Wechsler Intelligence Scale Research Articles

Evaluating the effectiveness of transcranial direct current stimulation on improving cognitive function in bipolar patients

BackgroundBipolar disorder is classified as one of the most debilitating mental diseases. Although patients receive medical treatment, cognitive deficits remain in the euthymic phase in many patients. It is hypothesized that brain electrical stimulation protocols that increase cognitive function may increase the quality of life. Therefore, this study aimed to evaluate the effectiveness of transcranial direct current stimulation in improving cognitive function in bipolar patients in the euthymic phase. Methods & MaterialsIn a double-blind, sham-controlled- clinical trial, 46 euthymic bipolar patients diagnosed based on DSM-V were randomly divided into the two intervention and control groups. tDCS was applied for the intervention group using an anode electrode at the left dorsolateral-peripheral cortex (F3) and the cathode at the right dorsolateral-frontal (F4) (based on the 10/20 system) at 2 mA for 20 min. The Strop Color and Word Test, The Rey Auditory Verbal Learning Test (RAVLT), and The Wechsler Adult Intelligence Scale (WAISR) were evaluated before, at the end of the third and the seventh weeks of the intervention. Statistical analysis was performed using SPSS v 16. ResultsThe scores of immediate and delayed auditory memory and visual memory in the intervention group, unlike the control group, improved significantly after treatment. Moreover, Wechsler's working memory score in the intervention group improved significantly after treatment. Consistent and inconsistent answers scores were also significantly improved in the intervention group compared with the controls. ConclusionThe present study indicated that tDCS might be an efficient and safe method for improving cognitive function in euthymic bipolar patients.

Epidemiology and Diagnosis of Slow Learners (Borderline Intellectual Functioning).

The definitions of "slow learners" and "borderline intellectual functioning (BIF)" have not reached a consensus and have continually evolved in terminology. The criteria for diagnosing BIF include the Full-Scale Intelligence Quotient, adaptive functioning, and onset of symptoms from the developmental period; however, specific standards have not been provided. Until the Diagnostic and Statistical Manual of Mental Disorders-IV, a range for the Full-Scale Intelligence Quotient was provided, but due to its limitations in reflecting the actual functioning of individuals with BIF, this criterion was removed from the Diagnostic and Statistical Manual of Mental Disorders-5. The absence of specific diagnostic criteria complicates the identification of individuals with BIF, highlighting the need for a more precise classification and definition.

Impact of Childhood Maltreatment on Cognitive Function and Its Relationship With Emotion Regulation in Young Adults.

Childhood maltreatment can negatively impact cognitive development, including executive function, working memory, and processing speed. This study investigated the impact of childhood maltreatment on cognitive function in young adults using various measurements, including computerized tests, and their relationship with emotional dysregulation. We recruited 149 healthy individuals with and without maltreatment experiences and used the Wechsler Adult Intelligence Scale IV (WAIS-IV) and a computerized battery to analyze cognitive function. Both the WAIS-IV and computerized tests revealed that individuals with a history of childhood maltreatment had decreased cognitive function, especially in terms of working memory and processing speed. These individuals tended to employ maladaptive emotion regulation strategies. Among cognitive functions, working memory is negatively related to maladaptive emotion regulation strategies such as catastrophizing. This study highlights the effects of childhood maltreatment on cognitive function in young adulthood. Moreover, the study suggests clinical implications of cognitive interventions for improving emotion regulation and cognitive function in individuals with a history of childhood maltreatment.

Cognitive functioning in adult psychiatric patients with and without attention-deficit/hyperactivity disorder.

Studies of cognitive functioning in patients with attention-deficit/hyperactivity disorder (ADHD) have often used healthy comparison groups. The present study examines cognitive profiles, including general intellectual and executive functions, in a young adult psychiatric outpatient clientele with ADHD and evaluates whether their cognitive profiles can help differentiate them from patients with non-ADHD-associated psychiatric disorders. The study group comprised 141 young adult psychiatric patients (age range 18-25 years) of whom 78 had ADHD. Comprehensive neuropsychological assessment included the Wechsler Adult Intelligence Scale, 4th version and subtests from Delis-Kaplan Executive Function System. Clinical psychiatric assessments and diagnostic evaluation were performed. The ADHD group (including all subtypes) had significantly lower verbal comprehension and full-scale intelligence quotient than the non-ADHD group. Tests measuring working memory or executive function did not separate those with and without ADHD. The results of our study suggest that, except for the need to establish overall cognitive performance level, the clinical implication of testing is small if the purpose is to "rule out" an ADHD diagnosis.

