title: Executive Dysfunction 25 Years after Treatment with Cranial Radiotherapy for Pediatric Lymphoid Malignancies.
abstract: The first cohorts to survive childhood lymphoid malignancies treated with cranial irradiation are now aging into adulthood, and concerns are growing about the development of radiotherapy-induced cognitive deficits in the aging brain. These deficits are hypothesized to increase over time. Their impact on daily functioning of older survivors, and the accompanying need for interventions, should be anticipated. By describing a detailed profile of executive function deficits and their associations with age, specific targets for neuropsychological intervention can be identified. Fifty survivors of childhood lymphoid malignancies and 58 related controls were assessed with the Amsterdam Neuropsychological Tasks program. The survivors were on average 31.1 (4.9) years old, treated with 22.5 (6.8) Gy cranial irradiation, and examined on average 25.5 (3.1) years after diagnosis. The survivors showed significantly decreased response speed, irrespective of the task at hand. Furthermore, we found deficits in working memory capacity, inhibition, cognitive flexibility, executive visuomotor control, attentional fluctuations, and sustained attention. Older age was associated with poorer performance on executive visuomotor control and inhibition. On executive visuomotor control, 50% of female survivors performed more than 1.5 SD below average, versus 15.4% of male survivors. The combination of visuospatial working memory problems and decreasing executive visuomotor control could result in difficulty with learning new motor skills at older ages, like walking with a cane. Deterioration of executive control and inhibition may result in decreased behavioral and emotional regulation in aging survivors. Especially the deficiency in executive visuomotor control in female survivors should be considered for (prophylactic) intervention.
authors.affiliation: 1Department of Health,Medical and Neuropsychology,Leiden University,Leiden,The Netherlands.
authors.forename: Ilse
authors.initials: I
authors.lastname: Schuitema
authors.affiliation: 2Department of Clinical Child and Adolescent Studies, Faculty of Social Sciences,Leiden University,Leiden,The Netherlands.
authors.forename: Leo
authors.initials: L
authors.lastname: de Sonneville
authors.affiliation: 4Department of Pediatrics,Division of Pediatric Hematology/Oncology,VU University Medical Center,Amsterdam,The Netherlands.
authors.forename: Gertjan
authors.initials: G
authors.lastname: Kaspers
authors.affiliation: 5Department of Pediatrics,Division of Pediatric Oncology,Academic Medical Center,Amsterdam,The Netherlands.
authors.forename: Helena
authors.initials: H
authors.lastname: van der Pal
authors.affiliation: 7Department of Pediatric Hematology and Oncology,University Hospitals Leuven,Leuven,Belgium.
authors.forename: Anne
authors.initials: A
authors.lastname: Uyttebroeck
authors.affiliation: 5Department of Pediatrics,Division of Pediatric Oncology,Academic Medical Center,Amsterdam,The Netherlands.
authors.forename: Cor
authors.initials: C
authors.lastname: van den Bos
authors.affiliation: 4Department of Pediatrics,Division of Pediatric Hematology/Oncology,VU University Medical Center,Amsterdam,The Netherlands.
authors.forename: Anjo
authors.initials: A
authors.lastname: Veerman
mesh_terms: D000328:Adult; D000367:Age Factors; D001921:Brain / Q000528:radiation effects*; D002675:Child, Preschool; D056344:Executive Function / Q000528:radiation effects*; D005260:Female; D006801:Humans; D008223:Lymphoma / Q000532:radiotherapy*; D008297:Male; D008570:Memory, Short-Term / Q000528:radiation effects; D009483:Neuropsychological Tests; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000532:radiotherapy*; D017741:Survivors; D013997:Time Factors
keywords: Accelerated aging; Adult; Age at diagnosis; Brain; Child; Cranial irradiation; Executive function; Female; Leukemia; Lymphoma; Outcome assessment; Radiation effects; Survivors; Time since diagnosis