Pretreatment Cognition in Patients Diagnosed With Pediatric Brain Tumors

Irestorm, Elin; Perrin, Sean; Olsson, Ingrid Tonning

doi:10.1016/j.pediatrneurol.2017.11.008

Cited by 10 publications

(13 citation statements)

References 37 publications

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“…The results presented here are thus in accordance with those from previous studies, demonstrating that cognitive fatigue and depression are different constructs despite having overlapping symptoms [13,20]. Previous studies reported a higher incidence of males in both paediatric ALL and BT [46][47][48], but the sex distribution in the current study was more skewed towards males than expected. However, in line with previous research [32] we found no gender differences regarding response patterns.…”

Section: Discussionsupporting

confidence: 93%

Cognitive fatigue in relation to depressive symptoms after treatment for childhood cancer

et al. 2020

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Background: Cognitive fatigue after childhood cancer is frequently overlooked despite guidelines recommending follow-up, and might be mistaken for depression due to overlapping symptoms. Our objectives were: 1) to examine ratings of fatigue in survivors of paediatric brain tumours (BT) and acute lymphoblastic leukaemia (ALL) compared to healthy controls, 2) to examine the relationship between symptoms of depression and cognitive fatigue, and 3) to evaluate parent-child concordance in ratings of cognitive fatigue. Methods: Survivors of BT (n = 30), survivors of ALL (n = 30), and healthy controls (n = 60) aged 8-18 years completed the Pediatric Quality of Life Multidimensional Fatigue Scale and the Beck Youth Inventories. Associations between cognitive fatigue, diagnosis and depression were assessed with general linear modelling. Group differences were analysed using the Kruskal-Wallis test. Parent-child concordance was investigated with internal consistency reliability. Results: Cognitive fatigue was prevalent in 70% of survivors of BT survivors and in 30% of survivors of ALL. Diagnosis was the main predictor of cognitive fatigue (p < .001, η p 2 = 0.178), followed by depression (p = .010, η p 2 = 0.080). Survivors of BT reported significantly more fatigue than healthy controls on all fatigue subscales. While they also expressed more symptoms of depression, we found no evidence for an interaction effect. Parent-child concordance was moderate to good among survivors, but poor for controls. Conclusions: Survivors of BT and ALL suffer from cognitive fatigue, with survivors of BT expressing more problems. Cognitive fatigue and depression should be assessed in survivors of childhood cancer using both self-rated and proxy-rated measures, and appropriate interventions offered.

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Section: Discussionsupporting

confidence: 93%

Cognitive fatigue in relation to depressive symptoms after treatment for childhood cancer

et al. 2020

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“…The participants in the current study scored below the normative mean at baseline and the mean score had further decreased at follow-up. This is in line with previous research showing that processing speed can be reduced already at baseline (Irestorm, Perrin, & Tonning Olsson, 2018). Hence, a reduction in processing speed is associated with cognitive fatigue.…”

Section: Discussionsupporting

confidence: 93%

Cognitive Fatigue and Processing Speed in Children Treated for Brain Tumours

Irestorm

Öra

Linge

et al. 2021

J Int Neuropsychol Soc

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Objective: The relationship between fatigue and cognition has not been fully elucidated in children and adolescent survivors of brain tumours. The aim of the present study was to investigate the potential relationship between fatigue and cognitive impairments in these survivors, as this group is at risk for both types of deficits. Methods: Survivors of paediatric brain tumours (n = 45) underwent a neuropsychological testing on average 4 years after diagnosis. Mean age at follow-up was 13.41 years. Cognition was assessed with neuropsychological tests, and fatigue with the Pediatric Quality of Life (PedsQL™) Multidimensional Fatigue Scale. Regression analysis, adjusted for cranial radiotherapy and age at diagnosis, was used to investigate the associations between cognitive variables and fatigue subscales. Cognitive variables associated with fatigue were subsequently exploratively assessed. Results: Significant associations were found for cognitive fatigue and measures of cognitive processing speed; Coding: p = .003, r = .583, 95% CI [9.61; 22.83] and Symbol Search: p = .001, r = .585, 95% CI [10.54; 24.87]. Slower processing speed was associated with poorer results for cognitive fatigue. Survivors with the largest decrease in processing speed from baseline to follow-up also experienced the most cognitive fatigue. Survivors expressed more cognitive fatigue compared to other types of fatigue. Conclusions: The association between cognitive fatigue and cognitive processing speed in children and adolescents treated for brain tumours is in concordance with the results previously reported in adults. Some survivors experience fatigue without impairment in processing speed, indicating the need for comprehensive assessments. Moreover, the study supports that fatigue is a multidimensional concept which should be measured accordingly.

