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Schouwenaars IT, de Dreu MJ, Rutten GJM, Ramsey NF, Jansma JM. Cognitive brain activity before and after surgery in meningioma patients. Eur J Neurosci 2024; 60:3759-3771. [PMID: 38736372 DOI: 10.1111/ejn.16378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 11/30/2023] [Accepted: 04/18/2024] [Indexed: 05/14/2024]
Abstract
Neuropsychological studies have demonstrated that meningioma patients frequently exhibit cognitive deficits before surgery and show only limited improvement after surgery. Combining neuropsychological with functional imaging measurements can shed more light on the impact of surgery on cognitive brain function. We aimed to evaluate whether surgery affects cognitive brain activity in such a manner that it may mask possible changes in cognitive functioning measured by neuropsychological tests. Twenty-three meningioma patients participated in a fMRI measurement using a verbal working memory task as well as three neuropsychological tests focused on working memory, just before and 3 months after surgery. A region of interest based fMRI analysis was used to examine cognitive brain activity at these timepoints within the central executive network and default mode network. Neuropsychological assessment showed impaired cognitive functioning before as well as 3 months after surgery. Neuropsychological test scores, in-scanner task performance as well as brain activity within the central executive and default mode network were not significantly different between both timepoints. Our results indicate that surgery does not significantly affect cognitive brain activity in meningioma patients the first few months after surgery. Therefore, the lack of cognitive improvement after surgery is not likely the result of compensatory processes in the brain. Cognitive deficits that are already present before surgery appear to be persistent after surgery and a considerable recovery period. Our study shows potential leads that comprehensive cognitive evaluation can be of added value so that cognitive functioning may become a more prominent factor in clinical decision making.
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Affiliation(s)
- Irena T Schouwenaars
- Department of Neurosurgery, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, Utrecht University, Utrecht, the Netherlands
| | - Miek J de Dreu
- Department of Neurosurgery, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, Utrecht University, Utrecht, the Netherlands
| | - Geert-Jan M Rutten
- Department of Neurosurgery, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands
| | - Nick F Ramsey
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, Utrecht University, Utrecht, the Netherlands
| | - J Martijn Jansma
- Department of Neurosurgery, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, Utrecht University, Utrecht, the Netherlands
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Fouda MA, Kallman S, Boorstin R, Sacks-Zimmerman A, Pannullo SC, Bender HA. The unseen impact - a deep dive into neurocognitive impairment among patients with intracranial meningiomas: a comprehensive systematic review of the literature. Neurosurg Rev 2024; 47:294. [PMID: 38922363 DOI: 10.1007/s10143-024-02530-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 06/12/2024] [Accepted: 06/17/2024] [Indexed: 06/27/2024]
Abstract
Meningiomas are the most common intracranial tumors, predominantly affecting adults, with a higher incidence in female and elderly populations. Despite their prevalence, research on neurocognitive impairment in meningioma patients remains limited compared to intra-axial tumors such as gliomas. We conducted a comprehensive systematic review of the current literature on neurocognitive outcomes in meningioma patients pre- and post-surgery. Our review revealed significant disparities in reported neurocognitive outcomes, with prospective studies suggesting tumor-related factors as the primary contributors to postoperative deficits, while retrospective studies imply surgical intervention plays a significant role. Regardless of study design or specifics, most studies lack baseline preoperative neurocognitive assessments and standardized protocols for evaluating neurocognitive function. To address these gaps, we advocate for standardized neurocognitive assessment protocols, consensus on neurocognitive domains to be targeted in this population by tailored test batteries, and more prospective studies to elucidate correlations between tumor characteristics, patient attributes, surgical interventions, neurocognitive status, and planning for implementing tailored neurocognitive rehabilitation strategies early in the postoperative course which is crucial for achieving optimal long-term neurocognitive outcomes and enhancing patients' quality of life.
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Affiliation(s)
- Mohammed A Fouda
- Department of Neurological Surgery, New York-Presbyterian Hospital, Weill Cornell Medicine, 525 East 68th Street, Box 99, New York, NY, 10065, USA.
