METHOD Studies were located that reported on performance of PBTS (age range 6-16y).Meta-analytic effect sizes were calculated for Full-scale IQ, Performance IQ, and Verbal IQ as measured by the WISC-III, and mean hit reaction time, errors of omission, and errors of commission as measured by the CPT. Exploratory analyses investigated the possible impacts of treatment mode, tumour location, age at diagnosis, and time since diagnosis on intelligence.RESULTS Twenty-nine studies were included: 22 reported on the WISC-III in 710 PBTS and seven on CPT results in 372 PBTS. PBTS performed below average (p s <0.001) on Full-scale IQ (Cohen's d=)0.79), Performance IQ (d=)0.90), and Verbal IQ (d=)0.54). PBTS committed more errors of omission than the norm (d=0.82, p<0.001); no differences were found for mean hit reaction time and errors of commission. Cranial radiotherapy, chemotherapy, and longer time since diagnosis were associated with lower WISC-III scores (p s <0.05).INTERPRETATION PBTS have seriously impaired intellectual functioning and attentiveness. Being treated with cranial radiotherapy and ⁄ or chemotherapy as well as longer time since diagnosis leads to worse intellectual functioning.In the USA the incidence of cancer in children aged 0 to 14 years is almost three per 100 000. 1 Approximately 17 to 22.5% of children with cancer have a brain tumour. 1,2 Advances in medicine have led to an increasing number of children surviving cancer. The 5-year survival rate of children diagnosed with a brain tumour under the age of 15 increased from 57% for patients diagnosed from 1975 to 1977 to 74% for patients diagnosed from 1996 to 2004. 3 With more children becoming long-term survivors, the need has grown to understand fully the nature and magnitude of the late effects of the tumour and treatment. Compared with survivors of other malignancies, survivors of brain tumours in childhood bear the greatest risk of neurocognitive impairment. 4 Numerous studies have shown that 40 to 100% of paediatric brain tumour survivors (PBTS) show some form of neurocognitive deficit. 5 Frequently reported impairments in PBTS are declining levels of general intelligence and attention deficits. Deficits in these areas can have a deleterious effect on academic achievement and psychosocial functioning. [6][7][8] Besides the burden of the tumour itself, the treatment can contribute to neurocognitive impairments. Radiotherapy is especially considered to have an impact on neurocognitive functioning.9,10 Chemotherapy, however, has also been found to be associated with poor outcomes in PBTS. 11 In addition to the treatment, tumour location can affect the neurocognitive outcome of PBTS, with infratentorial tumours being associated with worse outcomes than supratentorial tumours. 12Furthermore, age at diagnosis is known to have an impact on neurocognitive outcome. 13 The young brain is especially vulnerable to the adverse effects of treatment because of the rapid cell proliferation, dendritic and axonal outgrowth, as well as myelination, which ta...

SummarySickle cell disease can be complicated by cerebral white matter hyperintensities (WMHs), which are associated with diminished neurocognitive functioning. The influence of the total volume of WMHs on the degree of neurocognitive dysfunction has not yet been characterized. In our study of 38 patients (mean age 12Á5 years) we demonstrated that a higher volume of WMHs was associated with lower full-scale intelligence quotient (IQ), verbal IQ, Processing Speed Index and more fatigue. Our results suggest that volume of WMHs is an additional parameter to take into account when planning individual diagnostic and treatment options.

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Background: Survivors of childhood brain tumors are prone to sleep and neurocognitive problems.Effective interventions to improve neurocognitive functioning are largely lacking. In general, sleep problems are negatively related to neurocognitive functioning, but this relationship is unclear in survivors of childhood brain tumors. Therefore, the occurrence of sleep problems, potential risk factors, and the relation between sleep and executive functioning were evaluated. Procedure: Baseline data of a randomized controlled trial on the effectiveness of neurofeedback were used. Childhood brain tumor survivors 8-18 years of age with parent-reported neurocognitive complaints ≥2 years after treatment were eligible. Parents completed the Sleep Disturbance Scale for Children. Executive functioning was assessed by parents and teachers (Behavior Rating Inventory of Executive Functioning). Multiple linear regression analyses were used to examine sociodemographic and medical characteristics and emotional difficulties and hyperactivity/inattention (Strength and Difficulties Questionnaire) as potential risk factors for sleep problems, and to assess the association between sleep and executive functioning. Results: Forty-eight percent of survivors (n = 82, 7.0 ± 3.6 years post diagnosis, age 13.8 ± 3.2 years) had sleep problems and scored significantly worse than the norm on the subscales Initiating and Maintaining Sleep, Excessive Somnolence, and the total scale (effect sizes 0.58-0.92). Emotional problems and/or hyperactivity/inattention were independent potential risk factors. Sleep problems were associated with worse parent-reported executive functioning. Conclusions: Sleep problems occur among half of childhood brain tumor survivors with neurocognitive problems, and are associated with worse executive functioning. Future studies should focus on the development of sleep interventions for this population, to improve sleep as well as executive functioning. K E Y W O R D S executive functioning, pediatric hematology/oncology, sleep Abbreviations: ADHD/ADD, attention deficit (hyperactivity) disorder; BRIEF, Behavior Rating Inventory of Executive Functioning; DA, disorders of arousal; CBT, cognitive behavioral therapy;