Children's National Hospital, Division of Pediatric Neuropsychology, Washington DC, USA.
Department of Psychology, Oklahoma State University, Stillwater, Oklahoma, USA.
Psychooncology. 2021 Aug;30(8):1366-1374. doi: 10.1002/pon.5692. Epub 2021 Apr 16.
Pediatric brain tumor survivors (PBTS) are at risk for both neurocognitive impairments and psychological difficulties, yet these two domains have historically been discretely examined, with assessment of psychosocial outcomes rarely included in studies of cognitive outcomes. Taking a person-centered approach, the current study aimed to more comprehensively evaluate PBTS late effect profiles, including both neurocognitive and psychological sequelae, and predictors of these profiles.
PBTS (N = 89) were assessed in a pediatric neuropsychological clinic between May 2009 and May 2018, diagnosed at least 1 year prior, and off-treatment for at least 3 months (M = 6.57 years, SD = 4.53; 46.1% female). Parent- and teacher-report of psychological symptoms, and performance-based measures of neurocognitive functioning were examined using latent profile analysis. The R3STEP procedure identified predictors of class membership.
The optimal model identified four classes characterized by: (1) average functioning across all measures ("Average," n = 47), (2) average psychosocial functioning and impaired neurocognitive functioning ("Cognitive Deficit," n = 25), (3) elevated social problems and significant neurocognitive impairments ("Social/Cognitive Deficit," n = 9), and (4) impaired visual planning and problem-solving and elevated parent-reported psychosocial problems, but average processing speed, working memory, and teacher-reported psychosocial outcomes ("Discrepant," n = 8). Ethnicity, race, radiation treatment, and diagnoses of neurofibromatosis 1, hydrocephalus, and cerebellar mutism syndrome were significant predictors of class membership (ps < 0.05).
The present study identified distinct phenotypes with unique patterns of relations among neurocognitive and psychological domains. These findings are a vital first step toward identifying those at highest risk for poor outcomes and informing interventions that effectively address interrelated treatment targets for specific groups.
儿科脑肿瘤幸存者（PBTS）存在神经认知障碍和心理困难的风险，但这两个领域在历史上一直是分开研究的，很少有研究将心理社会结果评估纳入认知结果的研究中。本研究采用以人为中心的方法，旨在更全面地评估 PBTS 的晚期影响特征，包括神经认知和心理后遗症，以及这些特征的预测因素。
2009 年 5 月至 2018 年 5 月期间，在一家儿科神经心理诊所对 89 名 PBTS 进行了评估，这些患者在至少 1 年前被诊断出患有脑肿瘤，且至少在 3 个月前停止治疗（M = 6.57 岁，SD = 4.53；46.1%为女性）。使用潜在剖面分析评估了父母和教师报告的心理症状以及基于表现的神经认知功能。R3STEP 程序确定了类别的预测因素。
最佳模型确定了四个特征类，分别为：（1）所有测量指标平均功能（“平均”，n = 47）；（2）平均心理社会功能和神经认知功能障碍（“认知缺陷”，n = 25）；（3）社会问题显著增加且神经认知功能严重受损（“社会/认知缺陷”，n = 9）；（4）视觉规划和解决问题能力受损，父母报告的心理社会问题增加，但处理速度、工作记忆和教师报告的心理社会结果正常（“差异”，n = 8）。种族、种族、放疗以及神经纤维瘤病 1、脑积水和小脑缄默综合征的诊断是类别的显著预测因素（p 值均<0.05）。
本研究确定了具有独特神经认知和心理领域关系模式的不同表型。这些发现是朝着识别那些处于最差预后风险最高的人群迈出的重要的第一步，并为特定群体提供有效的干预措施，以有效地解决相互关联的治疗目标。