| | - Samantha Kallman
- Department of Neurological Surgery, New York-Presbyterian Hospital, Weill Cornell Medicine, 525 East 68th Street, Box 99, New York, NY, 10065, USA
| | - Rebecca Boorstin
- Department of Neurological Surgery, New York-Presbyterian Hospital, Weill Cornell Medicine, 525 East 68th Street, Box 99, New York, NY, 10065, USA
| | - Amanda Sacks-Zimmerman
- Department of Neurological Surgery, New York-Presbyterian Hospital, Weill Cornell Medicine, 525 East 68th Street, Box 99, New York, NY, 10065, USA
| | - Susan C Pannullo
- Department of Neurological Surgery, New York-Presbyterian Hospital, Weill Cornell Medicine, 525 East 68th Street, Box 99, New York, NY, 10065, USA
| | - H Allison Bender
- Department of Neurological Surgery, New York-Presbyterian Hospital, Weill Cornell Medicine, 525 East 68th Street, Box 99, New York, NY, 10065, USA
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Pillay L, Janse van Rensburg DC, den Hollander S, Ramkilawon G, Kerkhoffs G, Gouttebarge V. Neurocognitive Function Domains Are Not Affected in Active Professional Male Footballers, but Attention Deficits and Impairments Are Associated with Concussion. Sports (Basel) 2024; 12:170. [PMID: 38921864 PMCID: PMC11207795 DOI: 10.3390/sports12060170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 05/29/2024] [Accepted: 06/18/2024] [Indexed: 06/27/2024] Open
Abstract
OBJECTIVE To determine the neurocognitive function of active professional male footballers, determine whether deficits/impairments exist, and investigate the association between previous concussion(s) and neurocognitive function. METHODS An observational cross-sectional study conducted via electronic questionnaires. The CNS Vital Signs online testing system was used to evaluate neurocognitive function. RESULTS Of the 101 participants, 91 completed the neurocognitive function testing. Neurocognitive function domain deficits or impairments were unlikely in 54.5-89.1%, slight in 5.9-21.8%, moderate in 1.0-9.9%, and likely in 4.0-14.9% of participants. A history of zero concussions found a significant association between the neurocognitive index (Odds Ratio [OR] 0.6; 95% CI 0.2-0.4) and complex attention domain (OR 0.3; 95% CI 0.1-0.9), with 40% and 70% less odds, respectively, of deficit/impairment. Among the 54.5% who reported any number of concussions, there were increased odds of neurocognitive domain deficits/impairments for complex attention (CA) [3.4 times more] and simple attention (SA) [3.1 times more]. CONCLUSION In the active professional male footballer, most neurocognitive functions do not have significant deficits/impairments. The odds of neurocognitive function deficit/impairment were significantly increased threefold for CA and SA in those who reported a history of any concussion(s).
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Affiliation(s)
- Lervasen Pillay
- Amsterdam UMC Location University of Amsterdam, Department of Orthopedic Surgery and Sports Medicine, Meibergdreef 9, 1105AZ Amsterdam, The Netherlands; (L.P.)
- Section Sports Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria 0028, South Africa;
| | | | | | - Gopika Ramkilawon
- Department of Statistics, University of Pretoria, Pretoria 0028, South Africa
| | - Gino Kerkhoffs
- Amsterdam UMC Location University of Amsterdam, Department of Orthopedic Surgery and Sports Medicine, Meibergdreef 9, 1105AZ Amsterdam, The Netherlands; (L.P.)
- Academic Center for Evidence-Based Sports Medicine (ACES), 1105AZ Amsterdam, The Netherlands
- Amsterdam Collaboration on Health & Safety in Sports (ACHSS), IOC Research Center of Excellence, 1105AZ Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Aging & Vitality, Musculoskeletal Health, Sports, 1105AZ Amsterdam, The Netherlands
| | - Vincent Gouttebarge
- Amsterdam UMC Location University of Amsterdam, Department of Orthopedic Surgery and Sports Medicine, Meibergdreef 9, 1105AZ Amsterdam, The Netherlands; (L.P.)
- Section Sports Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria 0028, South Africa;
- Football Players Worldwide (FIFPRO), 2132LR Hoofddorp, The Netherlands
- Academic Center for Evidence-Based Sports Medicine (ACES), 1105AZ Amsterdam, The Netherlands
- Amsterdam Collaboration on Health & Safety in Sports (ACHSS), IOC Research Center of Excellence, 1105AZ Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Aging & Vitality, Musculoskeletal Health, Sports, 1105AZ Amsterdam, The Netherlands
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Boelders SM, De Baene W, Postma E, Gehring K, Ong LL. Predicting Cognitive Functioning for Patients with a High-Grade Glioma: Evaluating Different Representations of Tumor Location in a Common Space. Neuroinformatics 2024:10.1007/s12021-024-09671-9. [PMID: 38900230 DOI: 10.1007/s12021-024-09671-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2024] [Indexed: 06/21/2024]
Abstract
Cognitive functioning is increasingly considered when making treatment decisions for patients with a brain tumor in view of a personalized onco-functional balance. Ideally, one can predict cognitive functioning of individual patients to make treatment decisions considering this balance. To make accurate predictions, an informative representation of tumor location is pivotal, yet comparisons of representations are lacking. Therefore, this study compares brain atlases and principal component analysis (PCA) to represent voxel-wise tumor location. Pre-operative cognitive functioning was predicted for 246 patients with a high-grade glioma across eight cognitive tests while using different representations of voxel-wise tumor location as predictors. Voxel-wise tumor location was represented using 13 different frequently-used population average atlases, 13 randomly generated atlases, and 13 representations based on PCA. ElasticNet predictions were compared between representations and against a model solely using tumor volume. Preoperative cognitive functioning could only partly be predicted from tumor location. Performances of different representations were largely similar. Population average atlases did not result in better predictions compared to random atlases. PCA-based representation did not clearly outperform other representations, although summary metrics indicated that PCA-based representations performed somewhat better in our sample. Representations with more regions or components resulted in less accurate predictions. Population average atlases possibly cannot distinguish between functionally distinct areas when applied to patients with a glioma. This stresses the need to develop and validate methods for individual parcellations in the presence of lesions. Future studies may test if the observed small advantage of PCA-based representations generalizes to other data.
