Computerized assessment of cognitive late effects among adolescent brain tumor survivors
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Advantages of computerized assessment of neuropsychological functions include improved standardization and increased reliability of response time variables. Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) is a computerized battery developed for monitoring recovery following mild brain injuries that assesses attention, memory and processing speed. Despite evidence that core areas of deficit among cancer survivors are those assessed by ImPACT, it has not previously been used with this population. Twenty four childhood brain tumor (BT) survivors treated with conformal radiation therapy (mean age = 15.7 ± 1.6; mean age at irradiation = 9.8 ± 2.5), twenty solid tumor (ST) survivors treated without CNS-directed therapy (mean age = 16.2 ± 1.8) and twenty healthy siblings (mean age = 15.1 ± 1.6 years) were administered an age modified version of ImPACT. Additional computerized measures of working memory and recognition memory were administered. Univariate ANOVAs revealed group differences (p < 0.05) on measures of recognition memory, spatial working memory, processing speed and reaction time, with BT survivors performing significantly worse than ST survivors and siblings. Pearson correlation coefficients revealed significant associations between ImPACT memory tasks and computerized forced choice recognition tasks (rs = 0.30−0.33, p < 0.05). Multiple surgical resections, hydrocephalus and CSF shunt placement most consistently predicted worse ImPACT performance using linear mixed models (p < 0.05). The ImPACT test battery demonstrated sensitivity to cognitive late effects experienced by some BT survivors with clinical predictors of performance consistent with the pediatric oncology literature. Correlations with measures of similar constructs provide evidence for convergent validity. Findings offer initial support for the utility of ImPACT for monitoring of cognitive late effects.
KeywordsPediatric Cancer ImPACT
This work was supported in part by the National Cancer Institute (St. Jude Cancer Center Support [CORE] Grant number P30 CA21765), (H.C., grant number R21 CA131616); the International Neuropsychological Society (H.C., Rita Rudel Award); and the American Lebanese Syrian Associated Charities (ALSAC). Research and development of the pediatric and adolescent/midrange version of the ImPACT battery was provided by the Centers for Disease Control and Prevention (G.G., award number U17 CCU323352). We thank the patients and their families who volunteered their time to participate. Portions of this paper were presented at the annual meeting of the International Neuropsychological Society in Boston, Massachusetts, February, 2011. Dr. Gioia is a co-author of Pediatric ImPACT and in the future may receive royalties, but has no financial interest in the adolescent/midrange version presented here. The remaining authors declare that they have no conflict of interest.
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