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Executive Dysfunction 25 Years after Treatment with Cranial Radiotherapy for Pediatric Lymphoid Malignancies

Published online by Cambridge University Press:  22 September 2015

Ilse Schuitema ,
Leo de Sonneville ,
Gertjan Kaspers ,
Helena van der Pal ,
Anne Uyttebroeck ,
Cor van den Bos  and
Anjo Veerman
Ilse Schuitema*
Affiliation:
Department of Health, Medical and Neuropsychology, Leiden University, Leiden, The Netherlands
Leo de Sonneville
Affiliation:
Department of Clinical Child and Adolescent Studies, Faculty of Social Sciences, Leiden University, Leiden, The Netherlands Leiden Institute for Brain and Cognition, Faculty of Social Sciences, Leiden University, Leiden, The Netherlands
Gertjan Kaspers
Affiliation:
Department of Pediatrics, Division of Pediatric Hematology/Oncology, VU University Medical Center, Amsterdam, The Netherlands
Helena van der Pal
Affiliation:
Department of Pediatrics, Division of Pediatric Oncology, Academic Medical Center, Amsterdam, The Netherlands Department of Medical Oncology, Academic Medical Center, Amsterdam, The Netherlands
Anne Uyttebroeck
Affiliation:
Department of Pediatric Hematology and Oncology, University Hospitals Leuven, Leuven, Belgium
Cor van den Bos
Affiliation:
Department of Pediatrics, Division of Pediatric Oncology, Academic Medical Center, Amsterdam, The Netherlands
Anjo Veerman
Affiliation:
Department of Pediatrics, Division of Pediatric Hematology/Oncology, VU University Medical Center, Amsterdam, The Netherlands
*
Correspondence and reprint requests to: Ilse Schuitema, Department of Health, Medical and Neuropsychology, Faculty of Social Sciences, Leiden University, Wassenaarseweg 52, P.O. Box 9555, 2300 RB, Leiden, The Netherlands. E-mail: [email protected]
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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. (JINS, 2015, 21, 657–669)

Keywords

Executive functionSurvivorsOutcome assessmentBrainRadiation effectsLeukemiaLymphomaAccelerated agingCranial irradiationAdultChildFemaleAge at diagnosisTime since diagnosis
Type
Research Articles
Information
Journal of the International Neuropsychological Society , Volume 21 , Supplement 9 , October 2015 , pp. 657 - 669
Copyright
Copyright © The International Neuropsychological Society 2015 

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