746 - Neurocognitive Screening and Impact of Socioeconomic Disadvantage on Children and Adolescents with Sickle Cell Disease

Julia LaMotte, Indiana University School of Medicine/Riley Children's Health, Indianapolis, IN, United States; Hannah Koch, Indiana University School of Medicine, Bloomington, IN, United States; Jillian Bouck, Indiana University School of Medicine, Indianapolis, IN, United States; Olivia Coughlin, Indiana University School of Medicine, Indianapolis, IN, United States; James E. Slaven, Indiana University School of Medicine, Indianapolis, IN, United States; Seethal A. Jacob, Indiana University School of Medicine, Indianapolis, IN, United States

Background:

Background: Sickle Cell Disease (SCD) is an inherited blood disorder that predominately affects racial minorities. Given cerebrovascular involvement, observed differences in neurocognitive functioning exist across child development. Exploring the role of broader socioeconomic disadvantages specific to patient’s communities is imperative to understanding the potential impact on neurocognitive and academic performance.

Objective:

Objective: This project aimed to explore the relationship between indices of socioeconomic and educational disadvantage and neurocognitive performance as part of serial screening during a comprehensive SCD visit.

Design/Methods: Methods: Data were collected retrospectively from January 2023 to July 2024 for patients who completed neurocognitive screening (ages 3-16 years). Screening batteries were age-based and assessed for cognitive performance, academic functioning, and attention. Caregiver-proxy and self-report were completed for domains of executive functioning, emotional concerns, and sleep. Area deprivation index (ADI) and childhood opportunity index (COI) were determined using publicly available census block data for the patient at the time of screening. ADI is measured on a 1-10 ordinal scale (1 = least disadvantaged). COI is measured on a 5-point Likert Scale of Very Low to Very High. Descriptive statistics were completed using SAS 9.4. Spearman correlations were run to adjust for nonparametric data. ADI and COI were analyzed separately due to concerns with collinearity.

Results:

Results: Forty-five patients with an average age of 9.3 years (range 3-17) completed screening. Most had SS genotype (64%), identified as male (53%), and attended the appointment with their mother (68.4%). Six patients were not yet attending school.

Average State ADI for our cohort was 5.6 (+/-3.06), similar to our overall SCD population. Patients also mostly resided in areas with “Very Low” overall COI (44%) and in subindices of Education (51%), Health and Environment (37%), and Social and Economic (44%).

Higher State ADI scores were associated with lower working memory (p < 0.001), math (p=0.006) and spelling (p=0.002). Lower State COI scores were associated with lower reading (p=0.004), math (p=0.005), and spelling (p < 0.001). Both were individually associated with worse sleep initiation/maintenance (p < 0.001).

Conclusion(s):

Conclusion: Serial monitoring for changes in neurocognitive functioning is necessary for understanding the impact of SCD on brain health. Understanding performance in the context of environment is crucial for contextualizing deficits.