Possible association between the integrity of cerebellar pathways and neurocognitive performance in children with posterior fossa tumors.

BACKGROUND: Cerebellar tumor survivors often exhibit neuropsychological deficits that could be related to alterations in cerebro-cerebellar networks. This is a pilot study designed to understand if diffusion tensor imaging (DTI)-based tractography is able to identify possible correlations between cerebellar white matter structure and cognitive outcome in children on long-term follow-up for posterior fossa (PF) tumors who were thoroughly assessed for neuropsychological functioning. METHODS: DTI-based tractography was performed in pediatric patients with PF tumors. Fractional anisotropy (FA) and volumetric measurements of spinocerebellar, dentorubrothalamocortical and corticopontocerebellar tracts were analyzed. Cognitive and neuropsychological functioning was assessed by the Wechsler Intelligence Scale for Children-IV Edition (WISC-IV) and the Developmental Neuropsychological Assessment (NEPSY II). The associations between Full-Scale Intelligence Quotient (FSIQ), NEPSY-II scores, and fiber tracts were tested by the Spearman rank correlation coefficient. RESULTS: Seven patients (median age at diagnosis five years, range, 3-13) treated for medulloblastoma (2/7; 29%) and pilocytic astrocytoma (5/7; 71%) were retrospectively evaluated. All children had complete surgery. The median FSIQ was 84 (range, 67-93). Patients presented with several deficits on many NEPSY-II tasks; in particular, memory was impaired in nearly half of them. FSIQ and neurocognitive tasks significantly correlated with specific corticopontocerebellar tracts. CONCLUSION: Children on follow-up for PF tumor showed scattered cognitive impairments, including deficits in long-term and immediate memory. Tractography allowed us to describe a possible association between the integrity of cerebellar pathways and neurocognitive performance, suggesting that the myelinization of these fibers may represent an indicator for the development of long-term cognitive sequelae.

Toward a characterization of language development in children with congenital heart disease: A pilot study.

Congenital heart diseases (CHDs) represent one of the most common types of congenital abnormalities. More than 90% of children with critical heart defects achieve adulthood due to improvements in medical and surgical treatments. Nonetheless, survivors are at risk for neurodevelopmental disorders that may lead also to language impairments. The current study analyzed the linguistic profiles of a group of school-aged children treated surgically for CHD.Fifteen Children with CHDs (7 girls and 8 boys; mean age = 9.31 with SD = 2.10), without intellectual disability (i.e., IQ>70), who underwent cardiac surgery on cardiopulmonary bypass (CPB), were administered a selection of tests from the language assessment tool BVL 4-12. Their performance was compared with that of 15 healthy children matched for age and gender. As a result, children with CHDs scored significantly lower than healthy peers on tasks tapping lexical and grammatical processing as well as the episodic buffer component of working memory. Interestingly, the two groups did not differ on tasks assessing their lexical repertoire and phonological discrimination abilities. These findings are discussed in light of current theories of cognitive development and functioning.

Neuropsychological Impairment in Children With Class 1 Congenital Heart Disease.

Children with congenital heart disease (CHD) are at increased risk of neuropsychological impairments, but few studies are available on the nonlinguistic neuropsychological abilities of children with CHD. We conducted neuropsychological evaluations using the NEPSY II on a cohort of 17 school-age Italian children with diagnoses of Class 1 CHD, no genetic or chromosomal abnormalities, and normal intelligence scores, and we compared them with 34 matched controls. Children with CHD in this study had undergone at least one cardiac surgery with cardiopulmonary bypass support. We found that children with CHD scored significantly lower than their matched controls on memory and learning domain tasks, and they displayed subtle attention/executive dysfunctions and deficits in sensorimotor skills.