title: Cognitive function in children with brain tumors in the first year after diagnosis compared to healthy matched controls.
abstract: BACKGROUND
  Improved survival of children with brain tumors (BTs) has increased focus on ameliorating morbidity. To reduce the risk of progressive cognitive decline, remedial strategies need to be instituted early, based upon accurate appraisal of need, yet few studies have investigated cognition in BT children early post-diagnosis. The study aims were to investigate cognition in children with primary BTs 1, 6, and 12 months post-diagnosis compared with healthy children, exploring the impact of disease and treatment variables.
  
  
  METHODS
  Forty-eight children aged 2-16 years with primary BTs, referred to a Regional Neurosurgical Unit over the 2-year study period were eligible for enrollment. The "best friends" model was used to recruit matched controls. Cognition was assessed using age-appropriate Wechsler Intelligence scales; Children's Memory Scale; Test of Everyday Attention for Children, and Wechsler Quicktest.
  
  
  RESULTS
  Patients with BTs had significantly reduced performance compared to controls early post-diagnosis in tests of Performance IQ, processing speed, verbal and visual memory, and selective attention. Improved performance over 12 months was seen in patients with BTs although also, for some measures, in controls. Significant deficits in cognitive performance were seen one year post-diagnosis for Verbal IQ; processing speed, visual and verbal immediate memory, and selective attention. Infratentorial site, high tumor grade, hydrocephalus, radiotherapy, and chemotherapy were associated with poorer functioning.
  
  
  CONCLUSIONS
  Early cognitive impairment is present in BT children, sometimes prior to radiotherapy/chemotherapy treatment, and is associated with hydrocephalus, high tumor grade and infratentorial site. Future studies should investigate the role of early rehabilitation in improving cognition.
authors.affiliation: Neuropsychology, Frenchay Hospital, Bristol, England.
authors.forename: Robert I
authors.initials: RI
authors.lastname: Shortman
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Lowis
authors.forename: Anthony
authors.initials: A
authors.lastname: Penn
authors.forename: Renee J
authors.initials: RJ
authors.lastname: McCarter
authors.forename: Linda P
authors.initials: LP
authors.lastname: Hunt
authors.forename: Caroline C
authors.initials: CC
authors.lastname: Brown
authors.forename: Michael C G
authors.initials: MC
authors.lastname: Stevens
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Curran
authors.forename: Peta M
authors.initials: PM
authors.lastname: Sharples
mesh_terms: D000293:Adolescent; D001288:Attention; D001932:Brain Neoplasms / Q000473:pathology / Q000503:physiopathology / Q000523:psychology* / Q000628:therapy; D059248:Chemoradiotherapy; D002648:Child; D002675:Child, Preschool; D003071:Cognition; D005260:Female; D006801:Humans; D007360:Intelligence; D008297:Male; D008568:Memory; D060787:Neoplasm Grading
keywords: brain tumor; chemotherapy; child; cognition; outcome; radiotherapy