Improvement In Neurocognitive Function Research Articles

Neurocognitive correlates of the use of combined Antiretroviral Therapy among HIV-infected adults attending care and treatment center at Muhimbili National Hospital, Dar es Salaam, Tanzania: An analytical crosssectional study

Background: The discovery of the highly active antiretroviral therapy has improved the life span of people living with HIV/AIDS (PLWHA) to almost that of the general population. This, however, has been coupled with increased incidences of HIVassociated dementia, especially mild cognitive impairment. Combined antiretroviral therapy (cART) has been observed to improve neurocognitive functions but the ART regimen that is best suited for improvement of neurocognitive functions is still largely unknown. This study was aimed at determining how neurocognitive deficits in patients on cART were related to ART regimen. Methods: This was a cross-sectional analytical study. A sample of 351 adult patients attending care and treatment center (CTC) at Muhimbili National Hospital (MNH) in Dar es salaam, Tanzania were screened for HIV-associated neurocognitive deficits (HAND) against the ART regimens the patients were using. The study that was conducted from July to August 2012 and employed a standardized tool known as International HIV Dementia Scale (IHDS). Analysis was done using SPSS version 18. Frequency distribution, Chi-square, Fisher’s exact test and multivariate regression analysis were calculated to determine the levels of risk which was set at 5% significance level (p < 0.05). Results: Two hundred and forty of the 351 (68.4%) patients screened positive for neurocognitive deficits. Under descriptive statistics, factors such as age, years of formal education, central nervous system penetration effectiveness (CPE) score and the use of efavirenz containing regimens showed statistically significant association with HAND at p=0.03, p=0.038, p<0.001 and p=0.039, respectively, while on multivariate analysis only ART combination with CPE based on 2010 scoring system showed significant association system (p=0.02, AOR=0.449 and C.I=0.27-0.748) with HAND. Conclusion: These findings support the hypothesis that specific ART factors such as CPE may be protective against neurocognitive deficits. The study also highlights the need to choose appropriate ART regimen with special consideration to their potential neurotoxic side effect. Individual assessment for best therapeutic response is crucial for the patients’ cognitive wellbeing. Keywords: HIV-associated neurocognitive deficits (HAND), Antiretroviral, Central nervous system penetration, Muhimbili National Hospital, Dar es Salaam, Tanzania

Improvement in Subjective and Objective Neurocognitive Functions in Patients With Major Depressive Disorder

Although many patients with major depressive disorder (MDD) complain of neurocognitive impairment, the effects of antidepressant medications on neurocognitive functions remain unclear. This study compares neurocognitive effects of tianeptine and escitalopram in MDD. Patients with MDD (N = 164) were randomly assigned in a 1:1 ratio to either tianeptine (37.5 mg/d) or escitalopram (10 mg/d) for 12 weeks. Outcome measures included clinical improvement, subjective cognitive impairment on memory and concentration, the Mini-Mental State Examination, the Continuous Performance Test, the Verbal Learning Test, and the Raven Progressive Matrices, assessed every 4 weeks. After 12 weeks, the tianeptine group showed significant improvement in commission errors (P = 0.002), verbal immediate memory (P < 0.0001), Mini-Mental State Examination (P < 0.0001), delayed memory (P < 0.0001), and reasoning ability (P = 0.0010), whereas the escitalopram group improved in delayed memory and reasoning ability but not in the other measures. Both groups significantly improved in subjective cognitive impairment in memory (P < 0.0001) and concentration (P < 0.0001). Mixed effects model repeated measures analyses revealed that the tianeptine group had a significant improvement in scores of commission errors (F = 6.64, P = 0.011) and verbal immediate memory (F = 4.39, P = 0.038) from baseline to 12 weeks, compared with the escitalopram group, after controlling for age, sex, education years, baseline scores, and changes of depression severity. The treatment of MDD with tianeptine led to more improvements in neurocognitive functions, especially in commission errors and verbal immediate memory, compared with escitalopram, after controlling for changes in depression severity. Both drugs improved subjective cognitive impairment of memory and concentration.

