Acute effects of irradiation on cognition: changes in attention on a computerized continuous performance test during radiotherapy in pediatric patients with localized primary brain tumors

Abstract

Purpose: To assess sustained attention, impulsivity, and reaction time during radiotherapy (RT) for pediatric patients with localized primary brain tumors. Methods and Materials: Thirty-nine patients (median age 12.3 years, range 5.9–22.9) with primary brain tumors were evaluated prospectively using the computerized Conners’ continuous performance test (CPT) before and during conformal RT (CRT). The data were modeled to assess the longitudinal changes in the CPT scores and the effects of clinical variables on these changes during the first 50 days after the initiation of CRT. Results: The CPT scores exhibited an increasing trend for errors of omission (inattentiveness), decreasing trend for errors of commission (impulsivity), and slower reaction times. However, none of the changes were statistically significant. The overall index, which is an algorithm-based weighted sum of the CPT scores, remained within the range of normal throughout treatment. Older patients (age >12 years) were more attentive ( p < 0.0005), less impulsive ( p < 0.07), and had faster reaction times ( p < 0.001) at baseline than the younger patients. The reaction time was significantly reduced during treatment for the older patients and lengthened significantly for the younger patients ( p < 0.04). Patients with a shunted hydrocephalus ( p < 0.02), seizure history ( p < 0.0006), and residual tumor ( p < 0.02) were significantly more impulsive. Nonshunted patients ( p < 0.0001), those with more extensive resection ( p < 0.0001), and patients with ependymoma ( p < 0.006) had slower initial reaction times. Conclusion: Children with brain tumors have problems with sustained attention and reaction time resulting from the tumor and therapeutic interventions before RT. The reaction time slowed during treatment for patients <12 years old. RT, as administered in the trial from which these data were derived, has limited acute effects on changes in the CPT scores measuring attention, impulsiveness, and reaction time.