Radcliffe J, Bunin G R, Sutton L N, Goldwein J W, Phillips P C
Children's Seashore House, Department of Psychology, Children's Hospital of Philadelphia, PA.
Int J Dev Neurosci. 1994 Jun;12(4):327-34. doi: 10.1016/0736-5748(94)90081-7.
Twenty-four children, aged 1.5-20 yr at diagnosis, with noncortical brain tumors, primarily medulloblastoma, have been followed for 3-4 yr for intellectual status. All the children received craniospinal irradiation, and 19 of 24 received chemotherapy as well. For the group as a whole. Full Scale IQ fell from 104 at baseline to 91 at final follow-up. Children younger than 7 yr at diagnosis showed a significant decrease in IQ as early as year 1, and all changes from baseline to years 3 and 4 were significant. In contrast, children older than 7 yr at diagnosis did not show a significant IQ change from baseline to year 3 or 4. The Spearman correlation coefficient between IQ change and age at diagnosis from baseline to year 4 was 0.57 (P = 0.003). This study supports the hypothesis that children treated with whole brain radiation at a younger age have more severe cognitive impairment than those treated at a later age. Limitations in sample size and duration of observations do not permit us to identify whether a true plateau occurs 2-4 yr after irradiation versus a continued progressive decline in intellectual performance. Moreover, we cannot at this time distinguish between a true dementing process versus failure to acquire new cognitive skills at a rate comparable to age-matched peers.
24名诊断时年龄在1.5至20岁之间、患有非皮质性脑肿瘤（主要是髓母细胞瘤）的儿童，其智力状况已被跟踪3至4年。所有儿童均接受了颅脊柱照射，24名儿童中有19名还接受了化疗。就整个组而言，全量表智商从基线时的104降至最终随访时的91。诊断时年龄小于7岁的儿童早在第1年智商就出现了显著下降，从基线到第3年和第4年的所有变化均具有显著性。相比之下，诊断时年龄大于7岁的儿童从基线到第3年或第4年智商没有显著变化。从基线到第4年，智商变化与诊断时年龄之间的斯皮尔曼相关系数为0.57（P = 0.003）。本研究支持这样一种假设，即较年幼时接受全脑放疗的儿童比年龄较大时接受治疗的儿童有更严重的认知障碍。样本量和观察持续时间的限制使我们无法确定放疗后2至4年是否会出现真正的平稳期，还是智力表现会持续进行性下降。此外，目前我们无法区分是真正的痴呆过程，还是未能以与年龄匹配的同龄人相当的速度获得新的认知技能。
