Neurocognitive dysfunction in children treated from cancer

ABSTRACT

The study included 50 children with cancer [33 males and 17 females], aged from 6-15 years. All received chemotherapy and 23 of them received additional radiotherapy. One hundred and fifty matched healthy children were chosen as a control group. Thorough medical history, clinical examination and complete neurological evaluation were done to all cases. Wechsler Intelligence Scales for cases and controls were used to evaluate intellectual ability. A screening battery of neuropsychological tests was selected that measured elements of general, cognitive, language, perceptual, motor, affectional and nonverbal problem solving abilities. Three factors were calculated from the scales Verbal score [VIQ], Performance score [PIQ] and Full-Scale Intelligence Quotient [FSIQ]. Neurologic affection was present in 26 patients, [7 had cranial nerve affection, 17 motor affection, cerebellar ataxia in 4 cases and sensory affection in 6 cases]. No statistical relation was found between neurologic affection and cognitive function. The percentage frequency of children having IQ level [85 was significantly higher in patients than in the control group P<0.007. The mean FSIQ, VIQ and PIQ were significantly higher in control cases than in patients. The mean results in subdivision tests; Vocabulary test, Picture composition test and Coding test were significantly higher in control cases than in patients. The mean FSIQ, VIQ and PIQ were significantly higher in control cases with IQ [85 than in patients. The mean results in subdivision tests; Similarity-test, Vocabulary test, Composition test and Coding test were also significantly higher in control cases than in patients with IQ >85. The percentage frequency of patients who received combined chemotherapy and radiotherapy was significantly higher in the group of cases having IQ level< 85 than in the group of patients having IQ level =/<85. It is recommended that psychosocial and neurologic rehabilitation should be an integral part of the lines of management of such children. Treatment modalities of malignant disease should avoid as much as possible CNS injury to avoid decrease in the intellectual and cognitive impairment that could occur in late survivors