Declines Noted in Cognitive Processes and Association With Achievement Among Children With Leukemia
Declines Noted in Cognitive Processes and Association With Achievement Among Children With Leukemia
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DOI：
10.1188/17.onf.503-511
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发表时间：
2017-07-01
影响因子：
1.9
通讯作者：
Moore, Ida M. (Ki)
中科院分区：
文献类型：
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作者：
Insel, Kathleen C.;Hockenberry, Marilyn J.;Moore, Ida M. (Ki)
目的：评估急性淋巴细胞白血病(ALL)患儿在单纯化疗过程中特定认知过程的变化。设计：前瞻性重复措施设计。地点：班纳大学医学中心图森/班纳儿童钻石医学中心(亚利桑那大学)和德克萨斯儿童癌症和血液病中心(贝勒医学院)的儿科肿瘤治疗中心。样本：71例ALL儿童，确诊时平均年龄6.18岁。方法：采用混合效应潜伏生长曲线模型，以确诊后时间为固定效应，年龄调整标准化的工作记忆指标，处理速度、执行功能和注意力被获得，并在大约一到两年后重复。主要研究变量：言语工作记忆、视觉空间记忆、加工速度、学业成就、年龄和性别。结果：在治疗过程中，年龄对言语工作记忆下降有显著的主效应。计划对比显示，与五岁或以上确诊的儿童相比，五岁以下确诊的儿童的降幅更大。言语工作记忆的下降与字母-单词识别和计算技能的成就有关，空间记忆的下降与计算有关。性别对处理速度的影响主要表现为女性患者较男性患者表现出更大的下降。结论：本研究的结果可以指导干预措施的时机，以提高幸存者的学习成绩。护理启示：接受ALL治疗的儿童可能会遇到言语工作记忆问题和学习困难增加。护士可以将家长和孩子转介给学校资源，以获得额外的学业支持。
Purpose/Objectives: To assess change in specific cognitive processes during treatment with chemotherapy only among children with acute lymphoblastic leukemia (ALL).Design: A prospective, repeated measures design.Setting: Pediatric oncology treatment centers at Banner-University Medical Center Tucson/Banner Children's-Diamond Medical Center (University of Arizona) and Texas Children's Cancer and Hematology centers (Baylor College of Medicine) in Houston.Sample: 71 children with ALL, with a mean age of 6.18 years at the time of diagnosis.Methods: Using mixed-effects latent growth curve modeling with time since diagnosis as a fixed effect, age-adjusted standardized measures of working memory, processing speed, executive function, and attention were obtained and repeated about one and two years later. A subsample was tested for academic achievement at the end of treatment.Main Research Variables: Verbal working memory, visual spatial memory, processing speed, academic achievement, age, and gender.Findings: A significant main effect was observed for age at diagnosis on decline in verbal working memory during treatment. Planned contrasts revealed greater decline among children who were diagnosed when aged younger than five years compared to those diagnosed when aged five years or older. Decline in verbal working memory and achievement in letter-word identification and calculation skills were associated, and decline in spatial memory was associated with calculation. A main effect of gender was observed on processing speed, with female patients showing greater decline than male patients.Conclusions: Findings from this study may guide the timing of interventions that could improve school achievement among survivors.Implications for Nursing: Children undergoing treatment for ALL may experience issues with verbal working memory and increased difficulty in school. Nurses are in a position to refer parents and children to school resources for additional academic support.