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Memory Issues in Children With Medulloblastoma Undergoing Radiation Therapy

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Key Points

  • Children treated with radiation had a hard time forming new, detailed memories.
  • After treatment, children had less volume in the hippocampus, a part of the brain that plays an important role in memory.
  • Episodic memories from before the children’s treatment were not affected by treatment.

Children with certain types of brain tumors who undergo radiation treatment are less likely to recall the specifics of events they experienced after radiation than to remember pretreatment happenings, according to a Baylor University study comparing them to children with healthy brains. These findings were published by Sekeres et al in The Journal of Neuroscience.

The finding is significant because after treatment, children had less volume in the hippocampus, a part of the brain that plays an important role in memory. While such a decrease usually is associated with Alzheimer’s disease, dementia, brain injury, epileptic amnesia, encephalitis, and/or aging, with those conditions both remote and recent memories are impaired, said lead author Melanie Sekeres, PhD, Director of the Sekeres Memory Laboratory at Baylor University. “The surprise—and the upside—is that episodic memories from before the children’s treatment were spared,” she said.

In the study, researchers focused on autobiographic memory, which is linked to unique personal events and involves the recollection of emotional and perceptual details that allow a person to mentally reexperience the event, said Dr. Sekeres.

Radiotherapy and chemotherapy are used to treat the most common malignant brain tumor in children, medulloblastoma. The reduced volume of the hippocampus is likely associated with radiation’s impact on the development of new cells in the nervous system, including the growth of new neurons in the hippocampus (neurogenesis).

“We know that these new cells play crucial roles in regulating memory and spatial learning, which is required to navigate. These treatments limit the brain’s ability to produce these new cells, which, in turn, limits the ability to form new memories,” Dr. Sekeres said.

Study Methods

Research participants were 13 child survivors of brain tumors who had previously received radiotherapy and chemotherapy treatment at least 1 year before the study. Twenty-eight healthy youths of similar ages (ranging from 7–18) also were recruited for the study, conducted with The Hospital for Sick Children in Toronto. All the participants completed the Children’s Autobiographical Interview—a standardized memory test—and underwent magnetic resonance imaging (MRI) of the brain.

In individual interviews, children in both groups also were asked to recall memories from personal events that occurred at a specific time and place. Children were asked to recall a very old memory from an event before their radiation treatment (or an equally old memory for the healthy children) and a recent memory from within the past month. They were offered a list of events such as a birthday party, family trip, graduation, and getting a pet, but were told that they could choose another happening.

The interview allowed children to freely recall without prompting before being asked general and specific questions about the event.

Findings

“They have a hard time forming new, detailed memories,” Dr. Sekeres said. For example, when talking about a recent birthday party for a friend, they might tell how they met the friend and what that individual likes to do, but few specifics such as what they wore, the type of cake, what friends were there, and what activities they did at the party, she said.

“Such specific details might seem trivial, but these are precisely the kinds of details that allow us to vividly replay important events in our lives,” Dr. Sekeres said. “For most events, though, even healthy people forget a lot of specific details over time because we typically don’t need to retain all that incidental information. Some forgetting is normal and adaptive, and what we remember is the gist of an older event.” The patients were just as capable as healthy children of recalling these older memories, she said.

But for children with brain tumors who have undergone radiation, the study suggested “deficits in their ability to either encode and/or retrieve highly detailed memories for personal events,” Dr. Sekeres said. “And those are the kind of memories that allow us to understand who we are and give us rich personal lives.

“The study identifies an area of cognition that is inadvertently impacted by standard treatment, which has real consequences for the quality of life of the survivors,” Dr. Sekeres said.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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