Conklin Heather M, Ogg Robert J, Ashford Jason M, Scoggins Matthew A, Zou Ping, Clark Kellie N, Martin-Elbahesh Karen, Hardy Kristina K, Merchant Thomas E, Jeha Sima, Huang Lu, Zhang Hui
Heather M. Conklin, Robert J. Ogg, Jason M. Ashford, Matthew A. Scoggins, Ping Zou, Kellie N. Clark, Karen Martin-Elbahesh, Thomas E. Merchant, Sima Jeha, Lu Huang, and Hui Zhang, St Jude Children's Research Hospital, Memphis, TN; and Kristina K. Hardy, Children's National Medical Center and George Washington University School of Medicine, Washington, DC.
J Clin Oncol. 2015 Nov 20;33(33):3894-902. doi: 10.1200/JCO.2015.61.6672. Epub 2015 Oct 12.
Children receiving CNS-directed therapy for cancer are at risk for cognitive problems, with few available empirically supported interventions. Cognitive problems indicate neurodevelopmental disruption that may be modifiable with intervention. This study evaluated short-term efficacy of a computerized cognitive training program and neural correlates of cognitive change.
A total of 68 survivors of childhood acute lymphoblastic leukemia (ALL) or brain tumor (BT) with identified cognitive deficits were randomly assigned to computerized cognitive intervention (male, n = 18; female, n = 16; ALL, n = 23; BT, n = 11; mean age ± standard deviation, 12.21 ± 2.47 years) or waitlist (male, n = 18; female, n = 16; ALL, n = 24; BT, n = 10; median age ± standard deviation, 11.82 ± 2.42 years). Intervention participants were asked to complete 25 training sessions at home with weekly, telephone-based coaching. Cognitive assessments and functional magnetic resonance imaging scans (intervention group) were completed pre- and postintervention, with immediate change in spatial span backward as the primary outcome.
Survivors completing the intervention (n = 30; 88%) demonstrated greater improvement than controls on measures of working memory (mean ± SEM; eg, Wechsler Intelligence Scale for Children [fourth edition; WISC-IV] spatial span backward, 3.13 ± 0.58 v 0.75 ± 0.43; P = .002; effect size [ES], 0.84), attention (eg, WISC-IV spatial span forward, 3.30 ± 0.71 v 1.25 ± 0.39; P = .01; ES, 0.65), and processing speed (eg, Conners' Continuous Performance Test hit reaction time, -2.10 ± 1.47 v 2.54 ± 1.25; P = .02; ES, .61) and showed greater reductions in reported executive dysfunction (eg, Conners' Parent Rating Scale III, -6.73 ± 1.51 v 0.41 ± 1.53; P = .002; ES, 0.84). Functional magnetic resonance imaging revealed significant pre- to post-training reduction in activation of left lateral prefrontal and bilateral medial frontal areas.
Study findings show computerized cognitive training is feasible and efficacious for childhood cancer survivors, with evidence for training-related neuroplasticity.
接受中枢神经系统定向癌症治疗的儿童有认知问题的风险，且几乎没有经过实证支持的可用干预措施。认知问题表明神经发育受到干扰，可能可通过干预加以改善。本研究评估了计算机化认知训练计划的短期疗效以及认知变化的神经关联。
共有68名确诊有认知缺陷的儿童急性淋巴细胞白血病（ALL）或脑肿瘤（BT）幸存者被随机分配至计算机化认知干预组（男性18名；女性16名；ALL 23名；BT 11名；平均年龄±标准差，12.21±2.47岁）或等待名单组（男性18名；女性16名；ALL 24名；BT 10名；年龄中位数±标准差，11.82±2.42岁）。干预组参与者被要求在家中完成25次训练课程，并接受每周一次的电话指导。干预前后均完成了认知评估和功能磁共振成像扫描（干预组），以反向空间跨度的即时变化作为主要结果。
完成干预的幸存者（n = 30；88%）在工作记忆测量（均值±标准误；例如，韦氏儿童智力量表[第四版；WISC-IV]反向空间跨度，3.13±0.58对0.75±0.43；P = 0.002；效应量[ES]，0.84）、注意力（例如，WISC-IV正向空间跨度，3.30±0.71对1.25±0.39；P = 0.01；ES，0.65）和处理速度（例如，康纳斯连续作业测试击中反应时间，-2.10±1.47对2.54±1.25；P = 0.02；ES，0.61）方面比对照组有更大改善，并且报告的执行功能障碍有更大程度的减轻（例如，康纳斯父母评定量表III，-6.73±1.51对0.41±1.53；P = 0.002；ES，0.84）。功能磁共振成像显示，训练前后左侧前额叶和双侧内侧额叶区域的激活有显著减少。
研究结果表明，计算机化认知训练对儿童癌症幸存者是可行且有效的，有证据表明存在与训练相关的神经可塑性。