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Affiliation(s)
- S M Boelders
- Department of Neurosurgery, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
- Department of Cognitive Sciences and AI, Tilburg University, Tilburg, The Netherlands
| | - W De Baene
- Department of Cognitive Neuropsychology, Tilburg University Tilburg, Warandelaan 2, P. O. Box 90153, Tilburg, 5000 LE, The Netherlands
| | - E Postma
- Department of Cognitive Sciences and AI, Tilburg University, Tilburg, The Netherlands
| | - K Gehring
- Department of Neurosurgery, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands.
- Department of Cognitive Neuropsychology, Tilburg University Tilburg, Warandelaan 2, P. O. Box 90153, Tilburg, 5000 LE, The Netherlands.
| | - L L Ong
- Department of Cognitive Sciences and AI, Tilburg University, Tilburg, The Netherlands
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Sekely A, Zakzanis KK, Mabbott D, Tsang DS, Kongkham P, Zadeh G, Edelstein K. Long-term neurocognitive and psychological outcomes in meningioma survivors: Individual changes over time and radiation dosimetry. Neurooncol Pract 2024; 11:157-170. [PMID: 38496914 PMCID: PMC10940838 DOI: 10.1093/nop/npad072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024] Open
Abstract
Background This study investigates long-term changes in neurocognitive performance and psychological symptoms in meningioma survivors and associations with radiation dose to circumscribed brain regions. Methods We undertook a retrospective study of meningioma survivors who underwent longitudinal clinical neurocognitive assessments. Change in neurocognitive performance or psychological symptoms was assessed using reliable change indices. Radiation dosimetry, if prescribed, was evaluated based on treatment-planning computerized tomography co-registered with contrast-enhanced 3D T1-weighted magnetic resonance imaging. Mixed effects analyses were used to explore whether incidental radiation to brain regions outside the tumor influences neurocognitive and psychological outcomes. Results Most (range = 41%-93%) survivors demonstrated stable-albeit often below average-neurocognitive and psychological trajectories, although some also exhibited improvements (range = 0%-31%) or declines (range = 0%-36%) over time. Higher radiation dose to the parietal-occipital region (partial R2 = 0.462) and cerebellum (partial R2 = 0.276) was independently associated with slower visuomotor processing speed. Higher dose to the hippocampi was associated with increases in depression (partial R2 = 0.367) and trait anxiety (partial R2 = 0.236). Conclusions Meningioma survivors experience neurocognitive deficits and psychological symptoms many years after diagnosis, and a proportion of them decline over time. This study offers proof of concept that incidental radiation to brain regions beyond the tumor site may contribute to these sequelae. Future investigations should include radiation dosimetry when examining risk factors that contribute to the quality of survivorship in this growing population.
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Affiliation(s)
- Angela Sekely
- Graduate Department of Psychological Clinical Science, University of Toronto, Toronto, Ontario, Canada
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Konstantine K Zakzanis
- Graduate Department of Psychological Clinical Science, University of Toronto, Toronto, Ontario, Canada
- Department of Psychology, University of Toronto, Toronto, Ontario, Canada
| | - Donald Mabbott
- Department of Psychology, University of Toronto, Toronto, Ontario, Canada
- Department of Psychology, Neurosciences, and Mental Health Program, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Derek S Tsang
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Paul Kongkham
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Gelareh Zadeh
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Kim Edelstein
- Graduate Department of Psychological Clinical Science, University of Toronto, Toronto, Ontario, Canada
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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Brain Tumor at Diagnosis: From Cognition and Behavior to Quality of Life. Diagnostics (Basel) 2023; 13:diagnostics13030541. [PMID: 36766646 PMCID: PMC9914203 DOI: 10.3390/diagnostics13030541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 01/30/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The present narrative review aims to discuss cognitive-emotional-behavioral symptoms in adults with brain tumors at the time of diagnosis. METHODS The PubMed database was searched considering glioma, pituitary adenoma, and meningioma in adulthood as pathologies, together with cognitive, neuropsychological, or behavioral aspects. RESULTS Although a significant number of studies describe cognitive impairment after surgery or treatment in adults with brain tumors, only few focus on cognitive-emotional-behavioral symptoms at diagnosis. Furthermore, the importance of an effective communication and its impact on patients' quality of life and compliance with treatment are seldom discussed. CONCLUSIONS Adults with brain tumors have needs in terms of cognitive-emotional-behavioral features that are detectable at the time of diagnosis; more research is needed to identify effective communication protocols in order to allow a higher perceived quality of life in these patients.