Biphasic Change of Progenitor Proliferation in Dentate Gyrus After Single Dose of Isoflurane in Young Adult Rats

Isoflurane exposure causes improvement in long-term neurocognitive function in young adult rats; this is associated with an increase in dentate gyrus (DG) progenitor proliferation 4 days after anesthesia. However, the number of new neurons that were born from cells that incorporated bromodeoxyuridine (BrdU) 4 days after anesthesia is not affected by anesthesia. We tested the hypothesis that progenitor proliferation continues to increase past 4 days, which would imply the possibility that the number of new neurons after anesthesia could be increased if BrdU labeling occurred at a later time point. BrdU was injected at 0, 1, 2, 4, 9, 16 days after 4 hours of isoflurane exposure to 60-day old rats. Brains were harvested 2 hours later, immunohistochemically stained, and the number of BrdU+ cells in the DG was assessed microscopically. After 4 hours of exposure to isoflurane in 60-day old rats, the number of BrdU+ cells decreased on days 0 to 2, then increased on day 4 significantly, and regressed toward the control level on days 9 and 16. Anesthesia-induced progenitor proliferation in the DG was not sustained 9 days after anesthesia. We interpret these results to signify that an anesthetic effect on neurogenesis likely does not play a critical role in the previously observed isoflurane-induced long-term improvement in neurocognitive function in 60-day old rats and that the transient increase in progenitor proliferation serves to replenish the pool of neural stem cells. The mechanism of anesthesia-induced improvement in cognition of young adult rats remains elusive.

Cognitive function at 2443 μmol/l creatinine

BackgroundOne hallmark of uremia is the impairment of neuro-cognitive function. Anecdotal clinical description from the early days of chronic dialysis therapy impressively illustrates the improvement of those functions by chronic hemodialysis treatment. Fortunately, today, uremia is only rarely observed in industrialized countries as many patients seek medical/nephrological attention prior to the occurrence of deadly complications of uremia.Case presentationWe report a rare case of severe uremia and describe the day to day improvement in neuro-cognitive function by dialysis using state of the arte test battery – starting at a serum creatinine of 2443 μmol/l.ConclusionsEspecially executive functions, which are assumed to be localized in the frontal cerebral regions, are impaired in severe uremia and improve remarkably with the correction of severe uremia, i.e. initiation of dialysis.

Cognitive Function During Vagus Nerve Stimulation for Treatment-Refractory Epilepsy: A Pilot Study Using the Critical Flicker Fusion Test

This pilot study assessed neuro-cognitive functioning in 7 adults treated with Vagus Nerve Stimulation (VNS) for refractory epilepsy over a 12-month period. All patients were assessed using the Critical Flicker Fusion (CFF) test, a sensitive measure of the ability of the central nervous system to discriminate items of sensory information, along with a standardized battery of neuropsychological and behavioral measures. Reduction in seizure frequency and psychiatric ratings was accompanied by a selective but significant (p < .05) improvement in CFF performance. These findings suggest that the CFF test could be a useful indicator of improvement in neurocognitive functioning during VNS.

Dynamics of cognitive change in HIV‐infected individuals commencing three different initial antiretroviral regimens: a randomized, controlled study

