期刊
JOURNAL OF PEDIATRIC PSYCHOLOGY
卷 46, 期 2, 页码 168-178出版社
OXFORD UNIV PRESS INC
DOI: 10.1093/jpepsy/jsaa086
关键词
cancer and oncology; longitudinal research; neuropsychology
资金
- National Cancer Institute [P30 CA21765, P30 GM9266]
- American Lebanese Syrian Associated Charities
Most children with acute lymphoblastic leukemia (ALL) have stable neurocognitive profiles, but a small proportion exhibit significant impairments or worsening performance over time. Older age, female sex, and experiencing sepsis are associated with worsening attention problems, while lower baseline IQ is linked to improved memory and fewer attention issues over time.
Objective Children with acute lymphoblastic leukemia (ALL) are at risk for neurocognitive deficits, and examining individual variability is essential to understand these risks. This study evaluated latent longitudinal trajectories and risk factors of neurocognitive outcomes in childhood ALL. Methods There were 233 participants with ALL who were enrolled on a phase 3, risk-stratified chemotherapy-only clinical trial (NCT00137111) and who completed protocol-directed neurocognitive assessments [47.6% female, mean (SD)= 6.6 (3.7) years]. Measures of sustained attention, learning/memory, and parent ratings of attention were completed during and after treatment. Longitudinal latent class analyses were used to classify participants into distinct trajectories. Logistic regression was used to identify predictors of class membership. Results Within the overall group, attention performance was below age expectations across time (Conners Continuous Performance Test detectability/variability, p < 0.01); memory performance and parent ratings were below expectations at later phases (California Verbal Learning Test learning slope, p < 0.05; Conners Parent Rating Scale, Revised attention/learning, p < 0.05). Most participants (8089%) had stable neurocognitive profiles; smaller groups showed declining (3-6%) or improving (3-11%) trajectories. Older age (p= 0.020), female sex (p = 0.018), and experiencing sepsis (p= 0.047) were associated with greater attention problems over time. Lower baseline IQ was associated with improved memory (p= 0.035) and fewer ratings of attention problems (p= 0.013) over time. Conclusions Most patients with ALL have stable neurocognitive profiles. Smaller groups have significant impairments shortly after diagnosis or have worsening performance over time. A tiered assessment approach, which includes consideration of individual and clinical risk factors, may be useful for monitoring neurocognitive functioning during treatment and survivorship.
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