INS NYC 2024 Program

Poster	Poster Session 10 Program Schedule 02/17/2024 09:00 am - 10:15 am Room: Shubert Complex (Posters 1-60) Poster Session 10: Neurodevelopmental \| Congenital Conditions Final Abstract #4 Attention and Fine Motor Functioning in Pediatric Sickle Cell Disease Patients with Very Low Transcranial Doppler (TCD) Becca Althoff Bergmann, Fuller Graduate School of Psychology, Pasadena, United States Hasibul Hasan, Children's Hospital Los Angeles, Los Angeles, United States Yueh-Yun Chi, Children's Hospital Los Angeles, Los Angeles, United States Melissa Balderrama, Children's Hospital Los Angeles, Los Angeles, United States Category: Genetics/Genetic Disorders Keyword 1: pediatric neuropsychology Keyword 2: attention Keyword 3: motor function Objective: Sickle Cell Disease (SCD) is an inherited blood disorder that confers risk of stroke. A method of identifying those at most risk of stroke is transcranial doppler (TCD) ultrasound. TCD measures blood flow velocity through the major cerebral arteries of the anterior circulation, with abnormally high TCD velocities signaling increased risk of stroke. Several studies have been conducted to determine if high TCD values can also predict neuropsychological test performance, which have yielded mixed findings. Despite an overall emphasis on elevated TCD in the SCD literature, a published case series described a group of pediatric SCD patients who experienced cerebral insult following a low TCD screening (<70 cm/s). Additionally, research examining low TCD in other populations (e.g., non-SCD adults with internal carotid stenosis) has demonstrated a relationship between slow cerebral blood flow and cognitive deficits. However, no such studies have examined this in pediatric SCD. The primary purpose of our study was to determine if low TCD velocities are associated with worse attention and fine motor functioning in pediatric SCD. Participants and Methods: Participants included 66 patients (aged 3-20 years at time of neuropsychological screening) with SCD (type SS/β0) who had undergone TCD within six months of screening. Patients with conditional/elevated TCD results (≥170 cm/s) were excluded (n=4). Patients were grouped by TCD status, with patients classified as “Very Low” if their MFV of any of the four arteries was ≤51 cm/s (n=18); otherwise, they were classified as “Normal”. Attention was assessed using the Conners Continuous Performance Test –Third Edition (CPT-3) and fine motor using the Purdue Pegboard (PP). TCD groups were compared on CPT-3 and PP using multivariate analyses of variance (MANOVAs), with further analyses conducted by including gender, age, socioeconomic status (SES; estimated by median income by zip code), and hematocrit as covariates. Results: The TCD groups did not significantly differ in CPT-3 or PP performance, regardless of controlling for covariates. In the adjusted model, a significant effect was observed for SES with attentiveness, impulsivity, and vigilance (all p<.05), with higher SES associated with better performance in these areas. A significant effect was observed for age and PP, with older age associated with worse PP performance (p<.01). There was a trend towards an effect of age on attentiveness, impulsivity, and vigilance, with older age potentially associated with better performance in these areas, however the p-value was not significant for all variables. Conclusions: Very low TCD is not associated with attention or fine motor performance in pediatric SCD, even when controlling for important medical and demographic factors. Our study provides further evidence that TCD is likely not a reliable method of identifying SCD patients at greater risk of cognitive deficits (regardless of which extreme is being used). Given the vulnerability of this population to cognitive sequelae, ongoing research exploring best methods of screening and identifying those most at risk is critical. Additionally, further analysis is necessary to understand the potential association of older age with better attention functioning in our sample (which runs contrary to trends reported in previous research).

Poster

02/17/2024
09:00 am - 10:15 am
Room: Shubert Complex (Posters 1-60)

Poster Session 10: Neurodevelopmental | Congenital Conditions

Final Abstract #4

Attention and Fine Motor Functioning in Pediatric Sickle Cell Disease Patients with Very Low Transcranial Doppler (TCD)

Becca Althoff Bergmann, Fuller Graduate School of Psychology, Pasadena, United States
Hasibul Hasan, Children's Hospital Los Angeles, Los Angeles, United States
Yueh-Yun Chi, Children's Hospital Los Angeles, Los Angeles, United States
Melissa Balderrama, Children's Hospital Los Angeles, Los Angeles, United States

Category: Genetics/Genetic Disorders

Keyword 1: pediatric neuropsychology
Keyword 2: attention
Keyword 3: motor function

Objective:

Sickle Cell Disease (SCD) is an inherited blood disorder that confers risk of stroke. A method of identifying those at most risk of stroke is transcranial doppler (TCD) ultrasound. TCD measures blood flow velocity through the major cerebral arteries of the anterior circulation, with abnormally high TCD velocities signaling increased risk of stroke. Several studies have been conducted to determine if high TCD values can also predict neuropsychological test performance, which have yielded mixed findings. Despite an overall emphasis on elevated TCD in the SCD literature, a published case series described a group of pediatric SCD patients who experienced cerebral insult following a low TCD screening (<70 cm/s). Additionally, research examining low TCD in other populations (e.g., non-SCD adults with internal carotid stenosis) has demonstrated a relationship between slow cerebral blood flow and cognitive deficits. However, no such studies have examined this in pediatric SCD. The primary purpose of our study was to determine if low TCD velocities are associated with worse attention and fine motor functioning in pediatric SCD.

Participants and Methods:

Participants included 66 patients (aged 3-20 years at time of neuropsychological screening) with SCD (type SS/β0) who had undergone TCD within six months of screening. Patients with conditional/elevated TCD results (≥170 cm/s) were excluded (n=4). Patients were grouped by TCD status, with patients classified as “Very Low” if their MFV of any of the four arteries was ≤51 cm/s (n=18); otherwise, they were classified as “Normal”. Attention was assessed using the Conners Continuous Performance Test –Third Edition (CPT-3) and fine motor using the Purdue Pegboard (PP). TCD groups were compared on CPT-3 and PP using multivariate analyses of variance (MANOVAs), with further analyses conducted by including gender, age, socioeconomic status (SES; estimated by median income by zip code), and hematocrit as covariates.

Results:

The TCD groups did not significantly differ in CPT-3 or PP performance, regardless of controlling for covariates. In the adjusted model, a significant effect was observed for SES with attentiveness, impulsivity, and vigilance (all p<.05), with higher SES associated with better performance in these areas. A significant effect was observed for age and PP, with older age associated with worse PP performance (p<.01). There was a trend towards an effect of age on attentiveness, impulsivity, and vigilance, with older age potentially associated with better performance in these areas, however the p-value was not significant for all variables.

Conclusions:

Very low TCD is not associated with attention or fine motor performance in pediatric SCD, even when controlling for important medical and demographic factors. Our study provides further evidence that TCD is likely not a reliable method of identifying SCD patients at greater risk of cognitive deficits (regardless of which extreme is being used). Given the vulnerability of this population to cognitive sequelae, ongoing research exploring best methods of screening and identifying those most at risk is critical. Additionally, further analysis is necessary to understand the potential association of older age with better attention functioning in our sample (which runs contrary to trends reported in previous research).