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Published on: August 12, 2019
Predictors of Cognitive Performance Among Infants Treated for Brain Tumors: Findings From a Multisite, Prospective,
Jeanelle S Ali1, Jason M Ashford1, Michelle A Swain2
1Department of Psychology, St Jude Children's Research Hospital, Memphis, TN.
Insights
Infants with brain tumors show cognitive deficits before treatment, linked to age and socioeconomic status. Tumor location and surgery, not therapy, impact cognitive changes over time.
Area of Science:
- Pediatric Oncology
- Neuro-oncology
- Developmental Neuroscience
Background:
- Infants with central nervous system (CNS) malignancies face poor treatment response and neurodevelopmental risks.
- Limited and inconsistent literature exists on cognitive outcomes for this vulnerable population.
Purpose of the Study:
- Investigate predictors of cognitive outcomes in infants treated for brain tumors.
- Understand the long-term cognitive trajectory in this patient group.
Main Methods:
- Prospective, multisite, longitudinal trial of 139 infants with newly diagnosed CNS tumors.
- Cognitive assessments (IQ, executive function, adaptive functioning) at multiple time points.
- Analysis of treatment (chemotherapy, radiation therapy) and tumor-related factors.
Main Results:
- Infants presented with lower baseline intellectual quotient (IQ), working memory, and adaptive functioning.
- Younger age at diagnosis and lower socioeconomic status predicted worse baseline cognition.
- Cognitive difficulties increased over time, influenced by tumor location and CSF diversion, not treatment type.
Conclusions:
- Cognitive difficulties are present in infants with brain tumors even before adjuvant therapy.
- Tumor location and surgical factors, rather than treatment, dictate cognitive changes.
- Findings guide treatment planning and highlight targets for cognitive monitoring and intervention.
Purpose:
Infants treated for CNS malignancies experience a significantly poorer response to treatment and are particularly at risk for neuropsychological deficits. The literature is limited and inconsistent regarding cognitive outcomes among this group. We investigated predictors of cognitive outcomes in children treated for brain tumors during infancy as part of a large, prospective, multisite, longitudinal trial.
Patients And Methods:
One hundred thirty-nine infants with a newly diagnosed CNS tumor were treated with chemotherapy, with or without focal proton or photon radiation therapy (RT). Cognitive assessments were conducted at baseline, 6 months, 1 year, and then annually for 5 years. The median length of follow-up was 816 days (26.8 months). Neurocognitive testing included assessment of intellectual functioning (intellectual quotient [IQ]), parent ratings of executive functioning and emotional and behavioral functioning, and socioeconomic status.
Results:
At baseline, IQ, parent-reported working memory, and parent-reported adaptive functioning were worse than normative expectations. Baseline cognitive difficulties were associated with younger age at diagnosis and lower socioeconomic status. Linear mixed models did not demonstrate a decline in IQ over time. There were increased parent-reported attention and executive problems over time. Increased concerns were related to supratentorial tumor location and CSF diversion. There were no differences in cognitive outcomes based on treatment exposure (chemotherapy-only v chemotherapy with RT and proton v photon focal RT).
Conclusion:
Even before adjuvant therapy, young children with brain tumors experience cognitive difficulties that can affect quality of life. Changes in cognitive functioning over time were dependent on tumor location and surgical factors rather than adjuvant therapy. These findings may serve to guide treatment planning and indicate targets for cognitive monitoring and intervention.
