Cognitive deficits in long-term survivors of childhood medulloblastoma and other noncortical tumors: age-dependent effects of whole brain radiation.
Twenty-four children, aged 1.5-20 yr at diagnosis, with noncortical brain tumors, primarily medulloblastoma, have been followed for 3-4 yr for intellectual status. All the children received craniospinal irradiation, and 19 of 24 received chemotherapy as well. For the group as a whole. Full Scale IQ fell from 104 at baseline to 91 at final follow-up. Children younger than 7 yr at diagnosis showed a significant decrease in IQ as early as year 1, and all changes from baseline to years 3 and 4 were significant. In contrast, children older than 7 yr at diagnosis did not show a significant IQ change from baseline to year 3 or 4. The Spearman correlation coefficient between IQ change and age at diagnosis from baseline to year 4 was 0.57 (P = 0.003). This study supports the hypothesis that children treated with whole brain radiation at a younger age have more severe cognitive impairment than those treated at a later age. Limitations in sample size and duration of observations do not permit us to identify whether a true plateau occurs 2-4 yr after irradiation versus a continued progressive decline in intellectual performance. Moreover, we cannot at this time distinguish between a true dementing process versus failure to acquire new cognitive skills at a rate comparable to age-matched peers.
Children's Seashore House, Department of Psychology, Children's Hospital of Philadelphia, PA.
J
J
Radcliffe
G R
GR
Bunin
L N
LN
Sutton
J W
JW
Goldwein
P C
PC
Phillips
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D017668:Age of Onset; D001932:Brain Neoplasms / Q000523:psychology / Q000532:radiotherapy*; D002528:Cerebellar Neoplasms / Q000523:psychology / Q000532:radiotherapy; D002648:Child; D002675:Child, Preschool; D003072:Cognition Disorders / Q000209:etiology* / Q000523:psychology; D016371:Cranial Irradiation / Q000009:adverse effects*; D006801:Humans; D007223:Infant; D007361:Intelligence Tests; D008527:Medulloblastoma / Q000523:psychology / Q000532:radiotherapy*; D009483:Neuropsychological Tests; D011832:Radiation Injuries / Q000523:psychology*