Processing speed, attention, and working memory after treatment for medulloblastoma: an international, prospective, and longitudinal study

Abstract

Purpose: The current study prospectively examined processing speed (PS), broad attention (BA), and working memory (WM) ability of patients diagnosed with medulloblastoma over a 5-year period.

Patients and methods: The study included 126 patients, ages 3 to 21 years at diagnosis, enrolled onto a collaborative protocol for medulloblastoma. Patients were treated with postsurgical risk-adapted craniospinal irradiation (n = 36 high risk [HR]; n = 90 average risk) followed by four cycles of high-dose chemotherapy with stem-cell support. Patients completed 509 neuropsychological evaluations using the Woodcock-Johnson Tests of Cognitive Abilities Third Edition (median of three observations per patient).

Results: Linear mixed effects models revealed that younger age at diagnosis, HR classification, and higher baseline scores were significantly associated with poorer outcomes in PS. Patients treated as HR and those with higher baseline scores are estimated to have less favorable outcomes in WM and BA over time. Parent education and marital status were significantly associated with BA and WM baseline scores but not change over time.

Conclusion: Of the three key domains, PS was estimated to have the lowest scores at 5 years after diagnosis. Identifying cognitive domains most vulnerable to decline should guide researchers who are aiming to develop efficacious cognitive intervention and rehabilitation programs, thereby improving the quality of survivorship for the pediatric medulloblastoma population.

Fig 1.

Estimated change in processing speed standard score (blue line; 95% CI, black lines) over time (years) for patients diagnosed at (A) 6, (B) 10, and (C) 14 years old with either average-risk (AR) or high-risk (HR) medulloblastoma. Population mean, 100 (red line).

Fig 2.

Estimated change in working memory standard score (blue line; 95% CI, black lines) over time (years) for patients diagnosed with either average-risk (AR) or high-risk (HR) medulloblastoma. Population mean, 100 (red line).

Fig 3.

Estimated change in broad attention standard score (blue line; 95% CI, black lines) over time (years) for patients diagnosed with average-risk (AR) or high-risk (HR) medulloblastoma. Population mean, 100 (red line).