Cognitive deficits in long‐term survivors of childhood brain tumors: Identification of predictive factors

Abstract

Background To describe cognitive function and to evaluate the association between potentially predictive factors and cognitive outcome in an unselected population of survivors of childhood brain tumors. Procedure We studied a consecutive sample of 133 patients (76 had received radiotherapy (RT)) who had a brain tumor diagnosed before the age of 15 years and were treated during the period January 1970 through February 1997 in the Eastern part of Denmark. Biologic effective dose of irradiation (BED) was assessed in 71 patients. One hundred twenty‐seven patients were able to cooperate to WISC‐R and WAIS‐R. Multiple regression models were constructed to evaluate relationships between possible risk factors and cognitive outcome. Results and Conclusions The mean intelligence (IQ) scores were substantially lower than the expected means of the general population. Younger age at diagnosis, tumor site in cerebral hemisphere, hydrocephalus treated with shunt, and treatment with RT were found to be significant predictors of lower cognitive functions. RT was the most important risk factor for impaired intellectual outcome. The mean observed full scale IQ was 97.1 (SD = 14.3) for the non‐irradiated patients and 78.8 (SD = 14.3) for the irradiated patients (adjusted P < 0.001). Verbal IQ, but not performance and full scale IQ, had a significant negative correlation to BED to the tumor site (P < 0.05). These results can be used to identify subgroups of children who are at increased risk for cognitive deficits allowing early and goal‐directed intervention. Med Pediatr Oncol 2003;40:26–34, © 2003 Wiley‐Liss, Inc.

Educational attainment among survivors of childhood cancer: a population-based cohort study in Denmark

“…However, an internal comparison did not reach significance, which could be due to the analyses being based on small numbers in relation to this rather infrequent event. The finding that male survivors of CNS tumours had a reduced chance of completing basic education probably reflects the well-known risk for neuropsychological sequelae after cranial radiotherapy (Lannering et al, 1990;Jankovic et al, 1994;Langer et al, 2002;Reimers et al, 2003) and the subsequent learning difficulties, which cannot be compensated fully by special educational programmes (Peckham, 1991;Haupt et al, 1994;Dongen-Melman et al, 1997;Mitby et al, 2003). The finding that female survivors of CNS tumours had a reduced chance of attaining education at most levels may support the suggestion that the developing female brain is more vulnerable to cranial radiation (Schlieper et al, 1989;Bleyer et al, 1990).…”

“…Cancer survivors may face emotional difficulties, lack of energy, adjustment problems, social isolation, and restrictions on physical activity (Mancini et al, 1989;Adamoli et al, 1997;Glaser et al, 1997;Eiser and Vance, 2002). Treatment with cranial radiation therapy can affect academic performance by significantly decreasing the IQ or by more subtle neuropsychological effects (Jankovic et al, 1994;Dongen-Melman et al, 1997;Reimers et al, 2003).…”

The incidence of postoperative hyponatremia and associated neurological sequelae in children with intracranial neoplasms

“…12, 15,16 No studies have evaluated a link between long-term outcome and hyponatremia alone or in association with obstructive hydrocephalus.…”

Social outcomes in childhood brain disorder: A heuristic integration of social neuroscience and developmental psychology.

“…Specifically, outcomes vary along three distinct but interrelated dimensions: the age of the child at the onset of the disorder or time of insult, the amount of Reimers et al, 2003), and diabetes (Rovet, Ehrlich, & Czuchta, 1990).…”

“…However, recent studies of preschool children with traumatic brain injuries indicate that injuries sustained during infancy or early childhood are associated with more persistent deficits than are brain insults occurring during later childhood and adolescence (V. Anderson (Banich, Levine, Kim, & Huttenlocher, 1990), brain tumors (Reimers et al, 2003), and diabetes (Rovet, Ehrlich, & Czuchta, 1990).…”