Improvements in neurocognitive (NC) function have been associated with commencing antiretroviral therapy in HIV-infected subjects. However, the dynamics of such improvements are poorly understood. We assessed changes in NC function via a validated computerized battery (CogState™, Melbourne, Victoria, Australia) at baseline and after 24 and 48 weeks in a subset of therapy-naïve neuro-asymptomatic HIV-infected subjects, randomized to commence three different antiretroviral regimens. Of 28 subjects enrolled in the study, nine, eight and 11 were randomly allocated to commence tenofovir/emtricitabine with efavirenz (arm 1), atazanavir/ritonavir (arm 2) and zidovudine/abacavir (arm 3), respectively. Overall improvements in NC function were observed at week 24 and function continued to improve at week 48 (changes in z-score for overall cognitive global score of 0.16 and 0.18 at weeks 24 and 48, respectively). Within the NC speed domains, generally greater improvements were observed in arms 2 and 3, compared with arm 1 (changes in z-score for composite speed scores at weeks 24/48 of 0.16/0.16, -0.29/-0.24 and -0.15/-0.31 in arms 1, 2 and 3, respectively; P = 0.04 for change at week 48 in arm 3 versus arm 1). Finally, improvements in executive function occurred later (only observed at week 48) and were driven by improvements in arm 3 (z-score changes of 0.23, 0.06 and -0.78 in arms 1, 2 and 3, respectively; P = 0.02 for change in arm 3 versus arm 1). Improvements in NC function continue over the first year after initiating antiretroviral therapy in neuro-asymptomatic HIV-infected subjects.

Neurocognitive function: an emerging surrogate endpoint for neuro-oncology trials

Pediatric neuro-oncologists are familiar with the challenge that their potentially curative treatments may come at a high price because they may improve survival, but not without developmental delays and persistent neuropsychological sequelae in a significant proportion of patients. The view that the radiological determination of response or stable disease is a sufficient parameter to ascertain that “my patient is doing well” has long been challenged in adult neuro-oncology in the primary CNS lymphoma field as well as in cohorts of brain metastasis patients treated with whole-brain radiotherapy. In contrast, neurocognitive function in malignant glioma patients has traditionally been assumed to roughly reflect the status of tumor control. This has often been true because the treatment modalities administered to these patients have been less aggressive, in part because of their non-curative nature and because the lengths of survival have often been too short to allow patients to experience long-term adverse effects of treatment. Neurocognitive function has now become an interesting endpoint from another angle. The introduction of bevacizumab, an antibody to vascular endothelial growth factor (VEGF), and other VEGF-targeting agents into the repertoire of medical options for malignant glioma patients has challenged the view that our current imaging criteria are sufficient to estimate the benefit derived from all new agents, irrespective of their mode of action (1). In fact, the assessment of neurocognitive function may now become an important more-than-surrogate marker to determine whether an apparently successful treatment as assessed by neuroimaging truly translates into a clinical benefit for the patient. Fortunately, this issue was recognized when the BRAIN trial, which assessed the safety and efficacy of bevacizumab with and without irinotecan in patients with recurrent glioblastoma, was designed. Wefel and colleagues (2) now report the development of neurocognitive function in the first 24 weeks after study entry in a major proportion of the participants of the BRAIN trial. They found that most patients with at least stable disease at 24 weeks also had stable or improved neurocognitive function, whereas patients with progressive disease commonly had cognitive decline. In the absence of the demonstration of a survival benefit for bevacizumab in recurrent glioblastoma, because no study with an appropriate bevacizumab-free control arm was performed, these data are reassuring because they indicate that the responses seen by neuroimaging were most often associated with the preservation or improvement of neurocognitive function. The most interesting subgroup of patients is the one of approximately 30% that exhibited some neurocognitive decline in the absence of documented tumor progression. Although no correlative analyses with the MRI patterns were reported, it is tempting to assume that patients with non-enhancing diffuse progression, which escapes response criteria heavily based on contrast-enhanced imaging, may have been in that subgroup. On the other hand, cognitive decline preceding MRI-documented progression has also been noted in the pre-bevacizumab era (3). Neurocognitive function remains a difficult endpoint to assess and interpret, given the multitude of confounding factors such as co-medication, notably with antidepressant drugs, and psychiatric disorders, notably depression. Nevertheless, efforts such as the present analysis in the BRAIN trial are necessary and welcome to better estimate the clinical impact of new treatments administered in an eventually palliative setting.

