Characterizing neurocognitive late effects in childhood leukemia survivors using a combination of neuropsychological and cognitive neuroscience measures

Knowledge about cognitive late effects in survivors of childhood acute lymphoblastic leukemia (ALL) is largely based on standardized neuropsychological measures and parent reports. To examine whether cognitive neuroscience paradigms provided additional insights into neurocognitive and behavioral late effects in ALL survivors, we assessed cognition and behavior using a selection of cognitive neuroscience tasks and standardized measures probing domains previously demonstrated to be affected by chemotherapy.

130 ALL survivors and 158 control subjects, between 8 and 18 years old at time of testing, completed the n-back (working memory) and stop-signal (response inhibition) tasks. ALL survivors also completed standardized measures of intelligence (Wechsler Intelligence Scales [WISC-IV]), motor skills (Grooved Pegboard), math abilities (WIAT-III), and executive functions (Delis–Kaplan Executive Function System). Parents completed behavioral measures of executive functions (Behavior Rating Inventory of Executive Function [BRIEF]) and attention (Conners-3).

ALL survivors exhibited deficiencies in working memory and response inhibition compared with controls. ALL survivors also exhibited deficits on WISC-IV working memory and processing speed, Grooved Pegboard, WIAT-III addition and subtraction fluency, and numerical operations, as well as DKEFS number-letter switching. Parent reports suggested more attention deficits (Conners-3) and behavioral difficulties (BRIEF) in ALL survivors compared with referenced norms. Low correspondence between standardized and experimental measures of working memory and response inhibition was noted.

The use of cognitive neuroscience paradigms complements our understanding of the cognitive deficits evident after treatment of ALL. These measures could further delineate cognitive processes involved in neurocognitive late effects, providing opportunities to explore their underlying mechanisms.     

The relationship between short‐term memory and working memory: Complex span made simple?

This experiment addresses the question of what makes a working memory measure a good predictor of higher‐level abilities. Verbal and visuospatial processing episodes were interleaved with distinct verbal and visuospatial storage episodes to form four complex span tasks. Although these measures were reliable predictors of reading and mathematics ability in children, they were no more predictive of these abilities than corresponding simple span tasks involving storage alone. However, when individual differences in storage ability and processing capacity were controlled for, residual variance in complex span performance was related to academic ability in some cases. These findings indicate that complex span tasks are multiply determined, and that differences in task structure can dramatically influence the relative importance of these multiple constraints and the predictive power of a complex span measure.     

Children's memory for complex autobiographical events: Does spacing of repeated instances matter?

Often, when children testify in court they do so as victims of a repeated offence and must report details of an instance of the offence. One factor that may influence children's ability to succeed in this task concerns the temporal distance between presentations of the repeated event. Indeed, there is a substantial amount of literature on the “spacing effect” that suggests this may be the case. In the current research, we examined the effect of temporal spacing on memory reports for complex autobiographical events. Children participated in one or four play sessions presented at different intervals. Later, children were suggestively questioned, and then participated in a memory test. Superior recall of distributed events (a spacing effect) was found when the delay to test was 1?day (Experiment 1) but there was little evidence for a spacing effect when the delay was 1 week (Experiment 2). Implications for understanding children's recall of repeated autobiographical events are discussed.     

Changes in health status after one year for persons at-risk for and with HIV infection

Abstract

Health status is an important component of the evaluation of patient outcome in HIV infection where disease is chronic, progressive, and debilitating. This paper compares patient self-report for 9 dimensions of health status for patients followed in ATHOS (AIDS Time-Oriented Health Outcome Study). We compared changes in functioning after 12 months for 1, 524 patients with varying HIV disease severity: 238 asymptomatic, 447 symptomatic, 441 AIDS, and 398 HIV-negative individuals who are at-risk for infection.