The Effect of Developmental Bottom-up Approach Through Perceptual-motor Interventions on Performance of Children With Mild Intellectual Disability

Background and Aims Intellectual disability manifests through defects in cognitive, motor, and perceptual skills as elements affecting learning and acquiring individual skills. Efforts to improve these skills are essential in these children. This study investigated the durable effects of perceptual-motor process-oriented interventions with the Ramon and Johnston protocol on the motor, cognitive, and perceptual performance of children with mild intellectual disability. Methods In this quasi-experimental research, 21 children with mild intellectual disability aged 7 to 12 years were selected using the available sampling method and according to the inclusion criteria. Then, they were assigned to an experimental group of 10 students (10 weeks of perceptual-motor intervention according to the Johnstone and Ramon protocol, two sessions per week) and a control group of 11 students (no intervention) using a simple random method. The participants were evaluated before and 2 months after the intervention with movement assessment battery for children 2nd Edition, Conners’ continuous performance test-II, the working memory test of Wechsler intelligence scale for children fourth edition, and the test of visual perception skills revised. Univariate covariance test was used for data analysis. Results The findings showed a significant difference between the intervention and control groups in general motor performance, aiming and catching, the correct answer in the attention test, visual sequential memory, and visual figure-ground in the delayed post-test stage (P<0.05). Also, no significant difference was seen in other subtests (P>0.05). Conclusion Bottom-up approach interventions through Ramon and Johnston’s comprehensive perceptual-motor training can significantly help improve general and ball motor skills, sustained attention, visual sequential memory, and visual figure-ground in children with mild intellectual disability.

Physical Activity and Cognitive Function in Middle and Late Adulthood ‒ Results of a Preliminary Study

Objective: The aim of the study was to characterise the physical activity (PA) of middle-aged and older adults and to determine whether the amount of PA was related to their level of cognitive function. Methods: This was a cross-sectional study of 52 women and 30 men aged 50‒80 years. Subtests of the Wechsler Intelligence Scales for Adults Revised Version ‒ Renormalisation WAIS-R(PL) were used to assess cognitive function: Digit span, Block design and Digit symbol, as well as the Colour Trails Test (CTT) and the Link's cube task. Physical activity was measured using the International Physical Activity Questionnaire-Long Version (IPAQ-LF) and a pedometer worn by the volunteers for one week. Associations between cognitive function and PA were estimated using non-parametric correlations. In addition, cognitive function and PA were compared in healthy participants, participants with one chronic condition, and participants with two or more conditions. Results: Walking, as measured by a pedometer, was at an average level in the study participants, and PA, as reported on the IPAQ-LF questionnaire, was very high. There were few associations between PA and cognitive performance. Moderate and vigorous levels of PA reported on the IPAQ-LF were correlated with more accurate performance on the Block design and Link's cube tasks. Higher levels of leisure time PA reported on the IPAQ-LF were correlated with better performance on the CTT. More PA at work was correlated with higher performance on most tasks. Activity measured by number of steps did not correlate with cognitive function. More steps correlated with less time spent inactive on the IPAQ-LF. In addition, healthier participants performed better on cognitive tasks and took more steps than those with chronic conditions. Conclusion: The research has contributed to the understanding of the relationship between real-life PA and cognitive function in middle-aged and older adults, and has provided important insights into PA in these individuals.

The Relationship of Preterm and Small for Gestational Age with Child Cognition During School-Age Years

BackgroundChildren born preterm and/or small for gestational age (SGA) are at increased risk of poor cognitive outcomes, particularly in low and middle-income countries (LMICs). ObjectivesThis study aimed to examine the cognitive and academic deficits during the school-age years in children born preterm or SGA compared with those in children born term adequate for gestational age (AGA) in rural Vietnam. MethodsChildren born to women in a preconception micronutrient supplementation trial in Vietnam were classified into 3 groups: preterm AGA (n =138), term SGA (n =169), and term AGA (n = 1134). Cognitive abilities were assessed using the Wechsler Intelligence Scale for Children, measuring 4 domains [verbal comprehension index (VCI), perceptual reasoning index (PRI), working memory index (WMI), and processing speed index (PSI) scores] and full-scale intelligence quotient (FSIQ) at 6–7 and 10–11 y. Academic achievement was assessed with mathematic and language tests. Analysis of variance and multiple regression models were used to analyze differences in cognitive function and academic achievement at 6–7 and 10–11 y by birth phenotypes. ResultsCompared with term AGA children, those born SGA had lower cognitive scores at both 6–7 y (VCI, −2.3; PRI, −3.7; PSI −2.1; and FSIQ, −2.9) and 10–11 y (VCI, −3.7; PRI, −3.5; WMI, −2.7; PSI, −1.9; and FSIQ, −3.9). Children born SGA also had poorer academic achievement with lower language (5.3) and mathematic (2.5) scores. Adjustments for maternal factors and home environment attenuated the associations, but the differences in VCI, PRI, FSIQ, and language at 10–11 y remained significant. There were no differences in cognitive function and academic achievement between children born preterm and AGA. ConclusionsOur findings highlight the enduring association of birth phenotype on cognitive functioning and academic achievement during the school years, despite adjustments for maternal education and family environment. Further research is needed to implement effective interventions to improve birth outcomes and optimize child health and development in LMICs.The trial was registered at clinicaltrials.gov as NCT01665378 (URL: https://clinicaltrials.gov/ct2/show/NCT01665378).