474 Improvements in Neurocognitive Function Are Delayed after LVAD Implantation

474 Improvements in Neurocognitive Function Are Delayed after LVAD Implantation

Cognitive function in treated HIV patients

Cognitive function in treated HIV patients Valerio Tozzi, Pietro Balestra, Raffaella Libertone, Andrea AntinoriLazzaro Spallanzani National Institute for Infectious Diseases, Rome, ItalyAbstract: Although highly active antiretroviral therapy (HAART) has reduced the incidence of HIV-associated dementia, the overall prevalence of HIV-associated neurocognitive disorders (HAND) has increased. Since treatment and prevention of HAND are becoming an increasing concern, management strategies for cognitive impairment in patients living with HIV are expected to play an important role in the near future. This review summarizes the existing literature on studies investigating cognitive functions in patients receiving antiretroviral (ARV) treatment. Most studies indicate that HAART use results in improvement of neurocognitive functions, yet milder forms of HAND are not only prevalent, but also incident in patients with persistently undetectable plasma HIV RNA. We performed a systematic review on all studies performed in patients receiving ARV treatment that included neurocognitive evaluations as study end points. Thirty-six studies were examined. Study methodology varied from cross-sectional to double-blind, randomized, controlled designs. Aside from historic zidovudine monotherapy trials, in most studies, ARV schemes varied considerably, and in some cases, ARV regimens were not reported in detail. Only a few articles included virological studies on cerebrospinal fluid. Study duration was &lt;2 years in most cases. Differences in study design and presence of study limitations may account for difficulties in understanding the impact of HAART on cognition and in evaluating the effect of an individual agent or ARV regimen on cognitive functioning. The aim of the present article is to provide HIV clinicians with a comprehensive review of recent achievements and future prospects for ARV treatment and prevention of cognitive dysfunctions in HIV-infected patients.Keywords: highly active antiretroviral therapy, neurocognitive disorders, HIV dementia, central nervous system

Cognitive and adaptive functioning after liver transplantation for maple syrup urine disease: A case series

MSUD is a complex metabolic disorder that has been associated with central nervous system damage, developmental delays, and neurocognitive deficits. Although liver transplantation provides a metabolic cure for MSUD, changes in cognitive and adaptive functioning following transplantation have not been investigated. In this report, we present data from 14 patients who completed cognitive and adaptive functioning testing pre- and one yr and/or three yr post-liver transplantation. Findings show either no significant change (n=8) or improvement (n=5) in IQ scores pre- to post-liver transplantation. Greater variability was observed in adaptive functioning scores, but the majority of patients evidenced no significant change (n=8) in adaptive scores. In general, findings indicate that liver transplantation minimizes the likelihood of additional central nervous system damage, providing an opportunity for possible stabilization or improvement in neurocognitive functioning.

Longer term improvement in neurocognitive functioning and affective distress among methamphetamine users who achieve stable abstinence

Chronic use of methamphetamine (MA) is associated with neuropsychological dysfunction and affective distress. Some normalization of function has been reported after abstinence, but little in the way of data is available on the possible added benefits of long-term sobriety. To address this, we performed detailed neuropsychological and affective evaluations in 83 MA-dependent individuals at a baseline visit and following an average one-year interval period. Among the 83 MA-dependent participants, 25 remained abstinent, and 58 used MA at least once during the interval period. A total of 38 non-MA-addicted, demographically matched healthy comparison (i.e., HC) participants were also examined. At baseline, both MA-dependent participants who were able to maintain abstinence and those who were not performed significantly worse than the healthy comparison subjects on global neuropsychological functioning and were significantly more distressed. At the one-year follow-up, both the long-term abstainers and healthy comparison groups showed comparable global neuropsychological performance and affective distress levels, whereas the MA-dependent group who continued to use MA were worse than the comparison participants in terms of global neuropsychological functioning and affective distress. An interaction was observed between neuropsychological impairment at baseline, MA abstinence, and cognitive improvement, with abstinent MA-dependent participants who were neuropsychologically impaired at baseline demonstrating significantly and disproportionately greater improvement in processing speed and slightly greater improvement in motor abilities than the other participants. These results suggest partial recovery of neuropsychological functioning and improvement in affective distress upon sustained abstinence from MA that may extend beyond a year or more.