Declines in health status were observed for all HIV-infected persons, including also asymptomatic patients. Individuals with symptomatic disease or AIDS had significant declines (p < 0.001) in physical functioning, energy, global health, pain, and increased disease symptoms, but no significant declines in health distress, cognition, or mental health. Persons with AIDS had greater declines than those with symptomatic disease. All HIV-infected individuals reported significantly fewer hours at work and more disability days than HIV-negative patients from similar risk pools. The adverse impact that HIV infection has on the health status of HIV-positive asymptomatic individuals is striking; HIV-negative individuals are more similar to HIV-positive individuals than to the general population.     

The use of diabetes-specific perceived control and health belief measures to predict treatment choice and efficacy in a feasibility study of continuous subcutaneous insulin infusion pumps

Abstract

In the course of a feasibility study of continuous subcutaneous insulin infusion pumps, 382 insulin-requiring diabetic patients were offered a choice of CSII, intensified conventional treatment or conventional treatment. Two hundred and eighty-six (75%) patients completed newly developed diabetes-specific measures of health beliefs and attributions before any change of treatment regimen. The scales were useful predictors of patients' choice of treatment. Furthermore, they were useful in predicting efficacy of treatment in terms of glycosylated haemoglobin measures of diabetes control after one year of treatment in the study. The implications of the findings for introducing patients to new forms of treatment are discussed.     

Sleep Disturbances Among Combat Military Veterans: A Comparative Study Using Subjective and Objective Sleep Assessments

The sleep characteristics of 37 military veterans and active-duty service members (17 with PTSD and 20 without PTSD) of recent wars were analyzed to determine if combat deployment, with its associated sleep restriction, may be an alternative explanation for the sleep complaints found among combat veterans with PTSD (as determined by PTSD Checklist Military Version scores). Over a 1-week period, sleep data were collected using sleep actigraphy and self-report. Across the entire sample, subjective and objective assessment methods of sleep were strongly correlated, although there were some notable within-group differences. Specifically, although sleep duration between groups did not differ based on actigraphy, veterans without PTSD reported sleeping 1 h and 11 min (p = .002) longer than did veterans with PTSD. In an effort to determine why individuals without PTSD might be overreporting sleep, we found that symptoms of emotional arousal (anger, anxiety, and nightmares) were significantly correlated with self-reported sleep duration, suggesting a pattern of higher autonomic arousal found in veterans with PTSD. Thus, although sleeping for 6 h, the higher levels of emotional arousal reported by veterans with PTSD may mean that they do not perceive their sleep as restful. Further research is necessary to determine if the sleep architecture of veterans with PTSD is actually different from that of combat veterans without PTSD and if such differences are actually amenable to standard behavioral treatments for this disorder.     

Memory for Faces in Children with Autism

Previous research has established that children with Autistic Disorder have deficits in aspects of social cognition and in verbal memory, but research on social memory is limited. Twenty-four autistic boys aged 7 to 12 years and normal controls matched for verbal mental age were administered parallel social and nonsocial matching and memory tasks. Results showed that the children with autism were impaired relative to the normal children on the social (face) memory task only. Furthermore, of the four experimental tasks, the social memory task had the highest and most consistent correlations with measures of social development and adaptive skills. Whereas the normal children used the special status of faces to recall them more easily than objects, the children with autism showed equal recall of objects and faces.     

Predicting hopelessness: The interaction between optimism/pessimism and specific future expectancies

Improving our understanding of hopelessness is central to suicide prevention. This is the first study to investigate whether generalised expectancies for the future (optimism/pessimism) and specific future-oriented cognitions (future thinking) interact to predict hopelessness and dysphoria. To this end, participants completed measures of future thinking, optimism/pessimism and affect at Time 1 and measures of affect and stress at Time 2, 10–12 weeks later. Results indicated that changes in hopelessness but not dysphoria were predicted by the interaction between positive future thinking (but not negative future thinking), optimism/pessimism and stress beyond initial levels of hopelessness and dysphoria. Additional moderating analyses are also reported. These findings point to the fruits of integrating personality and cognitive processes, to better understand hopelessness.