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8/14/2019 Neuropsych Service
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Neuropsychology Service in
Children with SCD
Dr Kofi A AnieBrent Sickle Cell & Thalassaemia Centre
Imperial College School of Medicine
Central Middlesex HospitalLondon
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Children with SCD
High Risk of:
Neurological complicationsCVAs related to severity
Strokesmost disabling SCD complications
Silent strokes infarcts common in younger children
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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)
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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)
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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)
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Mind the Gap!!
TCD Screening
Neurological Examinations
MRIs
Neuropsychological Service??
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Considerations
Age-appropriateEvidence-based
ongoing researchSetting
clinics, referrals?
Universal routine?
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Rationale
Attention & Executive Function fundamentally important in neurocognitive &
educational performance
Comprehensive neuropsychologicalassessments in outpatients clinics? time consuming impractical
Two-tier Approach
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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
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Full Neuropsych Assessments
By Appointment
Attention
Memory
Learning
Executive Function
Psychomotor
Intellectual Functioning
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Educational Liaison
Neuropsychological Reports
Schools
Education Depts
Educational Psychologists
Extra Tuition
Statements
Special Needs
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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
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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)
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Child AW Neuropsych Screen
Attention inattention
impulsive
Executive Function some problems
TCD normal
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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
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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
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Child AW Neurology
MRI silent stroke
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Conclusion
Neuropsychological services for children
with SCD invaluable:
To complement Neurological Exams, TCDs,MRIs
To determine Educational Support
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LETS CLOSE THE GAP!!