Background: As survival outcomes in children with brain tumors have been improving over time, cognitive sequelae of treatment are becoming of interest. However, the role of histology and surgery in the development of these cognitive deficits remains unclear. This study aimed to evaluate cognitive functioning in children with brain tumors before and after surgery.
Methods: All children newly diagnosed with primary brain tumor or a recent head trauma were prospectively assessed. Neurocognitive evaluations were performed before surgery/at diagnosis (nT0), within 7-10 days from surgery (nT1) and 12-18 months after the end of treatment. Language, learning and memory, attention, executive functions, visuo-constructional and sensorimotor skills were evaluated at T0 and T1, whereas IQ was explored at T0 and T2.
Results: Twenty-one patients (13 males, mean age 10.5±3.8 years) were enrolled between January 2019 and September 2022. At baseline, patients showed significant major deficits in semantic (p=0.037) and phonemic fluency (p=0.01), direct span (p<0.001), copy design tasks (p=0.004) and theory of mind (p=0.016) in comparison to normal values. Children with high-grade lesions showed lower scores than the low-grade group in the Rey-Osterrieth Complex Figure evaluating visuospatial memory. Intrapatient evaluations did not change between nT0 and nT1, while at nT2 evaluation children showed median IQ values lower than in nT0 (93 vs 100, p=0.05),.
Conclusions: Children with brain tumors may present at diagnosis several neuropsychological impairments in memory, executive functions, and visuo-motor abilities, particularly those with high-grade diseases. Surgery, even when radical, didn’t impact cognitive functions, irrespectively from grading, while cognitive decline worsened later. Prospective protocols with baseline and periodic neurocognitive and neuroradiological evaluations should be encouraged to indicate targets for cognitive monitoring, to early detect functional difficulties and to develop a tailored treatment approach for the patient.
