Neuropsychological Consequences for Survivors of Childhood Brain Tumor in Malaysia.

Hamidah Alias,Leo M J De Sonneville,Ilse Schuitema,Sie Chong D Lau

doi:10.3389/fpsyg.2018.00703

Abstract

Objective: This study aimed to evaluate neuropsychological consequences in survivors of childhood brain tumor.Method: A case-control study was conducted over a period of 4 months in a tertiary referral center in Kuala Lumpur, Malaysia. Fourteen survivors of childhood brain tumor aged 7–18 years, who were off-treatment for at least 1 year and were in remission, and 31 unrelated healthy controls were recruited. The median age at diagnosis was 8.20 years (range: 0.92–12.96 years). The diagnoses of brain tumors were medulloblastoma, germ cell tumor, pineocytoma, pilocystic astrocytoma, suprasellar germinoma, and ependymoma. Eleven survivors received central nervous system irradiation. Seven tasks were selected from the Amsterdam Neuropsychological Tasks program to evaluate alertness (processing speed), and major aspects of executive functioning, such as working memory capacity, inhibition, cognitive flexibility, and sustained attention. Speed, stability and accuracy of responses were the main outcome measures.Results: Survivors of childhood brain tumor showed statistically significant poorer performance on all tasks compared to healthy controls. Both processing speed and accuracy were impaired in the survivors, in particular under more complex task conditions. The survivors demonstrated deficits in alertness, sustained attention, working memory capacity, executive visuomotor control, and cognitive flexibility. Longer duration off treatment appeared to be correlated with poorer alertness, memory capacity, and inhibition.Conclusion: Survivors of childhood brain tumor in our center showed impaired neuropsychological functioning. Development of less toxic treatment protocols is important to prevent late effects of cognitive deficits in survivors of childhood brain tumor.

Highlights

Primary brain tumors belong to the second most common type of cancer in children, representing about 20% of all pediatric cancers (Ellison et al, 2009; Kaatsch, 2010)
There were no significant differences between survivors with childhood brain tumor and healthy controls in the demographic variables except for the fathers’ education level (Table 1)
The Amsterdam Neuropsychological Tasks (ANT) tasks were performed by 14 survivors and 31 unrelated healthy controls

Summary

Introduction

Primary brain tumors belong to the second most common type of cancer in children, representing about 20% of all pediatric cancers (Ellison et al, 2009; Kaatsch, 2010). MB is the most common pediatric brain tumor, representing approximately 30% of all childhood brain tumors and is usually found in the PF (Saletta et al, 2014). Poor executive function and speed of processing were identified as the ‘core deficit’ by neuropsychological investigation of survivors with childhood brain tumor (Butler and Mulhern, 2005). Deficits in attentional functioning were evident approximately 4–5 years post CI and were associated with reduced volumes of normalappearing white matter (Dennis et al, 1998; Reddick et al, 2003; Mulhern et al, 2004b). Marked executive dysfunctions have been reported previously in survivors of PF tumor treated with surgical resection only (Levisohn et al, 2000), or combined with postsurgical adjuvant treatment (Koustenis et al, 2016)

Methods

Results

Discussion

Conclusion