Cognitive dysfunction in children with brain tumors at diagnosis

Abstract

BackgroundSurvivors of brain tumors have a high risk for a wide range of cognitive problems. These dysfunctions are caused by the lesion itself and its surgical removal, as well as subsequent treatments (chemo‐ and/or radiation therapy). Multiple recent studies have indicated that children with brain tumors (BT) might already exhibit cognitive problems at diagnosis, i.e., before the start of any medical treatment. The aim of the present study was to investigate the baseline neuropsychological profile in children with BT compared to children with an oncological diagnosis not involving the central nervous system (CNS).MethodsTwenty children with BT and 27 children with an oncological disease without involvement of the CNS (age range: 6.1–16.9 years) were evaluated with an extensive battery of neuropsychological tests tailored to the patient's age. Furthermore, the child and his/her parent(s) completed self‐report questionnaires about emotional functioning and quality of life. In both groups, tests were administered before any therapeutic intervention such as surgery, chemotherapy, or irradiation. Groups were comparable with regard to age, gender, and socioeconomic status.ResultsCompared to the control group, patients with BTs performed significantly worse in tests of working memory, verbal memory, and attention (effect sizes between 0.28 and 0.47). In contrast, the areas of perceptual reasoning, processing speed, and verbal comprehension were preserved at the time of measurement.ConclusionOur results highlight the need for cognitive interventions early in the treatment process in order to minimize or prevent academic difficulties as patients return to school. Pediatr Blood Cancer 2015;62:1805–1812. © 2015 The Authors. Pediatric Blood & Cancer, published by Wiley Periodicals, Inc.

Dose–volume metrics and their relation to memory performance in pediatric brain tumor patients: A preliminary study

“…As a group, our sample performed in the average range on measures of verbal and visual memory, with the exception of Word Pair learning and delayed recall of Faces, which fell in the low average to average range but significantly below the normative mean. Learning and memory outcomes following RT are mixed, with PBT patients demonstrating significantly worse verbal learning and memory than controls, stable or improved verbal and visual memory over time; or decline in verbal memory but not visual memory or vice versa …”

Cognitive deficits and psychopathological symptoms among children with medulloblastoma

“…Children who receive treatments targeting the central nervous system, such as MB patients, are at an increased risk of developing cognitive late effects in comparison with survivors of other types of childhood cancer (Conklin et al, ; Olson & Sands, ; Palmer et al, ). Evidence indicates that age at treatment (i.e., younger), longer time since diagnosis, female gender, treatment intensity, type of chemotherapy (especially methotrexate), craniospinal irradiation, perioperative complications and possibly hydrocephalus, increase the risk of low cognitive functioning after treatment (Margelisch et al, ). Studies have revealed that specific cognitive abilities, including attention, working memory, processing speed, psychomotor speed and visual‐motor control, are particularly vulnerable (Conklin et al, ).…”

“…This is the result of more effective treatments, with protocols that include surgical resection, irradiation, conventional and in certain cases high-dose chemotherapy with stem cell rescue (Sirachainan et al, 2011;Ullrich & Embry, 2012). As survival rates continue to improve, it is important to understand how MB treatments affect survivors' cognitive and psychological functioning and therefore, overall quality of life (Margelisch et al, 2015;Zeltzer et al, 2009). Children who receive treatments targeting the central nervous system, such as MB patients, are at an increased risk of developing cognitive late effects in comparison with survivors of other types of childhood cancer (Conklin et al, 2015;Olson & Sands, 2016;Palmer et al, 2013).…”

“…Evidence indicates that age at treatment (i.e., younger), longer time since diagnosis, female gender, treatment intensity, type of chemotherapy (especially methotrexate), craniospinal irradiation, perioperative complications and possibly hydrocephalus, increase the risk of low cognitive functioning after treatment (Margelisch et al, 2015). Studies have revealed that specific cognitive abilities, including attention, working memory, processing speed, psychomotor speed and visual-motor control, are particularly vulnerable (Conklin et al, 2015).…”

Neurocognitive Dysfunction in Brain Tumor Patients following Radiation Therapy: A Review of Biological Hypotheses, Current Treatment Outcomes, and Novel Therapeutic Strategies

“…(22) Similar studies have found that compared to age-matched controls, brain tumor patients treated with radiotherapy have significantly lower verbal IQ, processing speed, visual and verbal immediate memory, learning deficits, and selective attention. (23)(24)(25)(26) Interestingly, children with brain tumors have also been demonstrated to have significantly poorer working and verbal memory as well as attention deficits even prior to treatment, suggesting that interventions are necessary to mitigate the effects of both the disease process as well as radiotherapy on cognition. (27) Also of note is the strong correlation between cognitive dysfunction stemming from radiotherapy and a lower quality of life.…”