Post-traumatic stress, sleep, and neurocognitive problems in children newly diagnosed with a pediatric brain tumor

BACKGROUND: Children diagnosed with brain tumors are at risk to develop neurocognitive problems. Post-traumatic stress and sleep have been associated with poorer neurocognitive outcomes in the general population, and could be potential targets for intervention in brain tumor patients. Therefore, this study examined neurocognitive functioning in children newly diagnosed with a brain tumor and the associations between posttraumatic stress and sleep with neurocognitive outcomes.

METHODS: Children 6-16 years old who were newly diagnosed with a brain tumor completed questionnaires on post-traumatic stress and sleep, actigraphy for sleep, and tests for neurocognitive outcomes. One-sample t-tests and chi-square tests were used to compare neurocognitive scores with age norms. Multivariable regression examined associations between post-traumatic stress, sleep, demographics, and medical factors associated with neurocognitive functioning.

RESULTS: Of all eligible children, 60 patients with newly diagnosed brain tumors were included, at an average of 51 days after diagnosis (67% male, mean = 11.5 years at diagnosis). Compared to age norms, patients with brain tumors scored lower on measures of attention, inhibition, and verbal memory (meanZ = -0.40 to -0.98, p < .05). History of obstructive hydrocephalus was associated with poorer attention (p < .05) and processing speed (p < .05), posterior fossa tumor location was associated with poorer working memory (p < .01), and starting chemotherapy or radiotherapy treatment before the assessment was associated with poorer verbal memory (p < .05). Post-traumatic stress and sleep were not associated with neurocognitive outcomes at this phase (p > .20).

CONCLUSION: A subgroup of children with newly diagnosed brain tumors shows deficits in neurocognitive functioning, which highlights the importance of early monitoring to identify children at-risk for problems. Hydrocephalus, posterior fossa tumor location, and starting treatment, but not post-traumatic stress and sleep, are associated with poorer neurocognitive performance at this phase. Longitudinal research will be important for identifying biopsychosocial factors that may be associated with cognition over time.