Neurocognitive impairment, employment, and social status in radiotherapy-treated adult survivors of childhood brain tumors.

BACKGROUND: Little is known of the cognitive functions, employment, and social status in adult survivors of childhood brain tumor (BT). We aimed to determine the long-term neurocognitive profile of radiotherapy-treated adult survivors of childhood BT and the relationship between cognitive functions and employment and social status. METHODS: Neurocognitive profiles of survivors were assessed in a Finnish national cohort of 71 radiotherapy-treated survivors of childhood BT (median follow-up time: 21 years [range: 5-33 years]) using a cross-sectional design. Neurocognitive outcomes were compared to control (n = 45) and normative values. Tumor- and treatment-related data were collected from the patient files. Information on employment and social status was gathered. RESULTS: Survivors' (median age: 27 years [range: 16-43 years]) median verbal and performance intelligence quotient (IQ) was 90 (range: 49-121) and 87 (range: 43-119), respectively. The cognitive domains with the greatest impairment were executive functions (median z score, -3.5 SD [range: -25.0 to 1.3 SD]), and processing speed and attention (median z score, -2.5 SD [range: -24.9 to 0.5 SD]). Executive functions were associated with employment, educational level, living independently, having an intimate relationship, and having a driving license. Processing speed and attention were related to educational level, living independently, having an intimate relationship, and having a driving license. Performance IQ was associated with educational level and employment status. Working memory was associated with educational level and living independently. CONCLUSIONS: Radiotherapy-treated adult survivors of childhood BT experience significant neurocognitive impairment, which is associated with difficulties related to employment and social status.

Low depressive symptom and mental distress scores in adult long-term survivors of childhood acute lymphoblastic leukemia.

Childhood cancer survivors are thought to be at risk of psychological difficulties. We examined the prevalence of depressive symptoms and mental well-being in adult long-term survivors of childhood acute lymphoblastic leukemia (ALL) at a mean age of 20 years after the cessation of therapy. Depressive symptoms were assessed with Beck Depression Inventory (BDI-21) and mental distress with General Health Questionnaire (GHQ-12) among 73 ALL survivors and 146 healthy controls. The ALL survivors obtained significantly lower BDI scores (P=0.046) compared with the controls, indicating less depressive symptoms among the ALL survivors. BDI scores indicated a significantly less frequent moderate or severe depression in the ALL survivors compared with the controls (P=0.039). BDI scores indicated no depression in 80.8% of the ALL survivors and 73.3% of the control group. The female ALL survivors obtained lower BDI scores than did the female controls (P=0.005). No difference was found in GHQ-12 scores between the survivors and the controls. Survivors of ALL reported fewer depressive symptoms and equal mental well-being compared with healthy controls. Our findings support the idea that childhood leukemia survivors' subjective experience of well-being is possibly affected by repressive adaptive style.

Progressive neurocognitive impairment in young adult survivors of childhood acute lymphoblastic leukemia.

BACKGROUND: Despite the extensive literature on neuropsychological sequelae after treatment of childhood acute lymphoblastic leukemia (ALL), the very-long-term neurocognitive outcome of the survivors is poorly studied. We assessed neuropsychological functioning in a population-based cohort of young adult childhood ALL survivors. PROCEDURE: Neuropsychological testing was performed on 64 survivors an average of 20 years after the diagnosis. The test battery included verbal intelligence quotient (VIQ) and performance intelligence quotient (PIQ), memory function, orientation and attention as well as motor performance. Cranial irradiation had been administered to 44 survivors as part of ALL treatment, whereas 20 survivors had been treated solely with chemotherapy. A control group consisted of 45 healthy young adults. Earlier neuropsychological test results of 45 of the survivors were available for comparison. RESULTS: The ALL survivors attained significantly lower test scores than the controls in all the neuropsychological function areas. The mean VIQ test scores were 91, 100, and 109 (P < 0.001), and the mean PIQ test scores 100, 111, and 118 (P < 0.001) for the irradiated survivors, non-irradiated survivors and controls, respectively. Memory and motor functions were impaired among the irradiated survivor group compared with the controls. A significant decline in PIQ and VIQ test scores was observed in the irradiated survivor group during the follow-up period, but only in VIQ in the non-irradiated group. CONCLUSIONS: Survivors of childhood ALL suffer from long-lasting progressive neuropsychological impairment, especially when treatment includes cranial irradiation.

Recurrent traumatic brain injury is predicted by the index injury occurring under the influence of alcohol.

