Computerized assessment of cognitive impairment among children undergoing radiation therapy for medulloblastoma
Advantages to computerized cognitive assessment include increased precision of response time measurement and greater availability of alternate forms. Cogstate is a computerized cognitive battery developed to monitor attention, memory, and processing speed. Although the literature suggests the domains assessed by Cogstate are areas of deficit in children undergoing treatment for medulloblastoma, the validity of Cogstate in this population has not been previously investigated.
Children participating in an ongoing prospective trial of risk-adapted therapy for newly diagnosed medulloblastoma (n = 73; mean age at baseline = 12.1 years) were administered Cogstate at baseline (after surgery, prior to adjuvant therapy) and 3 months later (6 weeks after completion of radiation therapy). Gold-standard neuropsychological measures of similar functions were administered at baseline.
Linear mixed models revealed performance within age expectations at baseline across Cogstate tasks. Following radiation therapy, there was a decline in performance on Cogstate measures of reaction time (Identification and One Back). Females exhibited slower reaction time on One Back and Detection tasks at baseline. Higher-dose radiation therapy and younger age were associated with greater declines in performance. Pearson correlations revealed small-to-moderate correlations between Cogstate reaction time and working memory tasks with well-validated neuropsychological measures.
Cogstate is sensitive to acute cognitive effects experienced by some children with medulloblastoma and demonstrates associations with clinical predictors established in the literature. Correlations with neuropsychological measures of similar constructs offer additional evidence of validity. The findings provide support for the utility of Cogstate in monitoring acute cognitive effects in pediatric cancer.
KeywordsMedulloblastoma Brain tumor Cogstate Pediatric Neuropsychology
This work was supported, in part, by the National Cancer Institute (St. Jude Cancer Center Support [CORE] Grant No.: [P30-CA21765]) and the American Lebanese Syrian Associated Charities (ALSAC).
Compliance with ethical standards
Conflict of interest
At the time of this study, Brian Harel, PhD, JD and Adrian Schembri, PhD were employees of Cogstate Limited, which is the supplier of the computerized battery used in the study. The remaining authors have no conflicts of interest to disclose.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- 5.Gajjar A, Chintagumpala M, Ashley D et al (2006) Risk-adapted craniospinal radiotherapy followed by high-dose chemotherapy and stem-cell rescue in children with newly diagnosed medulloblastoma (St Jude Medulloblastoma-96): long-term results from a prospective, multicentre trial. Lancet Oncol Lond 7:813–820CrossRefGoogle Scholar
- 16.Lim YY, Ellis KA, Harrington K et al (2012) Use of the CogState brief battery in the assessment of Alzheimer’s disease related cognitive impairment in the Australian Imaging, Biomarkers and Lifestyle (AIBL) study. J Clin Exp Neuropsychol 34:345–358. https://doi.org/10.1080/13803395.2011.643227 CrossRefGoogle Scholar
- 17.Maruff P, Thomas E, Cysique L et al (2009) Validity of the CogState brief battery: relationship to standardized tests and sensitivity to cognitive impairment in mild traumatic brain injury, schizophrenia, and AIDS dementia complex. Arch Clin Neuropsychol 24:165–178. https://doi.org/10.1093/arclin/acp010 CrossRefGoogle Scholar
- 19.Pietrzak RH, Olver J, Norman T et al (2009) A comparison of the CogState Schizophrenia Battery and the Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) Battery in assessing cognitive impairment in chronic schizophrenia. J Clin Exp Neuropsychol 31:848–859. https://doi.org/10.1080/13803390802592458 CrossRefGoogle Scholar
- 24.Falleti MG, Maruff P, Collie A, Darby DG (2006) Practice effects associated with the repeated assessment of cognitive function using the CogState battery at 10-minute, one week and one month test-retest intervals. J Clin Exp Neuropsychol 28:1095–1112. https://doi.org/10.1080/13803390500205718 CrossRefGoogle Scholar
- 27.Snyder AM, Maruff P, Pietrzak RH et al (2008) Effect of treatment with stimulant medication on nonverbal executive function and visuomotor speed in children with attention deficit/hyperactivity disorder (ADHD). Child Neuropsychol 14:211–226. https://doi.org/10.1080/09297040701220005 CrossRefGoogle Scholar
- 31.Barratt W (2006) The Barratt simplified measure of social status (BSMSS). Indiana State University, Terre HauteGoogle Scholar
- 32.Wechsler D (2003) Wechsler intelligence scale for children (WISC-IV). Psychological Corporation, San AntonioGoogle Scholar
- 33.Wechsler D (2014) Wechsler adult intelligence scale—Fourth Edition (WAIS–IV). Psychological Corporation, San AntonioGoogle Scholar
- 34.Woodcock RW, McGrew KS, Mather N (2001) Woodcock-Johnson III tests of cognitive ability. Riverside Publishing, ItascaGoogle Scholar
- 35.Conners KC (2006) Conners’ kiddie continuous performance test. Multi-Health Systems, North TonawandaGoogle Scholar
- 36.Conners KC (2004) Conners’ continuous performance test II. Pearson Corporation, San AntonioGoogle Scholar
- 37.Delis DC, Kramer JH, Kaplan E, Ober BA (2000) California verbal learning test, second edition (CVLT-II). Psychological Corporation, San AntonioGoogle Scholar
- 38.Delis DC, Kramer JH, Kaplan E, Ober BA (1994) California verbal learning test, children’s version. Psychological Corporation, San AntonioGoogle Scholar
- 39.Gioia G, Isquith P, Guy S, Kenworthy L (2000) behavior rating inventory of executive function. Psychological Assessment Resources, OdessaGoogle Scholar
- 40.Kamphaus RW, Reynolds CR (2007) BASC-2 behavioral and emotional screening system manual. Pearson, Circle PinesGoogle Scholar
- 44.Mulhern RK, Kepner JL, Thomas PR et al (1998) Neuropsychologic functioning of survivors of childhood medulloblastoma randomized to receive conventional or reduced-dose craniospinal irradiation: a Pediatric Oncology Group study. J Clin Oncol 16:1723–1728. https://doi.org/10.1200/JCO.19184.108.40.2063 CrossRefGoogle Scholar