Neurocognitive Assessment Strategies
Historically, the BSC was primarily tasked with assessment and data collection in trials examining neurocognitive outcomes in response to treatment modifications. Our first concerted effort was the development of a free-standing protocol, ALTE07C1, designed to streamline and standardize neurocognitive data collection across COG trials. ALTE07C1 included a brief, direct assessment of cognitive domains commonly affected by cancer and its treatment and predictive of educational/occupational outcomes. A total of 945 children were enrolled on this protocol across COG trials over a span of 14 years, representing significantly improved data collection rates compared to prior COG trials. ALTE07C1 has been renamed the COG Standardized Neurocognitive Assessment Battery and is now embedded in relevant clinical trials.
After the development of ALTE07C1, BSC members began investigating the utility of a briefer, computerized assessment battery (Cogstate)6 that can be administered without a psychologist or neuropsychologist. These computerized assessments have the potential to characterize neurocognitive functioning with less cost, time, practice effects, and patient burden than traditional measures. However, there are minimal data linking these measures to functional (educational/occupational) outcomes. With this in mind, BSC members obtained R01 grant funding to develop a comprehensive model of neurocognitive development in children with high-risk acute lymphoblastic leukemia to guide prediction of individual risk for cognitive declines and inform intervention development and timing. Relying on an early detection model of frequent neurocognitive monitoring, this initiative uses a multi-method approach of Cogstate (embedded in protocol AALL1131) and traditional measures (ALTE07C1) to understand neurocognitive function during and after treatment. Data collection is ongoing, and analysis is pending.