Clinically significant and potentially treatable apathy occurs relatively commonly in adult survivors of an infantile childhood PFT, particularly women. Clinicians, including those managing posterior fossa pathology in very young children, should be aware of this association, and future research should clarify whether specific treatment-related variables are implicated in increasing this risk of apathy.

Purpose Posterior fossa brain tumours (PFT) and their treatment in young children are often associated with subsequent cognitive impairment. However, reported follow-up periods rarely exceed 10 years. This study reports very long-term cognitive consequences of surviving an early childhood PFT. Methods 62 adult survivors of a PFT, ascertained from a national register, diagnosed before 5 years of age, and a sibling control, received a single IQ assessment an average of 32 years (range 18–53) after initial diagnosis, using the Weschler Abbreviated Scale of Intelligence. Regression models were fitted to survivor–sibling pair differences on verbal and performance IQ (VIQ and PIQ) scores to investigate whether increasing time between PFT diagnosis and follow-up IQ assessment contributed to survivor–sibling IQ differences. Results At follow-up, survivors had, on average, VIQ 15 points and PIQ 19 points lower than their siblings. There was no significant effect of time since diagnosis on survivor–sibling VIQ difference. Survivors who received radiotherapy showed no significant effect of time since diagnosis on survivor–sibling PIQ difference. Survivors who did not receive radiotherapy demonstrated a trend for it to reduce. Conclusions VIQ and PIQ deficits persist in adulthood, suggesting the effect of a fixed injury imposing on cognitive development, rather than an ongoing pathological process. Implications for cancer survivors The findings will help parents and others supporting survivors of an early life PFT to identify and plan for possible cognitive outcomes, and highlight the importance of early interventions to optimize cognitive function during the developmental period.

Department of Applied Psychology, Salomons Campus, Canterbury Christ Church University, Broomhill Road, Southborough,Tunbridge Wells, TN3 0TG, UK Objective IQ deficits have been reported amongst survivors of early childhood brain tumours, with iatrogenic causes commonly being associated with these deficits. In this study we examined IQ scores and their associations in adult survivors of an early childhood posterior fossa brain tumour (PFT). Method 113 people who had brain tumours under the age of 5 years had their IQ assessed using the Wechsler Abbreviated Scale of Intelligence (WASI). They were assessed an average of 32 years (range 18–53) after their initial tumour diagnosis. 62 of their siblings were also assessed and used as a comparison group. Results Overall, 16.1% of survivors had an FIQ below 70, indicating a learning disability, compared to none of the sibling control group. Mean FIQ in survivors was 89, compared to 107 in siblings. Post-hoc analysis of matched controls (n=62) were conducted. Using sibling IQ as a marker for the survivor's premorbid IQ, a significant decline in FIQ of an average of 19 points was seen as a result of PFT and its treatment. For those who received radiotherapy this increased to 24 points. For those who did not receive radiotherapy this decline was 10 points. In survivors, but not in siblings, FIQ was related to height. In survivors, there was a significant gender difference between men and women on FIQ (t=2.47; df=110; p=0.015), VIQ (t=1.99; df=111; p=0.049) and PIQ (t=3.12; df=109; p=0.002), with females having lower scores. In siblings there was no significant gender difference on any IQ scale. In survivors, radiotherapy was associated with a significant reduction in FIQ, VIQ and PIQ. There was no significant difference on IQ of having received or not received chemotherapy. There was a significant interaction between gender and radiotherapy on FIQ, with females who had radiotherapy having lower IQ than males who had radiotherapy (F= 4.05; p=0.049). Conclusion Results suggested that early childhood PFT can result in significant decline in IQ, and that this decline is increased by use of radiotherapy, and may be more marked in females who had radiotherapy compared to males who had radiotherapy. Other factors, including growth hormone deficiency may influence the relationship between PFT and IQ, as suggested by the significant relationship between height and IQ.

ObjectiveApathy is a disorder of diminished motivation. It occurs in several neurological pathologies and is associated with pervasive and disadvantageous effects on daily functioning. It has been observed to occur transiently in a proportion of children undergoing surgery for posterior fossa tumours. In this study we examined prevalence, associations and predictors of apathy in adult survivors of an early childhood posterior fossa brain tumour (PFT).Method117 adult survivors of an early childhood PFT and 62 of their siblings were assessed an average of 32 years (range 18–53) after survivors' initial tumour diagnosis, using the Marin Apathy Evaluation Scale (AES), the Weschler Abbreviated Scale of Intelligence and the Composite International Diagnostic Interview.ResultsAES reached or exceeded a criterion score for diagnosis of apathy in 35% of survivors compared with 18% of a sibling comparison group. In survivors, apathy was associated with decreased likelihood of being in employment or education, and lower full scale IQ score. Apathy was not related to ICD-10 current diagnoses of depression. While in siblings, apathy was more common in males than in females, among survivors there was a trend for this imbalance to be reversed.ConclusionClinically significant apathy occurs relatively commonly in adult survivors of an early childhood PFT, and it does not result from increased levels of depression. Clinicians should be aware of this association and future research should clarify which tumour or treatment-related variables are implicated in increasing this risk of apathy.

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