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Identifying patterns of neurocognitive dysfunction through direct comparison of children with leukemia, central
Claire E Fraley1, Jamie S Neiman1, Charlotte R Feddersen2
1Center for Cancer and Blood Disorders, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
Insights
Children with ALL, CNS tumors, or SCD show neurocognitive deficits. These conditions impact different cognitive functions, with processing speed and attention most affected in ALL and CNS tumor groups.
Area of Science:
- Pediatric Neuro-oncology
- Pediatric Hematology
- Pediatric Neurology
Background:
- Neurocognitive dysfunction is a significant concern in children with chronic health conditions.
- Understanding specific cognitive deficits aids in targeted interventions for at-risk pediatric populations.
Purpose of the Study:
- To quantify and compare neurocognitive dysfunction in children with central nervous system (CNS) tumors, acute lymphoblastic leukemia (ALL), and sickle cell disease (SCD).
- To utilize a common assessment tool and metric for direct comparison across these distinct pediatric groups.
Main Methods:
- Fifty-three children (ages 7-12) with ALL (n=27), CNS tumors (n=11), or SCD (n=15) were assessed.
- The NIH Toolbox Cognition Battery (NIHTCB) was employed to evaluate cognitive functions.
- Participants with ALL/CNS tumors were 0-18 months post-therapy; SCD participants had specific genotypes and hydroxyurea treatment without prior stroke.
Main Results:
- Children with ALL and CNS tumors exhibited significant deficits in processing speed and attention compared to normative data.
- Children with SCD showed deficits primarily in cognitive flexibility.
- Episodic memory was relatively preserved across all participant groups.
Conclusions:
- A standardized metric reveals distinct neurocognitive dysfunction patterns across pediatric diseases (ALL, CNS tumors, SCD).
- These findings underscore the need for disease- and domain-specific interventions to address cognitive impairments in at-risk children.
Purpose:
To quantify and compare the magnitude and type of neurocognitive dysfunction in at-risk children with central nervous system (CNS) tumors, acute lymphoblastic leukemia (ALL), and sickle cell disease (SCD) using a common instrument and metric to directly compare these groups with each other.
Methods:
Fifty-three participants between the ages of 7 and 12 years (n = 27 ALL, n = 11 CNS tumor, n = 15 SCD) were enrolled and assessed using the NIH Toolbox Cognition Battery (NIHTCB). Participants with ALL or CNS tumor were 0-18 months posttherapy, while participants with SCD possessed the SS or Sβ0 genotype, took hydroxyurea, and had no known history of stroke.
Results:
Independent sample t-tests showed that participants with ALL and CNS tumor experienced greatest deficits in processing speed (ALL d = -0.96; CNS tumor d = -1.2) and inhibitory control and attention (ALL d = -0.53; CNS tumor d = -0.97) when compared with NIHTCB normative data. Participants with SCD experienced deficits in cognitive flexibility only (d = -0.53). Episodic memory was relatively spared in all groups (d = -0.03 to -0.32). There were no significant differences in function when groups were compared directly with each other by analysis of variance.
Conclusions:
Use of a common metric to quantify the magnitude and type of neurocognitive dysfunction across at-risk groups of participants by disease shows that participants perform below age-expected norms in multiple domains and experience dysfunction differently than one another. This approach highlights patterns of dysfunction that can inform disease- and domain-specific interventions.
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