Neurocognitive effects and electrophysiological findings in ADHD and self-limiting centrotemporal spike wave epilepsy (SeLECTS) − A prospective tertiary care study

ObjectiveThe study aimed to determine the prevalence of attention deficit hyperactivity disorder (ADHD) in patients with self-limiting epilepsy with centrotemporal spike wave (SeLECTS), as well as the electroclinical features associated with this comorbid condition and the neurocognitive effects using psychometric tests. Additionally, we analysed the electrophysiological findings and neurocognitive status of patients with ADHD to estimate the prevalence of epilepsy and neurocognitive effects in the ADHD population and evaluate their clinical features. MethodThe study included patients diagnosed with SeLECTS and ADHD who were matched for age and gender. Electrophysiological tests, psychometric tests, demographic and clinical characteristics of SeLECTS patients aged 7–13 years and ADHD patients of similar age were analysed. The study examined electrophysiological and psychometric tests, as well as demographic and clinical characteristics. Both groups underwent testing using the Wechsler Intelligence Scale for Children (WISC-R), Stroop Colour and Word Test (SCWT), and EEG (Electroencephalogram). The SeLECTS group also underwent the Bender Visual-Motor Gestalt Test. ResultsNo significant relationship was found between the SeLECTS and ADHD groups in terms of age and gender. The rate of epileptiform discharge in EEG findings without a diagnosis of epilepsy was 5.6 % (n = 2) in the ADHD group. The rate of ADHD in the SeLECTS group was 28 % (n = 11).Although all subsections of the WISCR test were higher in the ADHD patient group than in the SeLECTS patient group, only verbal IQ and total IQ showed a significant difference. No significant differences were found between the completion times, error rates, and correction averages of the SCWT sections in both groups.There was no significant correlation found between the performance IQ, verbal IQ, and total intelligence scores in either the isolated SeLECTS patient group or the SeLECTS + ADHD patient group (p > 0.05). However, it is worth noting that verbal IQ was below normal in both groups and slightly lower in the SeLECT + ADHD group. Additionally, the mean SCWT completion time was significantly longer in the SeLECT + ADHD group than in the isolated SeLECTS group. However, no significant difference was found in the Bender Gestalt Visual Motor Perception Test.In the psychometric analyses comparing the isolated SeLECTS, SeLECT + ADHD, and ADHD patient groups, the SCWT completion times were significantly longer in the SeLECT + ADHD group than in the other two groups. The verbal IQ score was significantly higher in the ADHD group than in the other two groups. ConclusionIn conclusion, although SeLECTS is commonly considered a benign form of epilepsy, our study found a high rate of comorbidity with ADHD. This condition has a negative impact on verbal intelligence and sustained attention, highlighting the importance of a complete neuropsychological evaluation at the stage of epilepsy diagnosis. It is crucial not to overlook the possibility of an ADHD diagnosis.

Volumetric brain reductions in adult patients with phenylketonuria and their relationship with blood phenylalanine levels

