Cognitive performance as a predictor of healthcare transition in sickle cell disease

Abstract

Summary Neurocognitive deficits in sickle cell disease (SCD) may impair adult care engagement. We investigated the relationship between neurocognitive functioning and socio‐environmental factors with healthcare transition outcomes. Adolescents aged 15–18 years who had neurocognitive testing and completed a visit with an adult provider were included. Transition outcomes included transfer interval from paediatric to adult care and retention in adult care at 12 and 24 months. Eighty adolescents (59% male, 64% HbSS/HbSβ0‐thalassaemia) were included. Mean age at adult care transfer was 18·0 (±0·3) years and transfer interval was 2·0 (±2·3) months. Higher IQ (P = 0·02; PFDR = 0·05) and higher verbal comprehension (P = 0·008; PFDR = 0·024) were associated with <2 and <6 month transfer intervals respectively. Better performance on measures of attention was associated with higher adult care retention at 12 and 24 months (P = 0·009; PFDR = 0·05 and P = 0·04; PFDR = 0·12 respectively). Transfer intervals <6 months were associated with smaller households (P = 0·02; PFDR = 0·06) and households with fewer children (P = 0·02; PFDR = 0·06). Having a working parent was associated with less retention in adult care at 12 and 24 months (P = 0·01; P = 0·02 respectively). Lower IQ, verbal comprehension, attention difficulties and environmental factors may negatively impact transition outcomes. Neurocognitive function should be considered in transition planning for youth with SCD.

Neurocognitive risk in sickle cell disease: Utilizing neuropsychology services to manage cognitive symptoms and functional limitations

“…FSIQ was a significant predictor of attendance at an adult haematology appointment within two months of transition, whereas more specific cognitive skills (e.g. verbal comprehension, non‐verbal reasoning and processing speed) supported long‐term retention in adult care 60 …”

“…verbal comprehension, non-verbal reasoning and processing speed) supported long-term retention in adult care. 60…”

The Montreal cognitive assessment as a cognitive screening tool in sickle cell disease: Associations with clinically significant cognitive domains

“…13,14 In SCD, improved literacy predicts successful transition to adult care. 18 A cognitive screening test that is sensitive to deficits in these domains would aid identification and intervention to improve outcomes.…”

Measuring transition readiness in adolescents and young adults with sickle cell disease using the transition readiness assessment questionnaire

“…Adolescents with SCD present with unique health concerns related to the disease and its treatment, and there are additional complications that manifest as patients age, including delayed sexual development, more frequent episodes of acute pain, and organ failure. 11,20,30 Cognitive functioning (i.e., verbal comprehension and attention difficulties) may also negatively impact transition outcomes. 31 SCD has known neurocognitive effects, and therefore cognitive function is an important consideration in transition planning for youth with SCD.…”