Effects of switching to long‐acting injectable risperidone from oral atypical antipsychotics on cognitive function in patients with schizophrenia

To investigate changes in cognitive function and clinical features following a switch from oral atypical antipsychotics (AAPs) to long-acting injectable risperidone (LAIR) in patients with schizophrenia. Thirty-six patients with schizophrenia treated with oral AAPs participated in this open-label, 26-week study. Cognitive functions were measured at baseline and at 12 and 26 weeks. The secondary outcome measures included the Positive and Negative Syndrome Scale (PANSS), Social and Occupational Functioning Assessment Scale (SOFAS), Scale for Unawareness of Mental Disorder (SUMD), and measurements for extrapyramidal symptoms. Significant improvements in cognitive function were observed in the backward Digit Span Test, Verbal Learning Test, Wisconsin Card Sorting Test, correct responses on the Continuous Performance Test, and Trail Making Test part B following a switch to LAIR. Scores on the PANSS, SOFAS, SUMD, and the Simpson-Angus Rating Scale also improved significantly. Most improvements in neurocognitive function were not correlated with clinical measures. Weight gain and hyperprolactinemia were the most common adverse events. Switching from oral AAPs to LAIR improved cognitive function including vigilance, verbal learning and memory, executive function, sustained attention, and visuomotor speed in patients with schizophrenia. It was also effective for improving psychotic symptoms, social functioning, and insight.

Atypical Antipsychotics, Neurocognitive Deficits, and Aggression in Schizophrenic Patients

The purpose of this study was to compare the effects of olanzapine, clozapine, and haloperidol on neurocognitive function in schizophrenic patients who present with documented episodes of physical aggression and to determine whether change in cognitive function is related to aggression. One hundred physically aggressive schizophrenic inpatients were assigned to a randomized, double-blind, parallel-group, 12-week treatment, and received cognitive evaluations at baseline. There were 33, 34, and 33 subjects in the clozapine, olanzapine, and haloperidol groups, respectively. They were administered a battery of tests assessing psychomotor function, general executive function, visual and verbal memory, and visuospatial ability. A general cognitive index was derived from the above battery. The overall score on the Modified Overt Aggression Scale was used to measure the number and severity of the aggressive events. Psychiatric symptoms and side effects were also assessed. The improvement in the general cognitive index differed significantly among the 3 treatment groups, with olanzapine being superior to both haloperidol and clozapine. Further analyses revealed significantly greater improvement with olanzapine in several cognitive domains. Furthermore, improvement in the general cognitive index was significantly associated with a decrease in aggression in the olanzapine group but not in the other 2 medication groups. In violent schizophrenic patients, olanzapine treatment is associated with better cognitive functioning relative to haloperidol and clozapine. This improvement in neurocognitive function is associated with a decrease in aggressive behavior. As clozapine markedly reduced aggression, there may be different pathways for the antiaggressive effect of olanzapine and that of clozapine.

A longitudinal analysis of neurocognitive function in unipolar depression

Neurocognitive function is reduced in major depression, but uncertainties remain about if and to what extent improvement in neurocognitive function follows remission of depressive symptoms. A total of 30 patients with Diagnostic and Statistical Manual of Mental Disorders–Fourth Edition (DSM-IV) diagnosis of unipolar major depressive disorder (MDD) at baseline were tested neuropsychologically again, after a mean test–retest interval of 2 years. At retest, patients were partly or completely recovered from depression. Remission of depression was followed by improvement in verbal memory function up to the level of healthy controls, but no associations between improvement in depression and improvement in other dimensions of neurocognitive function were found. Neurocognitive function at baseline was not predictive of improvement in depressive symptoms over time. The present study provided some support for the state hypothesis as to the association between neurocognitive impairment and depression.

