Endocrine Abstracts

Background: Survivors of childhood leukaemia (ALL) treated with cranial radiotherapy (CRT) are at risk for cognitive impairment. Whether the impairment progresses with follow-up time and if survivors with cognitive impairment have an increased risk for overweight, is unknown. We aimed to investigate the long-term cognitive functioning in ALL survivors treated with CRT in comparison to matched controls.

Method: Cognitive functioning was investigated in 38 ALL survivors, treated with CRT (24 Gy), at a median age of 5 years (1–17). The survivors were on complete hormone substitution. Median age at follow-up was 38 years (33–46) and the survivors were investigated 34 years (26–40) after diagnosis. Comparisons were made with 28 controls, matched for gender and age.

Results: After 34 years of treatment survivors demonstrated a lower performance in vocabulary, memory, learning capacity, spatial ability, executive functions, and attention (all, P<0.001), compared to controls. 58t % of the survivors had moderate/severe impairment in visuo-spatial function and episodic memory, and had significantly higher BMI (28.4 vs 25.9) (P=0.01), compared to survivors with normal cognitive function. Furthermore, this group was treated at younger age (3; 1–9) compared to the survivors with normal cognition (6; 3–17). From the age of 26 years to the age of 38 years, and in comparison to the same matched controls 69%, of the survivors, demonstrated a decline in psychomotor speed tests of reaction time (RT) (sustained attention) (P=0.02 and P<0.001). A significantly higher BMI was recorded among the survivors with an increased RT of >15%, compared to survivors with <15% increased RT.

Conclusion: 34 years after ALL diagnosis, we report persistent cognitive impairment and a progressive decline in sustained attention in survivors. The survivors with overweight had the most attenuated impairment in cognitive function. Intervention strategies should be multidimensional and include tailored psychosocial and healthy life-style support.