Associations among treatment-related neurological risk factors and neuropsychological functioning in survivors of childhood brain tumor

Abstract

Adverse neurological side effects associated with childhood brain tumors and their treatments contribute to long-term neurocognitive morbidity. Measures designed to quantify tumor-related risk factors are lacking. The neurological predictor scale (NPS) is designed to assess treatment-related neurological risks. Preliminary validation established associations between the NPS and global cognitive functioning in this population, though its associations with specific neurobehavioral domains has yet to be addressed. Participants referred for outpatient neuropsychological assessment completed performance-based measures of intellectual, attentional, working memory, motor speed, and executive abilities. Caregivers completed ratings of adaptive functioning. Neuropsychological and adaptive data were available for 100 brain tumor survivors (51 % female), ages 6 to 22 years (M = 12.83, SD = 4.37). Total NPS scores were generated via retrospective medical record review. Total NPS scores were significantly associated with several neurocognitive composite scores including verbal reasoning and working memory, after controlling for years post-diagnosis (ps < .05). NPS scores also were significantly associated with performance-based measures of attention, executive functioning, and cognitive efficiency (ps < .05). No significant relationship was demonstrated between NPS scores and caregiver-reported adaptive behavior skills (ps > .05). Results indicate that the NPS is associated with performance-based neurocognitive functioning and executive skills but not with functioning in specific caregiver-reported adaptive behavior domains. The NPS offers some value as a resource for understanding associations between treatment-related neurological risks and select aspects of neurocognitive morbidity. Future studies should examine whether the NPS can aid in planning appropriate therapeutic intervention as survivors progress into early adulthood.

The Neurological Predictor Scale: A predictive tool for long‐term core cognitive outcomes in survivors of childhood brain tumors

“…This finding is in line with the literature suggesting a negative association between tumor‐ and treatment‐related neurological risk factors and survivors’ core cognitive competencies . Our findings provide further evidence that the NPS affords the ability to predict how cumulative neurological factors impact core cognitive outcomes many years after initial diagnosis.…”

“…Overall, our findings demonstrate that the NPS may be more useful than individual risk factors in predicting core cognitive outcomes. This study further supports the effectiveness of the NPS as an efficient method for quantifying tumor‐ and treatment‐related risk factors . The NPS may serve as a fast and easy tool in identifying subgroups of individuals who are at increased risk for poor cognitive outcomes, allowing for early and goal directed interventions .…”

“…To date, only one study has explored the association between the NPS and long‐term core cognitive skills in survivors of brain tumors . This study reported a significant association between the NPS and core cognitive outcomes (i.e., working memory, processing speed, and attention), higher order cognitive outcomes (i.e., set shifting, cognitive flexibility), and broad intellectual functioning.…”

Long‐term issues and supportive care needs of adolescent and young adult childhood brain tumour survivors and their caregivers: A systematic review

“…Education experiences were often described as problematic including missing school, cognitive difficulties—feeling misunderstood, facing bullying and social isolation . Survivors were more likely to be unemployed later in life when compared with age and gender‐matched controls and other cancer survivors, with reported unemployment rates varying from 8% to 70%. Issues in attaining or keeping a job included fatigue, poor concentration, physical issues (eg, epilepsy), cognitive difficulties, and poor social skills .…”

Development of the Pediatric Neuro-Oncology Rating of Treatment Intensity (PNORTI)

“…If seeking to quickly predict neurocognitive late effects, an existing measure, the Neurological Predictor Scale NPS; [13], attempts to quantify a child’s exposure to treatment and medical factors that increases the risk for neurocognitive deficits. Increased exposure to risk factors as measured by the NPS have been associated with poorer global intellectual functioning [13], verbal reasoning, working memory, attention, executive function and processing speed in childhood brain tumor survivors [14]. Future research is needed to establish whether treatment intensity as rated by the PNORTI is associated with medical and neurodevelopmental late effects in CNS tumor survivors.…”