BackgroundContinued dietary treatment since early diagnosis through newborn screening programs usually prevents brain-related complications in phenylketonuria (PKU). However, subtle neurocognitive and brain alterations may be observed in some adult patients despite early treatment. Nevertheless, neuropsychological and neuroimaging studies in the field remain scarce.ObjectivesThis work aimed to determine possible neuropsychological and structural brain alterations in treated adult patients with PKU.MethodsThirty-five patients with PKU and 22 healthy controls (HC) underwent neuropsychological assessment and T1-weighted magnetic resonance imaging on a 3 T scanner. FreeSurfer (v.7.1) was used to obtain volumetric measures and SPSS (v27.0.1.0) was used to analyze sociodemographic, neuropsychological, volumetric, and clinical data (p < 0.05).ResultsAdult patients with PKU showed significantly lower performance than HC in Full Scale IQ (t = 2.67; p = .010) from the WAIS-IV. The PKU group also showed significantly lower volumes than HC in the pallidum (U = 224.000; p = .008), hippocampus (U = 243.000; p = .020), amygdala (U = 200.000; p = .002), and brainstem (t = 3.17; p = .006) as well as in total cerebral white matter volume (U = 175.000; p = .001). Blood phenylalanine (Phe) levels in PKU patients were negatively correlated with the pallidum (r = -0.417; p = .013) and brainstem (r = -0.455, p = .006) volumes.ConclusionsAdult patients with early-treated PKU showed significantly lower global intelligence than HC. Moreover, these patients showed reduced global white matter volume as well as reductions in the volume of several subcortical grey matter structures, which might be related to the existence of underlying neurodevelopmental alterations. Higher blood Phe levels were also negatively correlated with pallidum and brainstem, suggesting a higher vulnerability of these structures to Phe toxicity.

Family history of psychiatric conditions and development of siblings of children with autism.

Younger siblings (SIBS) of children with autism exhibit a wide range of clinical and subclinical symptoms including social, cognitive, language, and adaptive functioning delays. Identifying factors linked with this phenotypic heterogeneity is essential for improving understanding of the underlying biology of the heterogenous outcomes and for early identification of the most vulnerable SIBS. Prevalence of neurodevelopmental (NDD) and neuropsychiatric disorders (NPD) is significantly elevated in families of children with autism. It remains unknown, however, if the family history associates with the developmental outcomes among the SIBS. We quantified history of the NDDs and NPDs commonly reported in families of children with autism using a parent interview and assessed autism symptoms, verbal, nonverbal, and adaptive skills in a sample of 229 SIBS. Multiple regression analyses were used to examine links between family history and phenotypic outcomes, whereas controlling for birth year, age, sex, demographics, and parental education. Results suggest that family history of schizophrenia, depression, anxiety, bipolar disorder, and intellectual disability associate robustly with dimensional measures of social affect, verbal and nonverbal IQ, and adaptive functioning in the SIBS. Considering family history of these disorders may improve efforts to predict long-term outcomes in younger siblings of children with autism and inform about familial factors contributing to high phenotypic heterogenetity in this cohort.

Clinical utility of the at-risk for psychosis state beyond transition: A multidimensional network analysis.

To be relevant to healthcare systems, the clinical high risk for psychosis (CHR-P) concept should denote a specific (i.e., unique) clinical population and provide useful information to guide the choice of intervention. The current study applied network analyses to examine the clinical specificities of CHR-P youths compared to general help-seekers and non-CHR-P youth. 146 CHR-P (mean age = 14.32 years) and 103 non-CHR-P (mean age = 12.58 years) help-seeking youth were recruited from a neuropsychiatric unit and assessed using the Structured Interview for Psychosis-Risk Syndromes, Children's Depression Inventory, Multidimensional Anxiety Scale for Children, Global Functioning: Social, Global Functioning: Role, and Wechsler Intelligence Scale for Children/Wechsler Adult Intelligence Scale. The first network structure comprised the entire help-seeking sample (i.e., help-seekers network), the second only CHR-P patients (i.e., CHR-P network), and the third only non-CHR-P patients (i.e., non-CHR-P network). In the help-seekers network, each variable presented at least one edge. In the CHR-P network, two isolated "archipelagos of symptoms" were identified: (a) a subgraph including functioning, anxiety, depressive, negative, disorganization, and general symptoms; and (b) a subgraph including positive symptoms and the intelligence quotient. In the non-CHR-P network, positive symptoms were negatively connected to functioning, disorganization, and negative symptoms. Positive symptoms were less connected in the CHR-P network, indicating a need for specific interventions alongside those treating comorbid disorders. The findings suggest specific clinical characteristics of CHR-P youth to guide the development of tailored interventions, thereby supporting the clinical utility of the CHR-P concept.

