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Cognitive function in children with brain tumors in the first year after diagnosis compared to healthy matched
Robert I Shortman1, Stephen P Lowis, Anthony Penn
1Neuropsychology, Frenchay Hospital, Bristol, England.
Insights
Children with brain tumors (BTs) show early cognitive deficits, even before treatment. These impairments, affecting memory and attention, persist one year post-diagnosis and are linked to tumor factors and treatments.
Area of Science:
- Pediatric Oncology
- Neuroscience
- Cognitive Psychology
Background:
- Improved survival in pediatric brain tumors (BTs) necessitates addressing treatment-related morbidity.
- Early identification of cognitive deficits is crucial for timely intervention in children with BTs.
- Limited research exists on early cognitive function in pediatric BT patients post-diagnosis.
Purpose of the Study:
- To investigate cognitive function in children with primary BTs at 1, 6, and 12 months post-diagnosis.
- To compare cognitive performance between pediatric BT patients and healthy controls.
- To explore the influence of disease and treatment variables on cognitive outcomes.
Main Methods:
- Recruited 48 children (aged 2-16) with primary BTs and matched healthy controls using the 'best friends' model.
- Administered standardized cognitive assessments including Wechsler Intelligence scales, Children's Memory Scale, Test of Everyday Attention for Children, and Wechsler Quicktest.
- Assessed cognitive performance at 1, 6, and 12 months post-diagnosis.
Main Results:
- Pediatric BT patients exhibited significant early deficits in Performance IQ, processing speed, verbal/visual memory, and selective attention compared to controls.
- Cognitive function improved over 12 months in BT patients, but deficits remained, particularly in Verbal IQ, processing speed, and immediate memory.
- Infratentorial tumor location, high tumor grade, hydrocephalus, radiotherapy, and chemotherapy were associated with poorer cognitive outcomes.
Conclusions:
- Cognitive impairment is evident in children with BTs early after diagnosis, sometimes preceding treatment.
- Factors such as hydrocephalus, high tumor grade, and infratentorial location are linked to early cognitive deficits.
- Further research is warranted to evaluate the efficacy of early rehabilitation strategies for improving cognitive function in pediatric BT survivors.
Background:
Improved survival of children with brain tumors (BTs) has increased focus on ameliorating morbidity. To reduce the risk of progressive cognitive decline, remedial strategies need to be instituted early, based upon accurate appraisal of need, yet few studies have investigated cognition in BT children early post-diagnosis. The study aims were to investigate cognition in children with primary BTs 1, 6, and 12 months post-diagnosis compared with healthy children, exploring the impact of disease and treatment variables.
Methods:
Forty-eight children aged 2-16 years with primary BTs, referred to a Regional Neurosurgical Unit over the 2-year study period were eligible for enrollment. The "best friends" model was used to recruit matched controls. Cognition was assessed using age-appropriate Wechsler Intelligence scales; Children's Memory Scale; Test of Everyday Attention for Children, and Wechsler Quicktest.
Results:
Patients with BTs had significantly reduced performance compared to controls early post-diagnosis in tests of Performance IQ, processing speed, verbal and visual memory, and selective attention. Improved performance over 12 months was seen in patients with BTs although also, for some measures, in controls. Significant deficits in cognitive performance were seen one year post-diagnosis for Verbal IQ; processing speed, visual and verbal immediate memory, and selective attention. Infratentorial site, high tumor grade, hydrocephalus, radiotherapy, and chemotherapy were associated with poorer functioning.
Conclusion:
Early cognitive impairment is present in BT children, sometimes prior to radiotherapy/chemotherapy treatment, and is associated with hydrocephalus, high tumor grade and infratentorial site. Future studies should investigate the role of early rehabilitation in improving cognition.
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