the effectiveness and safety of neurofeedback for managing fatigue and cognitive impairment. METHODS A systematic review of the literature was conducted using Joanna Briggs Institute (JBI) methodology. A comprehensive search of 5 databases was conducted: Medline, CINAHL, AMED, PsycInfo, and Embase. Randomized and nonrandomized controlled trials, controlled before and after studies, cohort, case control studies, and descriptive studies were included in this review. RESULTS Twenty-seven relevant studies were included in the critical appraisals. The quality of most studies was poor to moderate based on the JBI critical appraisal checklists. Seventeen studies were deemed of sufficient quality to be included in the review: 10 experimental studies and 7 descriptive studies. Of these, only 2 were rated as high-quality studies and the remaining were rated as moderate quality. All 17 included studies reported positive results for at least one fatigue or cognitive outcome in a variety of populations, including 1 study with breast cancer survivors. Neurofeedback interventions were well tolerated with only 3 studies reporting any side effects. CONCLUSIONS Despite issues with methodological quality, the overall positive findings and few reported side effects suggest neurofeedback could be helpful in alleviating fatigue and cognitive impairment. Currently, there is insufficient evidence that neurofeedback is an effective therapy for management of these symptoms in cancer survivors, however, these promising results support the need for further research with this patient population. More information about which neurofeedback technologies, approaches, and protocols could be successfully used with cancer survivors and with minimal side effects is needed. This research will have significance to nurses and physicians in oncology and primary care settings who provide follow-up care and counseling to cancer survivors experiencing debilitating symptoms in order to provide information and education related to evidence-based therapy options.
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