Pediatric Head Injury

Pediatric Head Injury

Improvement of neurocognitive function after protected carotid artery stenting

To investigate the effect of protected carotid artery stenting on neurocognitive function with particular consideration of the angiographic filling of the ipsilateral anterior cerebral artery (ACA). An improved inflow to the supply area of the anterior cerebral artery after revascularisation of severe carotid artery stenosis may beneficially affect frontal lobe cognitive functions. We prospectively included 71 consecutive patients who underwent carotid artery stenting (CAS) due to high grade carotid artery stenosis. Intracranial angiograms and filling status of the ACA pre- and post-stenting were analyzed and a battery of 5 selected neuropsychological tests for frontal lobe function were applied prior to and 6 months after CAS. Patients with improvement in at least two tests were defined as having improved neurocognitive function. Compared to baseline, we found a significant improvement of the Trail-Making Test A (median 6% improved change-score; P = 0.01), the test of supermarket items showed a trend towards significant improvement (median 3.7% improved change-score; P = 0.09). In 32 patients (45%) an improvement of at least 2 neurocognitive tests was observed. Neuropsychological improvement was found more frequently in patients with a contrasted ipsilateral ACA after CAS (88%, 95% CI 77 to 99) compared to patients without angiographic filling of the ipsilateral ACA post CAS (13%, 95% CI 1 to 25), respectively (P < 0.01). Carotid artery stenting improves neurocognitive function in a considerable proportion of patients. A contrasted ipsilateral anterior cerebral artery after CAS is associated with improved neurocognitive function, presumably due to amelioration of frontal lobe perfusion.

Computer-assisted cognitive remediation in schizophrenia: What is the active ingredient?

An emerging body of research has shown that computer-assisted cognitive remediation, consisting of training in attention, memory, language and/or problem-solving, produces improvement in neurocognitive function that generalizes to untrained neurocognitive tests and may also impact symptoms and work functioning in patients with schizophrenia. The active ingredient of these interventions, however, remains unknown as control groups in these studies have typically included few, if any, of the elements of these complex behavioral treatments. This study compared the effects of an extended (12-month), standardized, computer-assisted cognitive remediation intervention with those of a computer-skills training control condition that consisted of many of the elements of the experimental intervention, including hours spent on a computer, interaction with a clinician and non-specific cognitive stimulation. Forty-two patients with schizophrenia were randomly assigned to one of two conditions and were assessed with a comprehensive neuropsychological test battery before and after treatment. Results revealed that cognitive-remediation training produced a significant improvement in working memory, relative to the computers-skills training control condition, but that there was overall improvement in both groups on measures of working memory, reasoning/executive-function, verbal and spatial episodic memory, and processing speed. Taken together, these findings suggest that specific practice in neurocognitive exercises targeted at attention, memory and language, produce improvements in neurocognitive function that are not solely attributable to non-specific stimulation associated with working with a computer, interacting with a clinician or cognitive challenge, but that non-specific stimulation has a salutary effect on neurocognition as well.

Normalisation of cerebrospinal fluid biomarkers parallels improvement of neurological symptoms following HAART in HIV dementia – case report

BackgroundSince the introduction of HAART the incidence of HIV dementia has declined and HAART seems to improve neurocognitive function in patients with HIV dementia. Currently, HIV dementia develops mainly in patients without effective treatment, though it has also been described in patients on HAART and milder HIV-associated neuropsychological impairment is still frequent among HIV-1 infected patients regardless of HAART. Elevated cerebrospinal fluid (CSF) levels of markers of neural injury and immune activation have been found in HIV dementia, but neither of those, nor CSF HIV-1 RNA levels have been proven useful as diagnostic or prognostic pseudomarkers in HIV dementia.Case presentationWe report a case of HIV dementia (MSK stage 3) in a 57 year old antiretroviral naïve man who was introduced on zidovudine, lamivudine and ritonavir boosted indinavir, and followed with consecutive lumbar punctures before and after two and 15 months after initiation of HAART. Improvement of neurocognitive function was paralleled by normalisation of CSF neural markers (NFL, Tau and GFAP) levels and a decline in CSF and serum neopterin and CSF and plasma HIV-1 RNA levels.ConclusionThe value of these CSF markers as prognostic pseudomarkers of the effect of HAART on neurocognitive impairment in HIV dementia ought to be evaluated in longitudinal studies.