BACKGROUND: Little is known of the role of alcohol intoxication as a risk factor for recurrent traumatic brain injuries (TBI). This study was a population-based longitudinal study to investigate this problem. METHODS: The record linkage technique was used and data gathered from the Finnish Hospital Discharge Register, hospital records and by a questionnaire of family characteristics regarding the 12 058 subjects forming the Northern Finland Birth Cohort of 1966. Excluded were TBI subjects injured before the age of 12 years. RESULTS: Of the 236 patients who had survived their first (mainly mild) TBI, 21 had had a recurrent TBI and three of them two recurrent TBIs during the follow-up period (from 1978-2000). An alcohol-related first injury (RR 4.41, 95% CI 1.53-12.70) and urban place of birth (RR 4.39, 95% CI 1.68-11.48) were significant independent predictors of recurrent TBI. A significant positive correlation between the first and recurrent TBIs with respect to alcohol involvement (rs = 0.61, p = 0.003) was observed. CONCLUSIONS: A first TBI related to alcohol drinking is predictive of recurrent TBI, which will often similarly be alcohol-related. The risk of recurrent injury seems to extend over several years after the first TBI. To prevent recurrence, efforts should be made to identify those with an alcohol-related first TBI. A brief intervention focused on drinking habits is needed as an immediate preventive measure.

Traumatic brain injuries in children and young adults: a birth cohort study from northern Finland.

AIMS: Incidence and mortality rates of traumatic brain injury (TBI) were investigated by using the Northern Finland Birth Cohort. This cohort provides a valuable source of data from the population born in 1966 (n = 12,058) in the 2 northernmost provinces of Finland. METHODS: The cohort was followed for 34 years, and data were gathered from the Finnish Hospital Discharge Register and the Registry for Causes of Death by Statistics Finland. RESULTS: The annual incidence of and mortality from TBI were 118 and 14/100,000, respectively. Case fatality was 12%. An estimated prevalence of TBI at the age of 34 years was 269/100,000. Peak occurrences were observed at the age of 6-7 years in both genders and at the age of 18-23 years in men. The proportion of TBI mortality out of total mortality was 12%. Young men aged 16-34 years had 10-fold proportionate mortality from TBI compared to boys aged

Parental alcohol misuse is a powerful predictor for the risk of traumatic brain injury in childhood.

BACKGROUND: Although the positive relationship between parental alcohol use and children's injuries is well established, it is not known whether parental alcohol misuse is a risk factor for traumatic brain injuries (TBIs) of their children and whether subjects with childhood TBI have hazardous drinking habits in adolescence. METHODS: The authors conducted a longitudinal cohort study at Oulu University Hospital. The cohort consisted of 12 058 subjects born in 1966, of which 207 had sustained TBI before the age of 14 years. Data on parental alcohol problems were obtained from the Finnish Hospital Discharge Register and the adolescents' drinking habits were analysed based on a postal inquiry at the age of 14 years. RESULTS: Parental alcohol misuse (RR 1.99, CI 1.19-3.33) and male gender (RR 1.53, CI 1.12-2.08) significantly predicted the risk of childhood TBI. Drinking to intoxication at the age of 14 was significantly associated with parental alcohol misuse (RR 1.62, CI 1.34-1.96), belonging to a one-parent family (RR 1.80, CI 1.61-2.02) and mild TBI (RR 1.67, CI 1.20-2.33). CONCLUSIONS: It was observed that parental alcohol misuse is a major risk factor for TBI in children and drinking to intoxication is a common drinking pattern of adolescents who have sustained TBI in childhood.

Adolescents' drinking habits predict later occurrence of traumatic brain injury: 35-year follow-up of the northern Finland 1966 birth cohort.

PURPOSE: To examine the relationship between adolescents' drinking habits and the risk of traumatic brain injury. METHOD: We prospectively studied the 10,424 adolescents from northern Finland who were born during the year 1966 after exclusion of those who died or emigrated. Data on the frequencies of alcohol use and drunkenness after alcohol intake were collected at the age of 14 years, and the subjects were thereafter followed up until the age of 35 years. The traumatic brain injuries (TBI) that had occurred after the age of 14 years were recorded from the Finnish Hospital Discharge Register and the Registry for Causes of Death by Statistics Finland. RESULTS: Compared with never-drinkers, those who drank alcohol once a month or more often(frequent drinkers) or had sometimes been drunk before the age of 14 years had an increased crude relative risk of TBI during the follow-up time of 21 years (relative risk [RR] 2.04; 95% confidence interval [CI] 1.06 -3.93 and RR 1.42; 95% CI 1.08 -1.88 for frequent alcohol use and drunkenness,respectively). Adjusted (for fathers' occupation, family background, place of residence and school performance) RRs for TBI during the 21-year follow-up were 2.21 (1.14-4.29) and 1.35 (1.01-1.79), respectively. CONCLUSIONS: The habit of frequent drinking and the feeling of having been drunk at the age of 14 years or before seem to increase the risk for TBI in adolescence and young adulthood. Increased efforts should be made by policy makers to restrict adolescents= alcohol drinking.