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Mederer T, Schachinger S, Rosengarth K, Brosig A, Schebesch KM, Doenitz C, Schmidt NO, Proescholdt MA. Symptom burden and surgical outcome in non-skull base meningiomas. Front Oncol 2022; 12:967420. [PMID: 36212448 PMCID: PMC9532974 DOI: 10.3389/fonc.2022.967420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 08/29/2022] [Indexed: 11/20/2022] Open
Abstract
Purpose Non-skull base meningiomas (NSBM) are a distinct entity and frequently present with focal neurological deficits. This study was designed to analyze functional and oncological outcome following microsurgical tumor resection in patients with NSBM. Patients and methods An analysis of 300 patients that underwent NSBM resection between 2003 and 2013 was performed. Assessment measures for functional outcome were Karnofsky Performance Scale (KPS), Medical Research Council - Neurological Performance Scale (MRC-NPS), and improvement rates of focal deficits and seizures. The extent of resection; recurrence-free survival (RFS) and tumor-specific survival (TSS) were also determined. Results Impaired KPS and MRC-NPS were present in 73.3% and 45.7%, respectively. Focal neurological deficits were recorded in 123 patients (41.0%), with hemiparesis (21.7%) and aphasia (9.3%) the most prevalent form of impairment. Most meningiomas were localized at the convexity (64.0%), followed by falcine tumors (20.3%). Both KPI and MRC-NPS scores were significantly improved by surgical resection. Postoperative improvement rates of 96.6%, 89.3%, 72.3%, 57.9%, and 27.3% were observed for aphasia, epilepsy, hemiparesis, cranial nerve, and visual field deficits, respectively. Long-term improvement was achieved in 83.2%, 89.3%, 80.0%, 68.4% and 54.6% of patients, respectively. Gross total resection (GTR) over subtotal resection (STR) significantly improved preoperative seizures and visual field deficits and correlated with reduced risk of new postoperative hemiparesis. Poor Simpson grade was the only significant prognostic factor in multivariate analysis for long-term functional deficit, which occurred in 7.3%. Median RFS was 45.9 months (6.0 - 151.5 months), while median TSS was 53.7 months (3.1 – 153.2 months). Both WHO grade (p= 0.001) and Simpson classification (p= 0.014 and p= 0.031) were independent significant prognostic factors for decreased RFS and TSS by multivariate analysis, respectively. Furthermore, tumor diameter > 50 mm (p= 0.039) significantly correlated with decreased TSS in multivariate analysis. Conclusion Surgical resection significantly and stably improves neurological deficits in patients with NSBM.
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Affiliation(s)
- Tobias Mederer
- Department of Neurosurgery, University Hospital Regensburg, Regensburg, Germany
- Wilhelm Sander-NeuroOncology Unit, University Hospital Regensburg, Regensburg, Germany
| | - Sebastian Schachinger
- Department of Neurosurgery, University Hospital Regensburg, Regensburg, Germany
- Wilhelm Sander-NeuroOncology Unit, University Hospital Regensburg, Regensburg, Germany
| | - Katharina Rosengarth
- Department of Neurosurgery, University Hospital Regensburg, Regensburg, Germany
- Wilhelm Sander-NeuroOncology Unit, University Hospital Regensburg, Regensburg, Germany
| | - Anja Brosig
- Department of Otorhinolaryngology, University Hospital Regensburg, Regensburg, Germany
| | - Karl-Michael Schebesch
- Department of Neurosurgery, University Hospital Regensburg, Regensburg, Germany
- Wilhelm Sander-NeuroOncology Unit, University Hospital Regensburg, Regensburg, Germany
| | - Christian Doenitz
- Department of Neurosurgery, University Hospital Regensburg, Regensburg, Germany
- Wilhelm Sander-NeuroOncology Unit, University Hospital Regensburg, Regensburg, Germany
| | - Nils-Ole Schmidt
- Department of Neurosurgery, University Hospital Regensburg, Regensburg, Germany
- Wilhelm Sander-NeuroOncology Unit, University Hospital Regensburg, Regensburg, Germany
| | - Martin Andreas Proescholdt
- Department of Neurosurgery, University Hospital Regensburg, Regensburg, Germany
- Wilhelm Sander-NeuroOncology Unit, University Hospital Regensburg, Regensburg, Germany
- *Correspondence: Martin Andreas Proescholdt,
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Langensee L, Mårtensson J, Jönsen A, Zervides K, Bengtsson A, Nystedt J, Cannerfelt B, Nilsson P, Mannfolk P, Lätt J, Rumetshofer T, Sundgren PC. Cognitive performance in systemic lupus erythematosus patients: a cross-sectional and longitudinal study. BMC Rheumatol 2022; 6:22. [PMID: 35440096 PMCID: PMC9019974 DOI: 10.1186/s41927-022-00253-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 02/16/2022] [Indexed: 12/02/2022] Open
