Neurocognitive outcomes in survivors of childhood acute lymphoblastic leukemia: Experience from a tertiary care center in India

Abstract

Background: Data of neurocognitive deficits in survivors of acute lymphoblastic leukemia (ALL) is scarce from low middle-income countries (LMICs), and is influenced by biological and cultural variations. The objective of this study was to assess the prevalence and spectrum of neurocognitive deficits in a cohort of survivors from India.Procedure: Seventy survivors of childhood ALL were evaluated for neurocognitive deficits by the Indian adaptation of Wechsler Intelligence Scale for Children -Fourth Edition (WISC-IV INDIA ). The prevalence of neurocognitive deficits was calculated based on the full-scale intelligence quotient (FSIQ), and scores in discrete domains like verbal comprehension, perceptual reasoning, working memory, and processing speed were calculated and compared to demographics, treatment, and sociocultural factors. Results:The mean (SD) current age and time since diagnosis was 10.5 (±3.2) years and 5 (±2.8) years, respectively. The mean FSIQ was 86.1 ± 20.5, with significant neurocognitive deficit (FSIQ <90) being prevalent in 50% (95% CI: 38%-62%) of the cohort. The proportion of survivors with deficits in individual domains of verbal comprehension, perceptual reasoning, working memory, and processing speed were 49%, 50%, 47%, and 44%, respectively. The odds of having neurocognitive deficits were higher when a child belonged to lower socioeconomic strata (OR 5.7, p = .004), parents with lower education attainment (OR 4.3, p = .041), and whose birth order was higher (OR 20.1, p = .005). Age at diagnosis/assessment, chemotherapy received, or dose of radiotherapy did not have a direct impact on neurocognition.Conclusions and relevance: Rates of neurocognitive deficits are higher in survivors in LMICs, with socioeconomic variables contributing more than the direct neurotoxic effects of treatment.

Deep-seated causes of behavioral problems in children with acute leukemia aged 3–12 years in western China

“…During hospitalization, children with leukemia face prolonged and painful treatment, multiple hospitalizations, and disruption of normal developmental experiences, which predispose them to poor social adjustment and induce abnormal emotional and behavioral problems. Studies have demonstrated that behavioral problems in children with leukemia are mainly characterized by disciplinary and neurotic behaviors [3], including social withdrawal, anxiety/depression, somatization, inattention, and hyperactivity [4][5][6]. Notably, previous studies have focused on the speci c manifestations of behavioral problems in children with leukemia; however, the key in uencing factors that differentiate the behavioral problems of children with leukemia from those of healthy children have not been thoroughly explored.…”

Comparison of Neurocognitive Functioning and Fine Motor Skills in Pediatric Cancer Survivors and Healthy Children

“…Acute lymphoblastic leukemia (ALL), as well as other types of childhood intracranial brain oncology, can result in decreased cognitive functions in children after treatment [ 30 ]. A meta-analysis of neurocognitive functioning in lymphoblastic leukemia survivors showed that patients with ALL scored significantly worse in full-scale IQ and verbal IQ tests.…”