Improvement in neurocognitive function (NCF) correlates with tumor regression after whole brain radiation therapy (WBRT) for brain metastases (BM)

1504 Background: Few prospective trials have explored the neurocognitive impact of WBRT in BM patients (pts), complicated by competing effects between benefit from WBRT and deterioration due to disease progression. Methods: 208 pts from the WBRT alone arm (30 Gy) of a phase III trial (PCYC-9801) evaluating motexafin gadolinium in BM were analyzed. NCF was assessed by 8 tests of memory, executive function and fine motor coordination, and correlated to BM volume change by MRI, using Spearman’s rank correlation. Pts with tumor shrinkage below and above the median (45%) were compared for survival and NCF deterioration using Kaplan-Meier analysis. Results: 135 pts (65%) were evaluable for BM volume at baseline and 2 months (mo). Pts were divided into “good” and “poor” responders based on % volume reduction at 2 mo above or below the population median of 45%. The uni-directional hypothesis of improved survival in good responders was significant (P = 0.03, median survival (MS) 300±26 days (d) vs 240±19 d). For all 8 tests, the median time to NCF deterioration was longer in good responders than in poor responders. Largest gains were for an executive function test Trailmaking B (131 d gain, P=0.02), fine motor tests Pegboard non-dominant hand (110 d gain, P=0.05) and Pegboard dominant hand (93 d gain, P=0.02). In 15 mo survivors, statistically significant correlation between tumor shrinkage and NCF preservation was seen for 4/8 NCF tests (r = 0.68–0.88), especially for executive function and fine motor coordination. At early follow-up, the population mean NCF scores were dominated by pts with progressive disease, as reflected by a sharp drop in the mean NCF scores at 4 mo. 15-mo survivors had stable or improving scores, associated with greater reduction in BM volume in the 15 versus 4 mo survivors. Conclusions: WBRT-induced tumor shrinkage correlates with better survival and NCF preservation. NCF is stable or improved in long-term BM survivors. The adverse impact of tumor growth on neurocognitive function appears greater than that of WBRT. [Table: see text]

Iron deficiency anaemia in Jamaican children, aged 1-5 years, with sickle cell disease

The aim of this study was to determine, using a combination of measures, the prevalence of iron deficiency anaemia (IDA) in children under five years-of-age who have sickle cell disease (SCD) and attend the Sickle Cell Clinic (SCU) of the Tropical Medicine Research Institute. Children with homozygous sickle cell anaemia (Hb SS) or doubly heterozygous for Hb S and Hb C (Hb SC) disease who had not received a blood transfusion within three months prior to the iron measurements, were enrolled. The diagnosis of IDA was made if transferrin saturation was less than 16% with serum iron less than 10.7 micromol/l and a low mean corpuscular volume (MCV) for age. Twelve children (8.5%), seven with Hb SS and five with Hb SC had IDA. Adjusting for genotype, children with IDA had significantly higher red blood cell (RBC) counts (4.3 x10(9)/l vs 3.0 x 10(9)/l, p < 0.001) and total iron binding capacity (TIBC) (65.6 micromol/l vs 55.2 micromol/l, p < 0.004) but significantly lower reticulocyte (retic) counts (7.8 % vs 12.2%, p = 0.001) than children without IDA. Iron deficiency anaemia is a clinical problem which affects children with SCD in Jamaica. The higher RBC counts in the IDA group may be due to decreased haemolysis and increased red cell survival whilst the lower reticulocyte counts may be due to impaired erythropoiesis. These observations need to be extended by clinical studies to establish improved diagnostic measures for IDA in SCD. Additionally, clinical trials are needed to determine whether treatment of IDA in children with SCD reduces morbidity and is associated with clinical benefits such as improvements in neurocognitive function.