Abstract
Background Previous research has provided evidence for cognitive dysfunction as a common symptom of systemic lupus erythematosus (SLE). In light of this, the primary goal of this study was to investigate how cognitive impairment in this patient group develops over time. In addition, the present dataset contributes to delineating the specific abilities that are impaired in SLE patients as well as answering the question whether the disease affects the cognition of SLE patients with neuropsychiatric manifestations (NPSLE) and without (non-NPSLE) in distinct ways. Methods 91 female participants (33 NPSLE, 29 non-NPSLE, 29 healthy controls (HC)) underwent standardized neurocognitive testing. A total of ten different cognitive abilities were assessed, among others executive function, memory, and attention. Some of the participants (30 NPSLE patients, 22 non-NPSLE, 13 HC) were tested twice (mean time between testing sessions: 50 months) to enable longitudinal tracking of cognitive abilities. Analyses of Variance (ANOVA) were conducted to determine whether cognitive performance differed cross-sectionally between the groups. Linear mixed effects models were fit to investigate performance differences between the groups over time. Results Cross-sectional analysis at follow-up demonstrated that the cognitive performance of both NPSLE and non-NPSLE was significantly lower than that of HC for the motor speed and the psychomotor speed domain. Additionally, NPSLE patients performed significantly weaker than HC in the complex attention domain. At the same time, the cross-sectional data did not yield any support for performance differences between NPSLE and non-NPSLE patients. Weak positive correlations between disease duration and psychomotor speed, motor speed and reaction time emerged. A temporal progression of cognitive dysfunction in SLE patients was not confirmed. Conclusions Cognitive performance is affected in both non-NPSLE and NPSLE patients. However, a linear decline in performance over time could not be verified. More in-depth longitudinal assessments of cognition in SLE patients are needed to establish how cognitive abilities in this patient population develop over time. Supplementary Information The online version contains supplementary material available at 10.1186/s41927-022-00253-3.
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Affiliation(s)
- L Langensee
- Department of Clinical Sciences Lund, Logopedics, Phoniatrics and Audiology, Faculty of Medicine, Lund University, 22185, Lund, Sweden
| | - J Mårtensson
- Department of Clinical Sciences Lund, Logopedics, Phoniatrics and Audiology, Faculty of Medicine, Lund University, 22185, Lund, Sweden
| | - A Jönsen
- Department of Clinical Sciences Lund, Rheumatology, Faculty of Medicine, Lund University, 22185, Lund, Sweden
| | - K Zervides
- Department of Clinical Sciences Lund, Rheumatology, Faculty of Medicine, Lund University, 22185, Lund, Sweden.,Department of Clinical Sciences Lund, Neurology, Faculty of Medicine, Lund University, 22185, Lund, Sweden
| | - A Bengtsson
- Department of Clinical Sciences Lund, Rheumatology, Faculty of Medicine, Lund University, 22185, Lund, Sweden
| | - J Nystedt
- Department of Clinical Sciences Lund, Radiology, Faculty of Medicine, Lund University, 22185, Lund, Sweden
| | - B Cannerfelt
- Department of Medical Imaging and Physiology, Skåne University Hospital, 221 85, Lund, Sweden
| | - P Nilsson
- Department of Clinical Sciences Lund, Neurology, Faculty of Medicine, Lund University, 22185, Lund, Sweden
| | - P Mannfolk
- Department of Medical Imaging and Physiology, Skåne University Hospital, 221 85, Lund, Sweden
| | - J Lätt
- Department of Medical Imaging and Physiology, Skåne University Hospital, 221 85, Lund, Sweden
| | - T Rumetshofer
- Department of Clinical Sciences Lund, Logopedics, Phoniatrics and Audiology, Faculty of Medicine, Lund University, 22185, Lund, Sweden
| | - P C Sundgren
- Department of Clinical Sciences Lund, Radiology, Faculty of Medicine, Lund University, 22185, Lund, Sweden. .,Department of Medical Imaging and Physiology, Skåne University Hospital, 221 85, Lund, Sweden. .,Lund University BioImaging Center (LBIC), Lund University, 22185, Lund, Sweden.
