Cognitive reserve and brain volumes in pediatric acute lymphoblastic leukemia

Department of Psychiatry and Behavioral Sciences, Neuropsychology and Neurorehabilitation Laboratory, Stanford University School of Medicine, Palo Alto, CA 94305, USA.
Brain Imaging and Behavior (Impact Factor: 4.6). 12/2010; 4(3-4):256-69. DOI: 10.1007/s11682-010-9104-1
Source: PubMed


Acute lymphoblastic leukemia (ALL) is associated with long-term, progressive cognitive deficits and white matter injury. We measured global and regional white and gray matter as well as cognitive function and examined relationships between these variables and cognitive reserve, as indicated by maternal education level, in 28 young survivors of ALL and 31 healthy controls. Results indicated significantly reduced white matter volumes and cognitive testing scores in the ALL group compared to controls. Maternal education was inversely related to both global and regional white matter and directly related to gray matter in ALL and was directly related to both gray and white matter in controls, consistent with the cognitive reserve hypothesis. Cognitive performance was associated with different brain regions in ALL compared to controls. Maternal education was significantly positively correlated with working and verbal memory in ALL as well as processing speed and verbal memory in controls, improving models of cognitive outcome over medical and/or demographic predictors. Our findings suggest that cognitive reserve may be an important factor in brain injury and cognitive outcome in ALL. Additionally, children with ALL may experience some neural reorganization related to cognitive outcome.

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Available from: Shelli R Kesler
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    • "The fact that survivors demonstrated increased BOLD signal in the left DACC throughout the n-back task may indicate this so-called compensatory activation, in which survivors required an increase in resources to this region in order to manage the increase in cognitive load. This is consistent with literature documenting structural reorganization in prefrontal regions in pediatric leukemia (Kesler, Tanaka, & Koovakkattu, 2010). However, survivors of ALL were able to successfully and accurately complete the n-back task during fMRI, whereas survivors of pediatric brain tumors performed significantly less accurately than controls. "
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    • "These candidate mechanisms might have diffuse effects on brain structure. Second, structural neuroimaging studies, including our own [34] have shown diffuse changes in white matter and gray matter structure associated with ALL [35]–[38]. Third, meta-analyses of neuropsychological studies on ALL survivors have indicated decline in a wide range of cognitive functions including executive functioning, processing speed and memory [39], [40] (see [41], [42] for a review). "
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