Exploring Interpersonal Meanings of Report Cards and WISC-V Scores: A Case Study of a Gifted Child

Using a discourse approach, this study examines interpersonal meanings and judgmental resources constructed in academic assessment reports and Wechsler Intelligence Scale for Children—Fifth Version (WISC-V) results. This research opens fresh avenues for analyzing the linguistic and cognitive elements of a gifted child’s early performance. The target child is a gifted student with a Fluid Reasoning score of 132 (98th percentile). In-depth English text analysis was performed on his eight academic report cards from the playgroup, prenursery, kindergarten, first two years of primary school, and one WISC-V test. The appraisal system serves as the study’s theoretical foundation, providing an interpersonal analysis of how behavior is evaluated and judged in the areas of capacity, normality, tenacity, veracity, and propriety. The findings indicate that when teachers’ observations and the WISC-V are integrated, a gifted student’s cognitive abilities and academic performance strengths and weaknesses can be revealed comprehensively. The alignment of teacher evaluations in the areas of languages, mathematics and science, as well as work habits and social attitudes and WISC-V test results, is also examined. This study contributes to the understanding of the behavioural patterns of gifted student and the implications for their education development.

QOL-28. NEUROCOGNITIVE DEFICITS, EMOTIONAL DISTURBANCES, PSYCHOSOMATIC COMPLAINS – ADDITIONAL SYMPTOMS OR COMORBID DIAGNOSIS IN CNS GERMINOMA? OVERVIEW OF GROUP AND CASE STUDIES

Abstract BACKGROUND CNS Germinoma cases are associated with good medical prognosis, low risk for neurological deficits and high cognitive functioning. Deeper psychological and neuropsychological examination and longitudinal observation shows also neurocognitive problems and emotional disturbances. The purpose of the study was to assess patients with CNS Germinoma (during and after anticancer treatment), expressed specific psychological and physical symptoms and to find the reason for this. METHODS Since 1998 all patients treated at our center are under psychological control and care. From these group 78 patients with CNS Germinoma with additional significant symptoms, seriously affected their quality of life and everyday activity, were selected for psychological and neuropsychological assessment. Age at psychological intervention ranged from 6 5/12 to 34 8/12 yrs. The patients have no pre-diagnosis history of neurological, developmental or psychiatric disorder. They were examined using a battery of standardized psychological and neuropsychological methods. RESULTS In our sample FIQ (full-scale intelligence quotient) score ranged from 59 to 139. The most patients presented average level of intelligence. However, cognitive functioning was often reduced due to emotional disturbances and psychosomatic complains. 2 patients showed memory disorders, one of them TGA (transient global amnesia) at the time of diagnosis. All patients struggled with emotional disturbances at different grades, especially internalizing type of problems (immaturity, depression, anxiety, instability, inhibition, negative attitude) or were considered to be at risk for psychological adjustment difficulties and tendency to somatization. Analyzed group of patients showed also social competences deficits. They may exhibit deficit in age-appropriate social competence and peers relations. CONCLUSIONS Although CNS Germinoma patients shows similar behavioral and emotional phenotype, there are significant differences between them in terms of cognitive functions. The range of results is wide, from high levels to neurocognitive disorders. Therefore, risk factors, diagnostic criteria and effective neuropsychological intervention, will also be presented and discussed.

RADT-05. MATURE OUTCOMES OF A PHASE II PROSPECTIVE STUDY OF PROTON RADIOTHERAPY FOR LOCALIZED BRAIN TUMORS

Abstract BACKGROUND Proton radiotherapy (PRT) is a highly targeted form of radiation that spares more normal brain tissue compared to modern photon radiotherapy. Therefore, we expect the late effect profile in children treated with PRT with curable brain tumors should be improved. METHODS Between 2010-2022, 100 patients were enrolled, treated with PRT, and then followed for disease control, hearing, neurocognitive and endocrine outcomes. Late effects of the tumor and treatment delivered were graded using CTCAE v4.0. RESULTS Median age at PRT was 8.0 years (1.1-20.8) and median follow up was 8.7 years (0.3-12.7). Tumor types included 40 (40%) ependymomas, 19 (19%) low grade gliomas (LGG), 21 (21%) craniopharyngiomas, and 20 (20%) other histologies. 26% of patients were treated with chemotherapy in addition to PRT. The location of PRT was 38 (38%) infratentorial, 56 (56%) supratentorial, and 6 (6%) both. The median radiation dose was 52.2 GyRBE (48.6-59.4). 8-year event-free survival (EFS) and overall survival (OS) was 71.7% and 86.2% for all patients. 8-year EFS and OS was 59.9% and 82.4% for ependymomas, 78.2% and 94.7% for LGG, 80.0% and 87.7% for craniopharyngiomas and 79.1% and 84.7% for all other tumor types. 19% of patients had new grade 3+ toxicities that were at least possibly related to radiotherapy. Baseline full-scale intelligence quotient (FSIQ) was 98.0 and follow-up FSIQ was 101.8 (p=0.14). 43% of patients had new endocrine deficiencies after radiation. 8 patients suffered new high-grade hearing loss after PRT. Dosimetry on critical brain structures was collected and correlated with late effects. More details will be presented at the conference. CONCLUSION PRT remains an effective treatment for children with curable brain tumors. While late effects of the tumor and treatment are still present, the overall burden of late effects is lower than other reports.

