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Updated: Mar 16, 2026
Evaluation of the Cognitive Performance of Hypertensive Patients with Silent Cerebrovascular Lesions
Published on: April 23, 2021
Presence of cerebral microbleeds is associated with worse executive function in pediatric brain tumor survivors
Erika Roddy1, Katherine Sear1, Erin Felton1
1School of Medicine University of California San Francisco (UCSF), San Francisco, California (E.R.); Department of Neurology UCSF, San Francisco, California (K.S., E.F., B.D.B., H.J.F., S.M.); D epartment of Radiology Children's Hospital Los Angeles, Los Angeles, California (B.T.); Department of Pediatrics, Washington University, St Louis, Missouri (K.G.); Department of Pediatrics, Benioff Children's Hospital Oakland, Oakland, California (J.T.); Department of Pediatrics, Valley Children's Hospital, Madera, California (D.S.); Department of Radiation Oncology, Dana Farber Cancer Institute, Boston, Massachusetts (D.A.H.-K.); Department of Radiation Oncology UCSF, San Francisco, California (J.C.); Department of Pediatrics UCSF, San Francisco, California (R.E.G., A.B., S.M.); Department of Neurological Surgery UCSF, San Francisco, California (A.B., A.M.M., S.M.); Department of Radiology and Biomedical Imaging UCSF, San Francisco, California (J.M.L.); Department of Biostatistics and Epidemiology UCSF, San Francisco, California (A.M.M.).
Background:
A specific form of small-vessel vasculopathy-cerebral microbleeds (CMBs)-has been linked to various types of dementia in adults. We assessed the incidence of CMBs and their association with neurocognitive function in pediatric brain tumor survivors.
Methods:
In a multi-institutional cohort of 149 pediatric brain tumor patients who received cranial radiation therapy (CRT) between 1987 and 2014 at age <21 years and 16 patients who did not receive CRT, we determined the presence of CMBs on brain MRIs. Neurocognitive function was assessed using a computerized testing program (CogState). We used survival analysis to determine cumulative incidence of CMBs and Poisson regression to examine risk factors for CMBs. Linear regression models were used to assess effect of CMBs on neurocognitive function.
Results:
The cumulative incidence of CMBs was 48.8% (95% CI: 38.3-60.5) at 5 years. Children who had whole brain irradiation developed CMBs at a rate 4 times greater than those treated with focal irradiation (P < .001). In multivariable analysis, children with CMBs performed worse on the Groton Maze Learning test (GML) compared with those without CMBs (Z-score -1.9; 95% CI: -2.7, -1.1; P < .001), indicating worse executive function when CMBs are present. CMBs in the frontal lobe were associated with worse performance on the GML (Z-score -2.4; 95% CI: -2.9, -1.8; P < .001). Presence of CMBs in the temporal lobes affected verbal memory (Z-score -2.0; 95% CI: -3.3, -0.7; P = .005).
Conclusion:
CMBs are common and associated with neurocognitive dysfunction in pediatric brain tumor survivors treated with radiation.
Insights
Cerebral microbleeds (CMBs) are common in pediatric brain tumor survivors treated with radiation, impacting executive function and verbal memory. These findings highlight the neurocognitive risks associated with radiation therapy in this population.
Area of Science:
- Neuroscience
- Oncology
- Radiology
Background:
- Cerebral microbleeds (CMBs), a form of small-vessel vasculopathy, are linked to dementia in adults.
- The incidence and neurocognitive impact of CMBs in pediatric brain tumor survivors are not well understood.
Purpose of the Study:
- To assess the incidence of CMBs in pediatric brain tumor survivors.
- To determine the association between CMBs and neurocognitive function in this cohort.
Main Methods:
- A multi-institutional cohort of 149 pediatric brain tumor patients treated with cranial radiation therapy (CRT) and 16 controls were analyzed.
- CMBs were identified on brain MRIs, and neurocognitive function was assessed using computerized testing (CogState).
- Survival analysis and regression models were used to examine CMB incidence, risk factors, and effects on cognition.
Main Results:
- The cumulative incidence of CMBs was 48.8% at 5 years post-treatment.
- Whole brain irradiation led to a 4-fold increase in CMBs compared to focal irradiation (P < .001).
- CMBs were associated with worse executive function (Groton Maze Learning test) and verbal memory.
Conclusions:
- CMBs are a frequent complication in pediatric brain tumor survivors receiving radiation.
- The presence of CMBs is significantly associated with neurocognitive deficits, including impaired executive function and verbal memory.
