Neuropsych Service

8/14/2019 Neuropsych Service

1/21

Neuropsychology Service in

Children with SCD

Dr Kofi A AnieBrent Sickle Cell & Thalassaemia Centre

Imperial College School of Medicine

Central Middlesex HospitalLondon


2/21

Children with SCD

High Risk of:

Neurological complicationsCVAs related to severity

Strokesmost disabling SCD complications

Silent strokes infarcts common in younger children


3/21

Neuropsychological Function

Neuropsychological problems considerable evidence

Neurological Complications generally lead to neurocognitive decline(Craft et al, 1993; 1994; Cohen et al, 1994; Schatz et al, 1999;

Boni et al, 2001)

Educational Risk possible cognitive & intellectual impairment academic underachievement(Brown et al, 1993; Schatz et al, 2001; Schatz, 2004)


4/21

Overt Strokes

Neuropsychological Complications associated with brain lesion location & size

Language & Verbal left hemisphere (Cohen et al, 1994)

Visual & Motor right hemisphere (Cohen et al, 1994)

Attention & Executive Function frontal lobe (Craft et al 1994, Schatz et al, 1999)


5/21

Silent Strokes

Attention & Executive Function frontal lobe

more subtle

(Debaun et al,1998; Brown et al, 2000; Wang et al, 2001)

Intellectual Functioning lesion size(Schatz et al, 2002)

Learning eg. reading & maths(Armstrong et al, 1996)


6/21

Mind the Gap!!

TCD Screening

Neurological Examinations

MRIs

Neuropsychological Service??


7/21

Considerations

Age-appropriateEvidence-based

ongoing researchSetting

clinics, referrals?

Universal routine?


8/21

Rationale

Attention & Executive Function fundamentally important in neurocognitive &

educational performance

Comprehensive neuropsychologicalassessments in outpatients clinics? time consuming impractical

Two-tier Approach


9/21

Screening Assessments

Paediatric SCD Clinic routine

All children aged 5 yrs +

school-going age younger if indicated

Attention & Executive FunctionEducation

loss of schooling achievement

Pain & Quality of Life


10/21


11/21


12/21

Full Neuropsych Assessments

By Appointment

Attention

Memory

Learning

Executive Function

Psychomotor

Intellectual Functioning


13/21

Educational Liaison

Neuropsychological Reports

Schools

Education Depts

Educational Psychologists

Extra Tuition

Statements

Special Needs


14/21

Child AW Demograph & Medical

Female, HbSSAge = 10yrs, School Yr = 6No History of Stroke, Neuro Complications

Pain (preceding 12 mons) 10+ episodes 24 hrs 7days

HSU (preceding 12 mons) 5 hospital admissions 3-7 days


15/21

Child AW - Psychosocial

Mood sometimes low did not want to talk about SCD

Quality of Life physical function moderate social function impeded

Schooling 30% loss (Sept-Dec) learning concerns (Mum)


16/21

Child AW Neuropsych Screen

Attention inattention

impulsive

Executive Function some problems

TCD normal


17/21

Child AW Full Neuropsych

Wechsler Norms: Mean = 100, SD = 15Achievement Tests (WIAT)

Reading Composite = 70

Maths Composite = 78 Language Composite = 96Writing Composite = 68

Intelligence Scales (WISC)Performance IQ = 96Verbal IQ = 92Full Scale IQ = 94


18/21

Child AW Educational

School Performance not optimal

School Support

literacy reading (group 1x weekly)

writing (group 3x weekly)

Home Tuition inc. vocabulary, spelling, maths

Sickle Cell Society Project


19/21

Child AW Neurology

MRI silent stroke


20/21

Conclusion

Neuropsychological services for children

with SCD invaluable:

To complement Neurological Exams, TCDs,MRIs

To determine Educational Support


21/21

LETS CLOSE THE GAP!!

Documents

Neuropsych Service