Visual-perceptual abilities were assessed in 5-year-old children with the following neonatal neurological conditions: born preterm with normal ultrasound scan (NL, n=17); born preterm with ultrasound diagnosis of intraventricular haemorrhage (IVH, n=17); born preterm with ultrasound diagnosis of periventricular leukomalacia (PVL, n=12); born term with hypoxic-ischaemic encephalopathy (HIE, n=11). Visual-perceptual ability was evaluated with the L94: eight visual-perceptual tasks designed to evaluate different aspects of visual perception at the preschool level in children with multiple disabilities. Impairment was established in comparison to the performance age obtained on non-verbal intelligence subtests, instead of chronological age. Frequency of L94 impairment was highest in children with PVL, while children with IVH did not differ from the NL control group. Impairment rates were increased also in children with transient periventricular echodensities, and in children with HIE. Impairments were only moderately related to the delay of visual acuity maturation in infancy.
Visual‐perceptual abilities were assessed in 5‐year‐old children with the following neonatal neurological conditions: born preterm with normal ultrasound scan (NL, n=17); born preterm with ultrasound diagnosis of intraventricular haemorrhage (IVH, n=17); born preterm with ultrasound diagnosis of periventricular leukomalacia (PVL, n=12); born term with hypoxic‐ischaemic encephalopathy (HIE, n=11). Visual‐perceptual ability was evaluated with the L94: eight visual‐perceptual tasks designed to evaluate different aspects of visual perception at the preschool level in children with multiple disabilities. Impairment was established in comparison to the performance age obtained on non‐verbal intelligence subtests, instead of chronological age. Frequency of L94 impairment was highest in children with PVL, while children with IVH did not differ from the NL control group. Impairment rates were increased also in children with transient periventricular echodensities, and in children with HIE. Impairments were only moderately related to the delay of visual acuity maturation in infancy.
Most studies that investigate cognitive long-term problems are crosssectional, making it difficult to evaluate the evolution of neurocognition and to disentangle tumor specific from treatment factors. In the present study we investigated the evolution of neurocognition between two time-points (at diagnosis and two years after diagnosis). A total of 35 children diagnosed with a brain tumor at the University Hospitals Leuven were tested twice with a comprehensive neuropsychological test battery. The first assessment was conducted as soon as possible after diagnosis and before initiation of chemo-and/or radiotherapy. Mean age at diagnosis was 9.27 years. The most common diagnoses were pilocytic astrocytoma (54.29%) and medulloblastoma (22.86%). 34.29% received ventricular drainage and 57.1% underwent surgery before baseline testing. Respectively, 28.6% and 25.7% received focal or craniospinal irradiation. A repeated measures analysis with cranial irradiation (no, focal, craniospinal) as between factor demonstrated no main effect of time or no interaction effect between time and cranial irradiation for intelligence, verbal and visual memory and visuomotor function. For some measures of selective, divided and sustained attention a main effect of time was found. For divided and sustained attention an interaction effect was present, indicating that cranial irradiation, especially craniospinal, had a negative impact. Two years after diagnosis we found only for some attentional functions a significant decline and this effect was more pronounced for children that received cranial irradiation. Our results are in line with other studies, indicating that especially attentional functions are vulnerable in children treated for a brain tumor.
We investigated whether neonatal brain damage can give rise to visual perceptual deficits, in addition to the well-documented impairments in visual acuity. To this end, forty-one children (age 5.02 to 5.89 years) were given four visual object identification tasks and three visuo-constructive tasks. These subjects were neonatal at risk owing to prematurity or birth asphyxia. From neonatal ultrasound scans, the occurrence of intracranial hemorrhage (ICH, N = 17), periventricular leukomalacia (PVL, N = 15), and/or white matter damage due to either of these conditions (WMD, N = 9) was determined for each subject. Scans were normal in fourteen of them. The number of subjects performing at or below Pc10 of same-age normal children was significantly above 10% for each task (range 27% – 49%). This was still true when mental instead of chronological age was used for comparison, as shown by the results of nine subjects for which intelligence data were available. This high incidence of impairment is not attributable to loss of visual acuity, since grating acuity was reduced in only four subjects (14 – 19 cycles deg−1). The frequency of scores < Pc10 correlated significantly with WMD in six tasks, with PVL in 4 tasks, but not with ICH. We conclude that neonatal at risk children are more likely to develop impaired visual perceptual skills, independent of mental disability and visual acuity loss. On ultrasound permanent white matter abnormalities are most strongly associated with visual perceptual deficit, whereas intracranial hemorrhage is unrelated.
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