Pretreatment neuropsychological deficits in children with brain tumors

Abstract

Treatment of childhood brain cancer has been associated with long-term cognitive morbidity in children. In the present study, the cognitive status of children with brain tumors was examined prior to any treatment to single out the role of tumor and tumor-related factors in cognitive deficits. Eighty-three children with newly diagnosed brain tumors (mean age, 8.6 years; range, 7 months to 16.6 years; median, 9.4 years) completed an extensive battery of age-related tests to assess cognitive function before any therapeutic intervention. Magnetic resonance imaging (MRI) was used to determine tumor site and volume and tumor-related factors. Performance under test was compared with symptom duration, neurological status, epilepsy, and MRI. Cognitive difficulties are detected at diagnosis in as many as 50% of patients for some cognitive domains; 6% of patients present with true-diagnosed mental retardation. The location of the tumor is the principal determinant of cognitive deficits, with major impairment in children with cortical tumors. Symptom duration and the presence of epilepsy are significantly associated with neuropsychological disabilities, while neuroradiological tumor-related variables do not correlate clearly with neurocognitive performance. The knowledge of the pre-existing cognitive deficits is critical to evaluate the results of treatment, providing a baseline for assessing the true impact of therapy in determining cognitive decline. In addition, the study suggests that some clinical variables require careful monitoring, because they could be specifically implicated in the neuropsychological outcome; the efforts to reduce the impact of these factors could ameliorate long-term prognosis.

Cognitive dysfunction in children with brain tumors at diagnosis

“…Despite the attentional and mnemonic deficits of children with BT, there was no significant difference between the two patient groups in general intelligence this early in the course of treatment. Mean IQs of patients with BT lie within the normal range, thus confirming the results of Iuvone and colleagues . Nevertheless, deficits in memory and attention as early as the time of diagnosis might make patients even more vulnerable to the damaging effects of the medical treatments to follow.…”

“…In our two different attention tasks (TAP and CPT), children with BT committed more errors of commission than the CG, reflecting an impulsive response style. Several studies have reported attentional deficits in children with BT, although most findings hint at inattention problems rather than impulsivity. One explanation for the discrepancy in results may lie in the different nature of the measures analyzed: Most studies used a composite measure of attention [e.g., 8,16,32,33] or have reported an accuracy variable in a single test [e.g., 17] rather than examining different attentional variables derived from two different attentional measures.…”

Prospective memory impairment following whole brain radiotherapy in patients with metastatic brain cancer

“…Moreover, the cognitive impairment due to tumor growth was much larger than that due to WBRT. Besides the effect of WBRT on cognitive function, there are other factors that affect the cognition of the patients, such as age, complications, tumor location, epilepsy due to the tumor, surgery, certain drugs, chemotherapy, the controlling situation of intracranial or extracranial diseases, as well as neurological diseases.…”

Long-Term Cognitive Sequelae After Pediatric Brain Tumor Related to Medical Risk Factors, Age, and Sex

“…Tumor size seems to be a better predictor of cognitive sequelae than sex and sex adds predictive value only for average-sized tumors (around 3 cm diameter). It has previously been described that tumor size at diagnosis has no correlation at all with cognition at diagnosis, 38 but few studies have compared brain tumor size at diagnosis with posttreatment cognition. Brain tumor size can be observed as an underlying cause for several other following risk factors such as larger radiation field, hydrocephalus, and ventriculoperitoneal shunt.…”