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Common functional tests detect cognitive deficits in pediatric patients with brain tumors
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Child-, parent- and teacher-reported questionnaires exhibited moderately good accuracy for detecting cognitive deficit in pediatric patients with cerebellar tumors, according to the results of a prospective, longitudinal analysis.
These tests may be used in clinical and educational settings to screen children treated for brain tumors for substandard full-scale Intellectual Quotient (FSIQ), the researchers reported.
Kim S. Bull, PhD, faculty member in medicine at University of Southampton, and colleagues sought to determine whether certain screening measures used to detect cognitive deficits in children treated for cerebellar tumors could be used in clinical practice.
The study included data from 72 pediatric patients aged 8 to 14 years. All patients received a diagnosis of standard-risk medulloblastoma (n = 37) or low-grade cerebellar astrocytoma (n = 35) within 3 years of study initiation. The researchers also enrolled a control group of 38 children without cerebellar tumors.
Bull and colleagues assessed patients’ cognitive abilities using the teacher-, parent- and children-reported Behavior Rating Inventory of Executive Function (BRIEF), Strengths and Difficulties Questionnaire (SDQ) and Pediatric Quality of Life Inventory (PedsQL). They assessed the accuracy of scores as a screening mechanism for FSIQ lower than 80 based on Wechsler Intelligence Scale for Children receiver operating characteristic (ROC) curves.
Overall, thirteen children (41%) with medulloblastoma and six (18%) with cerebellar astrocytoma had a FSIQ lower than 80, compared with one child (3%) without a tumor.
The researchers observed the highest areas under the ROC curves in child- and parent-reported PedsQL, teacher-reported BRIEF, and the SDQ. At the optimal cutoff, the PedsQL exhibited a sensitivity of detecting FSIQ lower than 80 of 84 (95% CI, 60-96) in child reports and 65 (95% CI, 41-84) in parent reports. Child reports had a specificity of 79 (95% CI, 68-86) and parent reports had a specificity of 87 (95% CI, 77-93).
The BRIEF test had a sensitivity of 79 (95% CI, 54-93) and a specificity of 77 (95% CI, 66-86). The SDQ had a sensitivity of 84 (95% CI, 60-96) and a specificity of 71 (95% CI, 64-84).
All cases of FSIQ lower than 80 screened positive on either the teacher-reported SDQ or the child-reported PedsQL.
The researchers identified the study’s stringent age restrictions as a potential limitation.
“In situations where children are not systematically assessed for rehabilitation following treatment for brain tumors, the PedsQL could be used in a clinical setting and the BRIEF and SDQ in educational settings to detect not only cognitive deficits, but also poor health-related quality of life,” Bull told HemOnc Today. “They could also be used to detect executive dysfunction, behavior and emotional disorders, indicating those in need for referral for a fuller psychological evaluation from an early stage.” – by Cameron Kelsall
For more information:
Kim S. Bull, PhD, can be reached at Southampton General Hospital, Mailpoint 803, Southampton SO16 6YD, U.K; email: k.s.bull@southampton.ac.uk.
Disclosure: The researchers report no relevant financial disclosures.
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