QOL-32. COGNITIVE AND PSYCHOLOGICAL LATE EFFECTS IN CHILDREN AND ADOLESCENTS WITH PINEAL REGION TUMORS: A 35-YEAR-LONG EXPERIENCE IN A TERTIARY REFERRAL HOSPITAL

Abstract BACKGROUND Pineal region tumors (PRT) account for 2.8% of all central nervous system tumors in children and adolescents up to 19 years of age. Modern therapies allow more than 2/3 of patients to overcome their disease, but late effects impair quality of life of survivors. This study aimed to define the prevalence of cognitive and psychological late effects in PRT-survivors. METHODS Demographic information, medical variables, cognitive and psychological age-appropriated assessments of childhood and adolescence PRT-survivors, followed-up at Gaslini Children’s Hospital between 1988 and 2023, were retrospectively collected. Neurocognitive assessment was performed using the Wechsler scale. Psychological assessment was obtained using the Child Behavior Checklist, Beck Depression Inventory, State-Trait Anxiety Inventory, Trauma Symptom Checklist for children and Impact of Event Scale–Revised. RESULTS Sixty patients were included (53 males, 88%); median age at diagnosis was 12.8 years (Interquartile range, IQR, 9.0–15.7 years). Main entities were: germinoma (17, 28%), non-germinomatous germ cell tumor (16, 27%), bifocal germinoma (13, 22%), pineoblastoma (6, 10%), teratoma (3, 5%). 20/60 patients (33%) had neuroaxis spread, 48/60 (80%) presented hydrocephalus, 41/60 (68%) underwent surgery, 16/60 (27%) needed ventricular-peritoneal shunt, 51/60 (86%) received chemotherapy and 56/60 (93%) required radiotherapy. Median follow-up was 8.9 years (IQR 4.1–15.2). Six patients died, 5/6 died for progressive disease. Intelligence quotient (IQ) score was available for 43/60 patients with a median value of 91 (IQR 85-107). Complete cognitive and neuropsychological assessment was available for 25/60 patients showing presence of: anxiety symptoms (16/25, 64%), depression symptoms (20/25, 80%) and post-traumatic symptoms (7/25, 28%). CONCLUSIONS In our cohort, PRT-survivors showed IQ scores within expected average and a high frequency of anxiety and depression symptoms. Deeper insights into the mechanisms underlying cognitive and psychological late effects are needed, focusing on the role of demographics, treatments and disease-specific variables as well as on tumor location.

QOL-50. THE ROLE OF TUMOR SIZE IN COGNITIVE FUNCTIONING AMONG SURVIVORS TREATED FOR MEDULLOBLASTOMA

Abstract BACKGROUND Medical and treatment variables, including presence of post-operative cerebellar mutism syndrome (CMS), shunt placement, craniospinal radiation, and total radiotherapy (RT) dose, have been evaluated as potential risk factors for adverse cognitive effects among pediatric patients diagnosed and treated for medulloblastoma. Larger brain tumor size is associated with increased risk of medical complications, but cognitive risk of larger tumor size remains unknown. METHODS Cognitive scores were examined for 40 participants diagnosed and treated for medulloblastoma. The age-appropriate Wechsler Intelligence Scale was administered at the start of RT and up to 10 years post-RT (M=4.96, SD=3.78). A total of 162 evaluations were examined across participants. Linear mixed models examined change in Wechsler Index scores over time since RT based on tumor size, which was dichotomized at the median diameter (small ≤4.6cm versus large &amp;gt;4.6cm), covarying for maternal education, total RT dose, and presence of CMS. RESULTS Patients (72.5% male) were diagnosed with medulloblastoma and began RT at a mean age of 8.89 years. Groups did not differ on demographic or medical variables with the exception of presence/absence of CMS, with a higher proportion of patients diagnosed with CMS having large-size tumors (40%) versus small-size tumors (5%). Tumor size did not predict change in IQ, working memory, or processing speed performance over time since RT after accounting for covariates. CMS was associated with significant decline in processing speed (p&amp;lt;.001) and IQ over time (p&amp;lt;.05); RT dose was associated with significant working memory and IQ decline (both p&amp;lt;.05); and maternal education was associated with decline in processing speed, working memory, and IQ (all p&amp;lt;.05). CONCLUSIONS While tumor size may be associated with treatment intensity and other medical risk factors, CMS and RT dose significantly increase cognitive risk, independent of tumor size. Lower socioeconomic status also increases cognitive risk post-RT, which may illuminate pathways for prevention and intervention efforts.

