Cognition and Anesthesia Exposure in Adolescent and Young Adult Retinoblastoma Survivors

Retinoblastoma (RB) is the most common intraocular malignancy diagnosed in early childhood. Treatment is extensive, requiring multiple general anesthetics to facilitate eye examinations. However, little is known how repeated exposure to general anesthesia in early childhood affects cognitive function in RB survivors.

The purpose of this cross-sectional study was to examine the effects of anesthesia exposure on cognition in 14- to 26-year-old RB survivors compared with those in healthy controls.

Patients who previously received care for RB (n = 98) were recruited and compared to a cohort of healthy subjects (n = 97). Participants' cognitive functioning was assessed using the Montreal Cognitive Assessment (MoCA). MoCA scores were compared between groups using Wilcoxon rank-sum tests. Relationships between MoCA scores and anesthesia exposure were assessed using Spearman's rank correlation coefficients. Multiple regression was used to evaluate the effect of anesthesia (both before the age of three and throughout childhood) on cognition.

RB patients scored significantly lower than controls on the MoCA and several of its subscales (Naming, Attention, Language, and Abstraction; adjusted ps < 0.05). Total childhood anesthesia exposure was negatively associated with MoCA total scores (ρ = -0.19, p = 0.009) and some subscale scores. In regression models adjusted for covariates, each time anesthesia was administered before the age of three (β = -0.06, p = 0.02) or throughout childhood (β = -0.04, p = 0.005) was associated with a small but statistically significant decrease in cognition. Hollingshead socioeconomic status (β = 0.04, p = 0.001) and public insurance (β = -1.75, p < 0.0001) were stronger predictors of MoCA total scores than anesthesia exposure.

Despite any effects of repeated anesthesia exposure in early childhood on cognition, MoCA scores for RB survivors were in the normal range. These findings add to the developing research on neurocognitive effects of anesthesia in early childhood in a population with large anesthesia exposure and minimal confounding factors. Future research should include additional measures of neurodevelopmental functioning and focus on the at-risk low socioeconomic status population. Continued follow-up and assessment of visual function in bilateral survivors are imperative.