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9
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Wolthuis N, Bosma I, Bastiaanse R, Cherian PJ, Smits M, Veenstra W, Wagemakers M, Vincent A, Satoer D. Distinct Slow-Wave Activity Patterns in Resting-State Electroencephalography and Their Relation to Language Functioning in Low-Grade Glioma and Meningioma Patients. Front Hum Neurosci 2022; 16:748128. [PMID: 35399357 PMCID: PMC8986989 DOI: 10.3389/fnhum.2022.748128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 02/16/2022] [Indexed: 12/03/2022] Open
Abstract
Introduction Brain tumours frequently cause language impairments and are also likely to co-occur with localised abnormal slow-wave brain activity. However, it is unclear whether this applies specifically to low-grade brain tumours. We investigate slow-wave activity in resting-state electroencephalography (EEG) in low-grade glioma and meningioma patients, and its relation to pre- and postoperative language functioning. Method Patients with a glioma (N = 15) infiltrating the language-dominant hemisphere and patients with a meningioma (N = 10) with mass effect on this hemisphere underwent extensive language testing before and 1 year after surgery. EEG was registered preoperatively, postoperatively (glioma patients only), and once in healthy individuals. Slow-wave activity in delta- and theta- frequency bands was evaluated visually and quantitatively by spectral power at three levels over the scalp: the whole brain, the affected hemisphere, and the affected region. Results Glioma patients had increased delta activity (affected area) and increased theta activity (all levels) before and after surgery. In these patients, increased preoperative theta activity was related to the presence of language impairment, especially to poor word retrieval and grammatical performance. Preoperative slow-wave activity was also related to postoperative language outcomes. Meningioma patients showed no significant increase in EEG slow-wave activity compared to healthy individuals, but they presented with word retrieval, grammatical, and writing problems preoperatively, as well as with writing impairments postoperatively. Discussion Although the brain-tumour pathology in low-grade gliomas and meningiomas has a different effect on resting-state brain activity, patients with low-grade gliomas and meningiomas both suffer from language impairments. Increased theta activity in glioma patients can be considered as a language-impairment marker, with prognostic value for language outcome after surgery.
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Affiliation(s)
- Nienke Wolthuis
- Center for Language and Cognition Groningen (CLCG), University of Groningen, Groningen, Netherlands
| | - Ingeborg Bosma
- Department of Neurology, University Medical Center Groningen, Groningen, Netherlands
| | - Roelien Bastiaanse
- Center for Language and Cognition Groningen (CLCG), University of Groningen, Groningen, Netherlands
- National Research University Higher School of Economics, Moscow, Russia
| | - Perumpillichira J. Cherian
- Department of Neurology, University Medical Center Rotterdam, Rotterdam, Netherlands
- Division of Neurology, Department of Medicine, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Marion Smits
- Department of Radiology & Nuclear Medicine, Erasmus MC - University Medical Center Rotterdam, Rotterdam, Netherlands
- Brain Tumour Centre, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Wencke Veenstra
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Michiel Wagemakers
- Department of Neurosurgery, University Medical Center Groningen, Groningen, Netherlands
| | - Arnaud Vincent
- Department of Neurosurgery, Erasmus MC – University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Djaina Satoer
- Department of Neurosurgery, Erasmus MC – University Medical Center Rotterdam, Rotterdam, Netherlands
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Sekely A, Zakzanis KK, Mabbott D, Tsang DS, Kongkham P, Zadeh G, Edelstein K. Long-term neurocognitive, psychological, and return to work outcomes in meningioma patients. Support Care Cancer 2022; 30:3893-3902. [PMID: 35041087 DOI: 10.1007/s00520-022-06838-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 01/13/2022] [Indexed: 10/19/2022]
Abstract
INTRODUCTION This study aimed to investigate long-term neurocognitive, psychological, and return to work (RTW) outcomes in meningioma patients, and to explore whether neurocognitive and psychological factors influence RTW outcomes in this population. METHODS In this retrospective study, 61 meningioma patients completed in-depth clinical neuropsychological assessments. Of these participants, 42 were of working-age and had RTW information available following neuropsychological assessment. Seventy-one percent and 80% of patients received radiation and surgery, respectively, with 49% receiving both radiation and surgery. Associations between demographic, medical, neurocognitive, psychological, and RTW data were analyzed using multivariable logistic regression analyses. RESULTS In our sample, 68% of patients exhibited global neurocognitive impairment, with the largest effect sizes found on tests of visual memory (d = 0.73), executive function (d = 0.61), and attention (d = 0.54). Twenty-seven percent exhibited moderate to severe levels of depressive symptoms. In addition, 23% and 30% exhibited clinically significant state and trait anxiety, respectively. Forty-eight percent of patients were unable to RTW. Younger age, faster visuomotor processing speed, and, unexpectedly, higher trait anxiety scores were associated with an increased likelihood of returning to work. CONCLUSIONS Meningioma patients are at risk of experiencing neurocognitive deficits, psychological symptoms, and difficulties returning to work. Our results suggest that neurocognitive and psychological factors contribute to RTW status in meningioma patients. Prospective research studies are necessary to increase our understanding of the complexity of functional disability in this growing population.
