Monitoring neurocognitive functioning in childhood cancer survivors: evaluation of CogState computerized assessment and the Behavior Rating Inventory of Executive Function (BRIEF)

Lyn M Balsamo; Hannah-Rose Mitchell; Wilhelmenia Ross; Catherine Metayer; Kristina K Hardy; Nina S Kadan-Lottick

doi:10.1186/s40359-019-0302-3

Monitoring neurocognitive functioning in childhood cancer survivors: evaluation of CogState computerized assessment and the Behavior Rating Inventory of Executive Function (BRIEF)

BMC Psychol. 2019 May 2;7(1):26. doi: 10.1186/s40359-019-0302-3.

Authors

Lyn M Balsamo¹, Hannah-Rose Mitchell², Wilhelmenia Ross³, Catherine Metayer⁴, Kristina K Hardy^{5

6}, Nina S Kadan-Lottick^{3

7}

Affiliations

¹ Yale University School of Medicine, 15 PO Box 208064, 16 333 Cedar Street, LMP-2073 (for courier mail), 17, New Haven, CT, 06520-8064, USA. lyn.balsamo@yale.edu.
² University of Miami, Coral Gables, FL, USA.
³ Yale University School of Medicine, 15 PO Box 208064, 16 333 Cedar Street, LMP-2073 (for courier mail), 17, New Haven, CT, 06520-8064, USA.
⁴ School of Public Health, University of California, Berkeley, California, USA.
⁵ Center for Neuroscience and Behavioral Medicine, Neuropsychology Division, Children's National Medical Center, Washington, DC, USA.
⁶ Department of Psychiatry and Behavioral Science, George Washington University School of Medicine, Washington, DC, USA.
⁷ Yale Cancer Center, New Haven, CT, USA.

Abstract

Background: Many childhood cancer survivors develop neurocognitive impairment, negatively affecting education and psychosocial functioning. Recommended comprehensive neuropsychological testing can be time- and cost- intensive for both institutions and patients and their families. It is important to find quick and easily administered surveillance measures to identify those in need of evaluation.

Methods: We evaluated, individually and in combination, the sensitivity and specificity of the 1) Behavior Rating Inventory of Executive Functioning-Metacognition Index (BRIEF-MCI), and 2) CogState Composite Index (computerized assessment of cognition) in identifying below grade-level performance on state-administered tests of reading and mathematics among childhood cancer survivors.

Results: The 45 participants (39% female) were a mean age of 7.1 ± 4.4 years at diagnosis, 14.0 ± 3.0 at evaluation, with a history of leukemia (58%), lymphoma (9%), central nervous system tumors (20%), and other tumors (13%). Impairment on the BRIEF-MCI was associated with low sensitivity (26% reading, 41% mathematics) but stronger specificity (88% reading, 96% mathematics). We found similar associations for the CogState Composite Index with sensitivity of 26% for reading and 29% for mathematics and specificity of 92% for both reading and mathematics. Combining the two measures did not improve sensitivity appreciably (47% reading, 59% mathematics) while reducing specificity (84% reading, 88% mathematics).

Conclusions: While individuals identified from the BRIEF-MCI or CogState Composite would likely benefit from a full neuropsychological evaluation given the strong specificity, use of these measures as screening tools is limited. With poor sensitivity, they do not identify many patients with academic difficulties and in need of a full neuropsychological evaluation. Continued effort is required to find screening measures that have both strong sensitivity and specificity.

Keywords: Computerized assessment; Late effects; Neurocognitive; Neuropsychological evaluation; Survivorship.

Publication types

Evaluation Study

MeSH terms

Adolescent
Behavior
Cancer Survivors*
Child
Cognition Disorders / etiology*
Cognition Disorders / physiopathology
Cognition*
Executive Function
Female
Humans
Male
Mass Screening
Neurophysiological Monitoring
Neuropsychological Tests*
Sensitivity and Specificity

Abstract

Publication types

MeSH terms

Grants and funding