QOL-43. COMPARISON OF SOCIAL DETERMINANTS OF HEALTH MEASURES ON IQ AND ACADEMIC OUTCOMES IN PEDIATRIC BRAIN TUMORS

Abstract BACKGROUND Treatment for pediatric brain tumors impacts IQ and academic achievement; fewer studies have examined the role of social determinants of health (SDoH). To date, studies have primarily focused on family-based SDoH such as insurance type or parental education as predictors of cognition. Limited studies have examined community factors, though our work highlighted the role of education quality on IQ and academics in pediatric brain tumors. To our knowledge, no study has examined the predictive value of family and community-based SDoH. METHODS Participants included 151 pediatric brain tumor patients (M age at diagnosis=8.82) seen for a clinical neuropsychological evaluation (M age at evaluation=13.71). IQ was obtained from age-appropriate intelligence measures (WISC&amp;gt;6 years, DAS-II&amp;lt;6 years); untimed reading and math calculation were examined via WIAT/KTEA/WJ subtests. Family-based SDoH included insurance type (public, private) and maternal education (&amp;lt;high school degree, some college, &amp;gt;college degree). Community-based SDoH included the Area Deprivation Index (ADI) and Education, Health-Environment, and Social-Economic indices from the Childhood Opportunity Index (COI). Multiple regressions examined variance in IQ, reading, and math accounted for by each of the SDoH measures, after controlling for treatment exposures using the Neurological Predictor Scale (NPS). RESULTS Insurance [β=-.302, t(151)=-4.00; p&amp;lt;001] and Education [β=.235, t(151)=3.14; p=.002] accounted for 14.9% and 19.7% of the IQ variance, respectively. Education also accounted for 12.8% of the reading variance (β=.304, t(109)=3.40; p&amp;lt;.001). Both the Education [β=.570, t(107)=3.41; p&amp;lt;.001] and Social-Economic [β=-.381, t(107)=-2.28; p=.03] indices accounted for 7.7% and 11.3% of the math calculation variance, respectively. CONCLUSIONS Community, particularly those related to education and social &amp; economic resources, and family factors (e.g., insurance status) were associated with IQ and academic performance. Findings indicate the importance of investigating both family and community factors that may contribute to outcomes in pediatric brain tumors.

QOL-02. PREDICTING NEUROCOGNITIVE OUTCOMES AMONG CHILDREN EXPERIENCING VARYING DEGREES OF POSTOPERATIVE POSTERIOR FOSSA SYNDROME

Abstract BACKGROUND Postoperative posterior fossa syndrome (PFS) has historically been diagnosed as present vs. absent despite a continuum of severity in presentations. We recently demonstrated categorizing children into PFS1 (complete mutism) and PFS2 (diminished speech) has prognostic utility for neurological recovery. Given children who experience PFS are also at increased risk for neurocognitive impairments, we investigated whether these PFS variants predict neurocognitive outcomes while considering well-established risk factors (i.e., age and treatment intensity). METHODS Children treated for medulloblastoma at St. Jude on a prospective, risk-stratified protocol (SJMB12; NCT 01878617) were study eligible if they had at least two neurocognitive evaluations. SJMB12 participants received neurological and neurocognitive evaluations prior to irradiation and annually for 5 years. Neurocognitive outcomes included intellectual functioning (Wechsler Intelligence Scale for Children [WISC-IV] estimated IQ [EIQ]), processing speed (WISC-IV Processing Speed Index [PSI]), working memory (WISC-IV Working Memory Index [WMI]), and adaptive functioning (Behavior Assessment System for Children [BASC2] Activities of Daily Living [ADL]). RESULTS 149 patients (age at diagnosis= 10.7±5.6; 64% male; 9% 15Gy, 40% 23.4Gy, 51% ≥36Gy) were included. No significant differences between PFS1 (n=34) or PFS2 (n=16) compared to NonPFS (n=99) were identified in age, sex, or irradiation dose (ps&amp;gt;.05). Multivariable linear mixed models indicate NonPFS have better EIQ than PFS1 and PFS2 (p&amp;lt;.03), with EIQ improving over time (p=.01). NonPFS have better PSI than PFS1 and PFS2 (p&amp;lt;.001). PSI declines over time irrespective of age (p&amp;gt;.05); however, PSI declines for those receiving 36Gy while improving for those receiving 15Gy (p&amp;lt;.001). NonPFS have better WMI than PFS1 and PFS2 (p&amp;lt;.05); older age at diagnosis is associated with improvement in WMI over time (p&amp;lt;.0005). ADL declines only in PFS1 patients (p&amp;lt;.05). CONCLUSIONS PFS variants add value beyond established risk factors in predicting neurocognition. Severity of PFS, in addition to treatment intensity, predicts worse outcomes.