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Affiliation(s)
- Angela Sekely
- Graduate Department of Psychological Clinical Science, University of Toronto, Toronto, ON, Canada. .,Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, ON, Canada.
| | - Konstantine K Zakzanis
- Graduate Department of Psychological Clinical Science, University of Toronto, Toronto, ON, Canada.,Department of Psychology, University of Toronto, Toronto, ON, Canada
| | - Donald Mabbott
- Department of Psychology, University of Toronto, Toronto, ON, Canada.,Department of Psychology, Neurosciences, and Mental Health Program, The Hospital for Sick Children, Toronto, ON, Canada
| | - Derek S Tsang
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada.,Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Paul Kongkham
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, Toronto, ON, Canada
| | - Gelareh Zadeh
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, Toronto, ON, Canada
| | - Kim Edelstein
- Graduate Department of Psychological Clinical Science, University of Toronto, Toronto, ON, Canada.,Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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11
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Goldbrunner R, Stavrinou P, Jenkinson MD, Sahm F, Mawrin C, Weber DC, Preusser M, Minniti G, Lund-Johansen M, Lefranc F, Houdart E, Sallabanda K, Le Rhun E, Nieuwenhuizen D, Tabatabai G, Soffietti R, Weller M. EANO guideline on the diagnosis and management of meningiomas. Neuro Oncol 2021; 23:1821-1834. [PMID: 34181733 PMCID: PMC8563316 DOI: 10.1093/neuonc/noab150] [Citation(s) in RCA: 242] [Impact Index Per Article: 80.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Meningiomas are the most common intracranial tumors. Yet, only few controlled clinical trials have been conducted to guide clinical decision making, resulting in variations of management approaches across countries and centers. However, recent advances in molecular genetics and clinical trial results help to refine the diagnostic and therapeutic approach to meningioma. Accordingly, the European Association of Neuro-Oncology (EANO) updated its recommendations for the diagnosis and treatment of meningiomas. A provisional diagnosis of meningioma is typically made by neuroimaging, mostly magnetic resonance imaging. Such provisional diagnoses may be made incidentally. Accordingly, a significant proportion of meningiomas, notably in patients that are asymptomatic or elderly or both, may be managed by a watch-and-scan strategy. A surgical intervention with tissue, commonly with the goal of gross total resection, is required for the definitive diagnosis according to the WHO classification. A role for molecular profiling including gene panel sequencing and genomic methylation profiling is emerging. A gross total surgical resection including the involved dura is often curative. Inoperable or recurrent tumors requiring treatment can be treated with radiosurgery, if the size or the vicinity of critical structures allows that, or with fractionated radiotherapy (RT). Treatment concepts combining surgery and radiosurgery or fractionated RT are increasingly used, although there remain controversies regard timing, type, and dosing of the various RT approaches. Radionuclide therapy targeting somatostatin receptors is an experimental approach, as are all approaches of systemic pharmacotherapy. The best albeit modest results with pharmacotherapy have been obtained with bevacizumab or multikinase inhibitors targeting vascular endothelial growth factor receptor, but no standard of care systemic treatment has been yet defined.
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Affiliation(s)
- Roland Goldbrunner
- Center of Neurosurgery, Department of General Neurosurgery, University of Cologne, Cologne, Germany
| | - Pantelis Stavrinou
- Neurosurgical Department, Metropolitan Hospital, Athens, Greece and Center of Neurosurgery, Department of General Neurosurgery, University of Cologne, Cologne, Germany
| | - Michael D Jenkinson
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Felix Sahm
- Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Christian Mawrin
- Department of Neuropathology, University of Magdeburg, Magdeburg, Germany
| | - Damien C Weber
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland
| | - Matthias Preusser
- Department of Medicine I, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
| | - Giuseppe Minniti
- Radiation Oncology Unit, Sant’Andrea Hospital, Sapienza University, Rome, Italy
| | - Morten Lund-Johansen
- Department of Neurosurgery, Bergen University Hospital, Bergen, Norway
- Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
| | - Florence Lefranc
- Department of Neurosurgery, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Emanuel Houdart
- Service de Neuroradiologie, Hopital Lariboisiere, Paris, France
| | - Kita Sallabanda
- Department of Neurosurgery, University Hospital San Carlos, Universidad Complutense de Madrid, Madrid, Spain
- Hospital Clinico Universitario San Carlos, Madrid, Spain
- CyberKnife Centre, Genesiscare Madrid, Madrid, Spain
| | - Emilie Le Rhun
- Department of Neurology and Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, Zurich, Switzerland
| | | | - Ghazaleh Tabatabai
- Center for Neurooncology, Comprehensive Cancer Center, University Hospital Tübingen, Tübingen, Germany
| | - Riccardo Soffietti
- Department of Neuro-Oncology, City of Health and Science University Hospital, Turin, Italy
| | - Michael Weller
- Department of Neurology, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
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12
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Abstract
Background. Meningiomas are the most common primary intracranial tumor in adults. Although frequently histologically benign, the clinical severity of a lesion may range from being asymptomatic to causing severe impairment of global function and well-being. The diversity of intracranial locations and clinical phenotypes poses a challenge when studying functional impairments, however, more recent attention to patient-reported outcomes and health-related quality of life (HRQOL) have helped to improve our understanding of how meningioma may impact a patient’s life.Methods. Treatment strategies such as observation, surgery, radiation, or a combination thereof have been examined to ascertain their contributions to symptoms, physical and cognitive functioning, disability, and general aspects of daily functioning.Results. This review explores the multidimensional nature of HRQOL and how patients may be influenced by meningiomas and their treatment.Conclusion. Overall, treatment of symptomatic meningiomas is associated with improved HRQOL, cognitive functioning, and seizure control while tumor size, location, histologic grade, and epileptic burden are associated with worse HRQOL.
