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Cogstate Computerized Battery Effective For Long-Term Monitoring of Cognitive Side Effects in Pediatric Leukemia Patients

October 20, 2016

supportive-care-in-cancer-coverChildren with acute lymphoblastic leukemia (ALL) often battle neurocognitive deficits as a result of their radiation or chemotherapy treatment. During treatment and sometimes up to two years after treatment, their quality of life is affected by impairments in attention, processing speed and executive functioning. While many pediatric leukemia studies have identified possible counter measures later in the treatment schedule, little is known about the initial onset of cognitive decline early in therapy schedules.

To better understand these impairments over time, researchers conducted a neurocognitive screening study that enrolled 34 young patients, with a median age of 9 years old, from the Dana Farber Cancer Institute ALL Consortium, and recently published in Supportive Care in Cancer. This longitudinal study will continue to follow them through their treatment protocol, measuring their cognition at six different times before, during and after therapy. In addition, cerebrospinal fluid (CSF) was collected from a subset of the group, as cognitive dysfunction may be preceded by biomarkers within the CSF.

The Cogstate computerized battery of tests was selected due to its proven construct and criterion validity, the absence of cultural bias and practice effects, and its sensitive detection of subtle cognitive changes. An advantage of using the Cogstate battery over traditional paper and pencil neuropsychological tests was the ability to administer via a laptop at bedside, the engaging user interface and the shorter test time of 20-25 minutes. With a normative pediatric database of over 55,000 healthy children, the ALL patients could be compared to age-matched peers at the baseline assessment. Any test scores that were 2 or more standard deviations below the age-matched norm were considered impaired.

The first set of tests were conducted within the first month of leukemia treatment. The goal of this initial pilot study was to confirm that Cogstate is a tool that can be effectively and reliably used for a longitudinal study with young patients facing serious medical treatment.

“To demonstrate the feasibility of using Cogstate during treatment for leukemia, we assessed the willingness of participants to consent to the study, as well as the ability of the participants to successfully perform Cogstate,” wrote the study authors. “Successful performance was defined as completing each test in a manner that complied with test requirements.”

Eighty percent of the ALL patients approached agreed to participate in the neurocognitive sub-study.  Of those 34 patients, 100% were able to complete the initial baseline test successfully. Across all five Cogstate tests, 29 patients showed no initial cognitive deficit compared to the age-matched norms, while five patients were impaired on one of the tests.

“This finding of high participation and even higher completion is particularly promising given the traditionally poor compliance with neuropsychological testing seen in many US cooperative group studies,” concluded the researchers. “Additionally, the computer-based format is engaging to children and adolescents as well as being both focused in domain assessment and brief in duration.”

Also, the CSF biomarkers were shown to be within expected norms confirming that the initial cognitive test data would provide a reliable baseline.

Going forward, the researchers stated that the Cogstate battery will be ideal for the demands of a longitudinal study.

“Serial testing can be performed across the wide age range eligibility by trained non-psychologists using the same assessment instrument without having to switch test measures based upon the age of the subject. Lastly, serial assessments using Cogstate also benefit significantly from the ability of the software to change the stimuli within each test, thereby minimizing any practice effect from repeated exposure, which is not possible with paper and pencil test measures.”

Questions or comments?  Please contact Dan Peterson