QOL-07. EFFICIENT NEUROPSYCHOLOGICAL ASSESSMENT IN PATIENTS WITH BRAIN TUMORS AND ACUTE LYMPHOBLASTIC LEUKEMIA

Abstract BACKGROUND Children treated for cancer may experience a decline in performance for a variety of reasons, one of which is the impact of treatment. Children treated for leukemias and brain tumours are at the highest risk of developing neurocognitive sequale (Daly and Brown, 2015). METHODS In our study we used Bayesian regression to identify assessment tools that would best predict the sequale of brain tumors (BT) and acute lymphoblastic leukemia (ALL) in children and adolescents. Using data from 15 patients with BT, 15 patients with (ALL) and 9 siblings controls we compared the predictive validity of the Wechsler Intelligence Scales for Children (WISC-V), Delis-Kaplan Executive Function System (D-KEFS), Continuous Performance Test (CPT-3), the Developmental Neuropsychological Assessment (NEPSY-II) and the parent and teacher report forms of the Achenbach Assessment System (ASEBA). RESULTS We found that the best predictors of ALL were d’ scores on the CPT (BF = 20.69, pd =.05) and CPT ommission scores (BF = 17.50, pd =.05), while the best predictor a BT was the WISC-IV Coding subtest (BF = 21.17, pd =.05) in addition to CPT omission scores (BF = 12.00, pd =.08) and HRT SD scores (BF = 11.91, pd =.08). CPT d’s scores were also predictive of Methotrexate treatment (MTX) (BF = 32.61, pd = 0.03), as were WISC-V Symbol Search scores (BF = 32.61, pd = 0.03) and the NEPSY-II Auditory Attention subtest (BF = 26.06, pd = 0.04). We also noted differential sensitivity of the ASEBA teacher report form for detecting deficits identified during the neuropsychological assessment. CONCLUSIONS We feel our findings will, together with previous meta-analyses, contribute to more efficient neuropsychological assessment in patients with BT and ALL. Neuropsychological asseessment is vital for identifying potential sequale of disease and treament in pediatric oncology.

RADT-04. ASSESSMENT OF CLINICAL AND NEUROLOGICAL ALTERATIONS BEFORE RADIATION THERAPY IN CHILDREN WITH MALIGNANT BRAIN TUMORS

Abstract BACKGROUND Young patients with malignant brain tumors show neurocognitive alterations as both consequences of the tumor and of treatments received. A prospective study of longitudinal radiation damages after focal RT was activated in 2017. We present the first analysis correlating tumor localization, symptoms, neurological/endocrinological impairments, surgery/ies if adopted, and cognitive assessments at the time of enrollment. METHODS Sixty-six children eligible for focal RT were enrolled and underwent a neurocognitive assessment based on standardized tests (“impaired”/“non-impaired”). The database included demographical, clinical and pathological variables. The latter, together with MRI morphological scans, were used to define different kind of damage scores. The pattern of associations between clinical variables and damage scores was investigated. RESULTS Patients median age was 8 years; the most frequent tumor was Ependymoma (41%) and Posterior Fossa (29%) was the prevalent tumor site. All but 5 children (with Germ Cell Tumors), had undergone surgery and 32 had undergone chemotherapy before irradiation and evaluations. Ad-hoc scores of neurological deficits and endocrine alterations were created to characterize each patient. Moreover, structural abnormalities were quantified in a score for each cortical/subcortical region. Patients with posterior fossa Ependymomas and infratentorial tumors showed higher neurological damage scores. Endocrine alterations were more serious in supratentorial tumors, specifically in patients with Craniopharyngioma and Germ Cell tumors of the sellar region and ventricular system. Deficit scores were not associated to the presence of hydrocephalus and surgery, unlike endocrine alteration scores. The median number of child’s structural damaged areas was equal to 2 (IQR: 2-3). Tumor sites of patients with an impaired or non-impaired full-scale IQ or visual-perception index, was found to be different. CONCLUSIONS The analysis of baseline evaluations highlights damages preexisting to irradiations and generated by multiple factors. In light of these findings, damages over time could be better investigated by distinguishing multiple generating factors.