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Remes TM, Suo-Palosaari MH, Arikoski PM, Harila M, Koskenkorva PKT, Lähteenmäki PM, Lönnqvist TRI, Ojaniemi MK, Pohjasniemi H, Puosi R, Ritari N, Sirkiä KH, Sutela AK, Toiviainen-Salo SM, Rantala HMJ, Harila AH. Radiotherapy-induced vascular cognitive impairment 20 years after childhood brain tumor. Neuro Oncol 2024; 26:362-373. [PMID: 37758202 PMCID: PMC10836776 DOI: 10.1093/neuonc/noad186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Indexed: 10/03/2023] Open
Abstract
BACKGROUND Studies have established that radiotherapy for childhood brain tumors (BTs) increases the risk of cerebrovascular disease (CVD); however, it is unclear how this will affect cognitive function. This study aimed to investigate the associations between radiotherapy-induced CVD, white matter hyperintensities (WMHs), and neurocognitive outcomes in adult survivors of childhood BTs. METHODS In a cross-sectional setting, we conducted a national cohort that included 68 radiotherapy-treated survivors of childhood BTs after a median follow-up of 20 years. Markers of CVD and WMHs were evaluated using brain MRI, and the sum of CVD-related findings was calculated. Additionally, the associations among CVD findings, WMHs, and neuropsychological test results were analyzed. RESULTS Of the 68 childhood BT survivors, 54 (79%) were diagnosed with CVD and/or WMHs at a median age of 27 years. CVD and/or WMHs were associated with lower scores for verbal intelligence quotient, performance intelligence quotient (PIQ), executive function, memory, and visuospatial ability (P < .05). Additionally, survivors with microbleeds had greater impairments in the PIQ, processing speed, executive function, and visuospatial ability (P < .05). WMHs and CVD burden were associated with greater difficulties in memory function and visuospatial ability (P < .05). Small-vessel disease burden was associated with PIQ scores, processing speed, working memory, and visuospatial ability. CONCLUSIONS The study results suggest that markers of radiotherapy-induced CVD, the additive effect of CVD markers, and risk factors of dementia are associated with cognitive impairment, which may suggest that the survivors are at a high risk of developing early-onset dementia.
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Affiliation(s)
- Tiina Maria Remes
- Department of Pediatrics and Adolescence Medicine, Oulu University Hospital, and Research Unit of Clinical Medicine, University of Oulu, Oulu, Finland
- Department of Child Neurology, New Children’s Hospital, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - Maria Helena Suo-Palosaari
- Department of Diagnostic Radiology, Oulu University Hospital, University of Oulu, Research Unit of Medical Imaging, Physics, and Technology, Faculty of Medicine, University of Oulu, Medical Research Center Oulu, University of Oulu, Oulu, Finland
| | - Pekka Matti Arikoski
- Kuopio Pediatric Research Unit, University of Eastern Finland, Kuopio University Hospital, Kuopio, Finland
| | - Marika Harila
- Department of Neurology, Oulu University Hospital, University of Oulu, Oulu, Finland
| | | | - Päivi Maria Lähteenmäki
- Department of Pediatrics and Adolescent Medicine, Turku University Hospital, Turku University, Turku, Finland
| | - Tuula Riitta Irmeli Lönnqvist
- Department of Child Neurology, New Children’s Hospital, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - Marja Katariina Ojaniemi
- Department of Pediatrics and Adolescence Medicine, Oulu University Hospital, and Research Unit of Clinical Medicine, University of Oulu, Oulu, Finland
| | | | - Riina Puosi
- Department of Child Neurology, New Children’s Hospital, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - Niina Ritari
- Department of Child Neurology, New Children’s Hospital, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - Kirsti Helena Sirkiä
- Department of Pediatrics and Adolescence, Helsinki University, Helsinki University Hospital, Helsinki, Finland
| | - Anna Kaarina Sutela
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
| | - Sanna-Maria Toiviainen-Salo
- Department of Pediatric Radiology, HUS Medical Imaging Center, Radiology, University of Helsinki, Helsinki University Hospital, Finland
| | - Heikki Markku Johannes Rantala
- Department of Pediatrics and Adolescence Medicine, Oulu University Hospital, and Research Unit of Clinical Medicine, University of Oulu, Oulu, Finland
| | - Arja Helena Harila
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
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