Peer-reviewed article
Early Impact of Childhood Opportunity on Neurocognitive Outcomes in Sickle Cell Disease.
LaMotte JE, Koch H, Coughlin OA, Bouck JR, Carter A et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined how neighborhood-level social and economic opportunities affect brain development and learning in children with sickle cell disease. Researchers assessed 90 children aged 7.7 years on average and found that children living in neighborhoods with more educational and economic opportunity performed better on tests of reasoning, memory, language, and academic skills. The findings suggest that factors beyond the disease itself, such as access to quality education and resources in a child's neighborhood, significantly influence cognitive outcomes.
Key points
- Ninety children with sickle cell disease were assessed using standardized neurocognitive screening between January 2023 and May 2025
- Most participants lived in areas of low or very low childhood opportunity
- Higher Childhood Opportunity Index (COI) scores were significantly associated with better performance in fluid reasoning, working memory, language, reading, spelling, and math
- The education subdomain of COI showed consistent associations across all cognitive and academic measures
- Neighborhood-level childhood opportunity was associated with neurocognitive outcomes independently of known neurological injury from stroke
Limitations
This is a retrospective cohort study without a comparison group, so causality cannot be established. The study only included English-fluent participants without prior stroke history, which may limit generalizability to the broader sickle cell disease population.
Abstract
Introduction Neurocognitive impairment is a well-recognized complication of sickle cell disease (SCD) that begins early in childhood and persists across development. While cerebrovascular injury contributes substantially to risk, neurocognitive deficits are also observed in children without overt or silent cerebral infarctions, suggesting additional contributing factors. Social drivers of health (SDoH) may modify neurocognitive outcomes but remain underexplored in SCD. Methods We conducted a retrospective cohort study of children and adolescents with SCD who completed standardized neurocognitive screening between January 2023 and May 2025. Participants were English-fluent and had no history of overt stroke or moyamoya. Neighborhood-level SDoH were measured using the Childhood Opportunity Index (COI). Neurocognitive domains assessed included visual-spatial, fluid reasoning, working memory, language, processing speed, auditory attention, and academic achievement. Results Ninety participants with a mean age of 7.7 years completed screening. More than half had the HbSS genotype. Most lived in areas of low or very low childhood opportunity. Areas with more childhood opportunity (higher COI) were significantly associated with better performance in fluid reasoning, working memory, language, reading, spelling, and math. COI education subdomain scores showed consistent associations across cognitive and academic measures. Conclusion Neighborhood-level childhood opportunity is strongly associated with neurocognitive outcomes in children with SCD, independent of known neurological injury. These findings highlight the importance of integrating SDoH into neurocognitive risk assessment and support early, embedded screening models in SCD care to address structural contributors to cognitive disparities.
Findings the Hub has extracted
Each claim below is labelled by its type of design and links back to this report.
- Intervention
- Assessment of neighborhood-level social drivers of health (measured by Childhood Opportunity Index) and their association with neurocognitive outcomes
- Population
- 90 children and adolescents with sickle cell disease, mean age 7.7 years, English-fluent, without history of overt stroke or moyamoya
Key finding
Higher COI scores associated with significantly better performance in fluid reasoning, working memory, language, reading, spelling, and math