ABSTRACT:
BACKGROUND: Neurocognitive deficits are an important late
effect in survivors of acute lymphoblastic Leukemia(ALL). Data from low
middle income countries is scarce and highly influenced by biological
and cultural variations. Such data would be useful for highlighting the
importance of early intervention in an already disadvantaged population.
PROCEDURE: 70 consecutive survivors of childhood ALL were
evaluated for neurocognitive deficits by the Indian adaptation of
Wechsler Intelligence Scale for Children-Fourth
Edition(WISC-INDIA). Prevalence of neurocognitive
deficits was calculated based on Full Scale Intelligence Quotient(FSIQ)
and scores in discrete domains like Verbal Comprehension, Perceptual
Reasoning, Working Memory and Processing Speed were calculated and
compared to baseline characteristics, chemotherapy and radiation dose
received.
RESULTS: The mean FSIQ was 86.1 ± 20.5, with significant
neurocognitive deficit(FSIQ <90) being prevalent in 50%(95%
CI 38% to 62%) of the cohort. The proportion of survivors with
deficits in individual domains of verbal comprehension, perceptual
reasoning, working memory and processing speed were 49%, 50%, 47% and
44% respectively. The odds of having deficits in neurocognitive
function was higher when a child belonged to lower socioeconomic strata,
had parents with less than primary school education and whose birth
order was higher(All p<0.05). Age at diagnosis, current age at
assessment, receiving lower or higher dose of radiotherapy, high dose
methotrexate or cytarabine did not have a direct impact on
neurocognitive function.
CONCLUSIONS AND RELEVANCE: The current need is to develop
country specific neurocognition assessment tools to initiate early
screening and develop culturally appropriate preventive and
rehabilitative interventions.