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“…There has previously been some conflicting results regarding gender and processing speed. In one previous study (Irestorm et al, 2018), where processing speed was measured by tasks from Wechsler tests, male gender was associated with worse outcome. In another study (Panwala et al, 2019), where processing speed was measured by an oral task, females had lower processing speed than males.…”

Section: Discussionmentioning

confidence: 87%

“…However, despite the prevalence of the secondary medical complications, the consequences for cognitive functioning have not been extensively studied. It is known that increased intracranial pressure and epileptic seizures are associated with lowered cognition at time of diagnosis (Irestorm et al, 2018), that persistent hydrocephalus requiring shunting is negatively associated with processing speed and verbal comprehension (Moxon-Emre et al, 2014), and that pituitary dysfunction is associated with informant-reported executive impairments (Fox & King, 2016). The scarcity of research is somewhat surprising, as these medical complications are otherwise known to be associated with cognitive challenges.…”

Section: Secondary Medical Complicationsmentioning

confidence: 99%

“…Other studies report a difference. Reduced processing speed has been reported for both males (Irestorm et al, 2018) and females (Panwala et al, 2019). However, in the studies reporting an impact of gender, females seem to struggle more both on cognitive tasks and on measures of adaptive skills (Holland et al, 2018;Kautiainen et al, 2020;Panwala et al, 2019;Ris et al, 2001).…”

Section: Secondary Medical Complicationsmentioning

confidence: 99%

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Neuropsychological functioning in survivors of childhood medulloblastoma/CNS-PNET: The role of secondary medical complications

Stadskleiv

Stensvold

Stokka

et al. 2020

The Clinical Neuropsychologist

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Objective: To investigate the long-term cognitive consequences of malignant pediatric brain tumor and its treatment, and factors explaining variability in cognitive functioning among survivors. Method: A geographical cohort of survivors of pediatric medulloblastoma (MB) and supratentorial primitive neuroectodermal tumor (CNS-PNET), treated between 1974 and 2013, was invited to participate. Of the 63 surviving patients, 50 (79%) consented to participation. The participants were tested with a battery of neuropsychological tests covering a wide age range. Verbal cognition, nonverbal cognition, processing speed, attention, memory, executive functioning, and manual dexterity were assessed. The participants were between 5:5 and 51:11 years of age at time of assessment. Assessments took place on average 19 years after primary tumor resective surgery. Results: One participant had a severe intellectual disability. For the rest, IQ varied from 52 to 125, with a mean score of 88.0 (SD 19.7). Twenty-eight (56%) of the participants had full-scale IQ scores in the age-average range or above. Gender, age at operation, time since operation, the presence of secondary medical complications, and treatment variables explained 46% of the variability in IQ scores, F(4,44) ¼ 9.5, p<.001. The presence of endocrine insufficiency in combination with either epilepsy and/or hydrocephalus was associated with lowered IQ, lowered processing speed, and memory impairments. Conclusion: Patients treated for childhood MB and CNS-PNET have a lifelong risk of medical sequelae, including impaired cognitive functioning. This study adds to the literature by demonstrating the importance of following neuropsychological functioning closely, especially processing speed, learning, and memory, in survivors who have multiple secondary medical complications.

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Pretreatment Cognition in Patients Diagnosed With Pediatric Brain Tumors

Cited by 10 publications

References 37 publications

Cognitive fatigue in relation to depressive symptoms after treatment for childhood cancer

Cognitive fatigue in relation to depressive symptoms after treatment for childhood cancer

Cognitive Fatigue and Processing Speed in Children Treated for Brain Tumours

Neuropsychological functioning in survivors of childhood medulloblastoma/CNS-PNET: The role of secondary medical complications

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