title: Long-term cognitive sequelae after pediatric brain tumor related to medical risk factors, age, and sex.
abstract: BACKGROUND
  Young age at diagnosis and treatment with cranial radiation therapy are well studied risk factors for cognitive impairment in pediatric brain tumor survivors. Other risk factors are hydrocephalus, surgery complications, and treatment with intrathecal chemotherapy. Female gender vulnerability to cognitive sequelae after cancer treatment has been evident in some studies, but no earlier studies have related this to tumor size. The purpose of our study was to find factors correlated with lowered IQ in a nationally representative sample of pediatric brain tumor patients referred for neuropsychologic evaluation.
  
  
  METHODS
  Sixty-nine pediatric brain tumor patients, diagnosed 1988-2005 and tested 1995-2006, were included in the study. In a series of stepwise multiple regressions, the relationship of IQ to disease, treatment, and individual variables (sex and syndromes) were evaluated. A subanalysis was made of the covariation between sex and tumor size.
  
  
  RESULTS
  The patients had generally suppressed IQ and impairments in executive function, memory, and attention. Lowered IQ was associated with young age at diagnosis, being male, tumor size, and treatment with whole-brain radiation therapy. A sex difference was evident for patients with increased intracranial pressure at diagnosis with males having larger tumors. Tumor size was found to be a better predictor of cognitive sequelae than sex.
  
  
  CONCLUSIONS
  Whole-brain radiation therapy, large tumors, young age at diagnosis, and male gender are risk factors for late cognitive sequelae after pediatric brain tumors. When examining sex differences, tumor size at diagnosis needs to be taken into account.
authors.affiliation: Department of Psychology, Lund University, Lund, Sweden; Department of Pediatrics, Skåne University Hospital, Lund, Sweden. Electronic address: ingrid.tonning_olsson@med.lu.se.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Tonning Olsson
authors.affiliation: Department of Psychology, Lund University, Lund, Sweden; Department of Psychology, Institute of Psychiatry, King's College London, London, United Kingdom.
authors.forename: Sean
authors.initials: S
authors.lastname: Perrin
authors.affiliation: Department of Pediatrics, Skåne University Hospital, Lund, Sweden; Department of Clinical Sciences, Lund University, Lund, Sweden.
authors.forename: Johan
authors.initials: J
authors.lastname: Lundgren
authors.affiliation: Department of Pediatrics, Skåne University Hospital, Lund, Sweden; Department of Clinical Sciences, Lund University, Lund, Sweden.
authors.forename: Lars
authors.initials: L
authors.lastname: Hjorth
authors.affiliation: Department of Psychology, Lund University, Lund, Sweden; Department of Psychiatry, Lund University, Lund, Sweden.
authors.forename: Aki
authors.initials: A
authors.lastname: Johanson
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001932:Brain Neoplasms / Q000150:complications* / Q000473:pathology / Q000532:radiotherapy; D002648:Child; D002675:Child, Preschool; D003072:Cognition Disorders / Q000209:etiology*; D016371:Cranial Irradiation; D005260:Female; D006801:Humans; D007223:Infant; D007360:Intelligence / Q000502:physiology*; D008297:Male; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors; D055815:Young Adult
keywords: cognition; pediatric brain tumor; sex; whole-brain radiation therapy