Lofstad Grete Elisabeth, Reinfjell Trude, Weider Siri, Diseth Trond H, Hestad Knut
Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway.
Department of Child and Adolescent Psychiatry, St. Olav's University Hospital, Trondheim, Norway.
Front Psychol. 2019 May 16;10:1027. doi: 10.3389/fpsyg.2019.01027. eCollection 2019.
To examine the neurocognitive outcomes in children and adolescents with acute lymphoblastic leukemia (ALL) in remission who were treated with systemic chemotherapy only (CTO). Neurocognitive performances in 36 children and adolescents, aged 8.4-15.3 years, in long-term remission from ALL 4.3-12.4 years post diagnosis, without relapse, and with no pre-diagnosis history of neurodevelopmental disorder were compared with 36 healthy controls matched for gender, age, and parents' socio-economic status. The former patients and the healthy controls completed an extensive battery of standardized neuropsychological tests. Survivors who were treated by CTO obtained significantly lower scores than did healthy controls on the domains of Copy and drawing ( = 0.001; Cohen's 0.85; after controlling for Type 1 errors = 0.006), Arithmetic ( = 0.001; Cohen's 0.80; after controlling for Type 1 errors, = 0.006), and Tactile sensory functions ( = 0.008; Cohen's 0.65; after controlling for Type 1 errors, = 0.03). Fifty percent of the ALL group were more than 1 SD below the control groups mean on Copy and drawing. There was an interaction between age and group (ALL vs. Control, = 0.042) on Copy and drawing, indicating that the youngest ALL patients exhibited the worst performance. The oldest ALL patients performed equal to or better than the controls. A tendency in the same direction was seen for Arithmetic and Tactile sensory functions. The ALL survivors exhibited a steeper rising learning slope on repeated tests, with lower scores on a tactile problem-solving task, tactile sensory tests, verbal memory, and visual attention, but they performed as well as the controls when stimuli were repeated. The results indicate that neurocognitive long-term sequelae in ALL survivors are limited to specific domains - particularly complex drawing, arithmetic, and tactile processing, and novelty processing. Cognitive deficits are shown among the youngest ALL patients. Intervention programs and school programs should account for difficulties with processing new information and taking advantage of repetitions as a strength, which may prevent survivors from falling behind their peers.
为了研究仅接受全身化疗（CTO）的缓解期急性淋巴细胞白血病（ALL）儿童和青少年的神经认知结局。将36名年龄在8.4 - 15.3岁、诊断后4.3 - 12.4年处于长期缓解期、无复发且无诊断前神经发育障碍病史的ALL儿童和青少年的神经认知表现，与36名在性别、年龄和父母社会经济地位相匹配的健康对照者进行比较。前者患者和健康对照者完成了一系列广泛的标准化神经心理学测试。接受CTO治疗的幸存者在临摹与绘图（p = 0.001；科恩d = 0.85；控制一类错误后p = 0.006）、算术（p = 0.001；科恩d = 0.80；控制一类错误后，p = 0.006）和触觉感觉功能（p = 0.008；科恩d = 0.65；控制一类错误后，p = 0.03）领域的得分显著低于健康对照者。ALL组中有50%的人在临摹与绘图方面比对照组均值低超过1个标准差。在临摹与绘图方面，年龄与组别（ALL组与对照组）之间存在交互作用（p = 0.042），这表明最年幼的ALL患者表现最差。年龄最大的ALL患者表现与对照组相当或更好。在算术和触觉感觉功能方面也观察到相同方向的趋势。ALL幸存者在重复测试中表现出更陡峭的学习上升斜率，在触觉问题解决任务、触觉感觉测试、言语记忆和视觉注意力方面得分较低，但在刺激重复时表现与对照组相当。结果表明，ALL幸存者的神经认知长期后遗症仅限于特定领域——特别是复杂绘图、算术、触觉处理和新颖性处理。最年幼的ALL患者存在认知缺陷。干预项目和学校项目应考虑到处理新信息的困难，并将重复作为一种优势加以利用，这可能会防止幸存者落后于同龄人。