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Affiliation(s)
- Sameah Haider
- Department of Neurosurgery, Hermelin Brain Tumor Center, Henry Ford Health System, Detroit, Michigan, USA
| | - Martin J B Taphoorn
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
| | - Katharine J Drummond
- Department of Neurosurgery, Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Surgery, University of Melbourne, Parkville, Victoria, Australia
| | - Tobias Walbert
- Department of Neurosurgery, Hermelin Brain Tumor Center, Henry Ford Health System, Detroit, Michigan, USA
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13
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Bette S, Ruhland JM, Wiestler B, Barz M, Meyer B, Zimmer C, Ryang YM, Ringel F, Gempt J. Postoperative cognitive functions in patients with benign intracranial lesions. Sci Rep 2021; 11:8757. [PMID: 33888794 PMCID: PMC8062599 DOI: 10.1038/s41598-021-88061-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 04/06/2021] [Indexed: 12/05/2022] Open
Abstract
The aim of this study was to assess pre- and postoperative cognitive functions in patients who underwent surgery for benign intracranial lesions. In total, 58 patients (21 men, 37 women, mean age 51.6 years [range 24–76 years]) with benign intracranial lesions (including benign tumors and vascular lesions) and neuralgia of the trigeminal nerve were included in this prospective study. Extensive cognitive testing was used to categorize attention, memory, and executive functions. Mood and pain were assessed preoperatively (t0, mean 3.7 days before surgery), immediately after surgery/during inpatient stay (t1, mean 7.6 days after surgery), and at first outpatient check-up (t2, mean 99.5 days after surgery). All 58 patients were tested at t0 and t1, but at t2 only 24 patients were available at t2. The data were categorized as improvement/stable condition or deterioration and shown as percentages. The pre- and postoperative values of BDI-II and mood were compared by the Wilcoxon test for paired samples. Binary logistic regression analyses were performed to identify parameters influencing cognition in the subgroup of meningioma patients. Immediately after surgery (t1), the percentage of patients with improvement/stable condition was > 50% in all categories in the majority of subtests (attention: 12/14 subtests, memory: 11/13 subtests, executive functions: 6/9 subtests). Similar results were shown at t2. Mood and pain did not change significantly after surgery. Factors like age, Karnofsky performance status, and tumor volume were not shown as significant influencing factors for cognitive functions in meningioma patients. The results of this study suggest that—in contrast to neuroepithelial tumors—cognitive functions do not deteriorate after surgery of benign intracranial lesions. Further studies are necessary to evaluate the results of this study.
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Affiliation(s)
- Stefanie Bette
- Department of Neuroradiology, Klinikum Rechts Der Isar, Technische Universität München, Munich, Germany.,Department of Diagnostic and Interventional Radiology, Universitätsklinikum Augsburg, Augsburg, Germany
| | - Julia M Ruhland
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaningerstr. 22, 81675, Munich, Germany
| | - Benedikt Wiestler
- Department of Neuroradiology, Klinikum Rechts Der Isar, Technische Universität München, Munich, Germany
| | - Melanie Barz
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaningerstr. 22, 81675, Munich, Germany
| | - Bernhard Meyer
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaningerstr. 22, 81675, Munich, Germany
| | - Claus Zimmer
- Department of Neuroradiology, Klinikum Rechts Der Isar, Technische Universität München, Munich, Germany
| | - Yu-Mi Ryang
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaningerstr. 22, 81675, Munich, Germany
| | - Florian Ringel
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaningerstr. 22, 81675, Munich, Germany.,Department of Neurosurgery, University Medical Centre, Johannes-Gutenberg-University Mainz, Mainz, Germany
| | - Jens Gempt
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaningerstr. 22, 81675, Munich, Germany.
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14
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Gondar R, Patet G, Schaller K, Meling TR. Meningiomas and Cognitive Impairment after Treatment: A Systematic and Narrative Review. Cancers (Basel) 2021; 13:cancers13081846. [PMID: 33924372 PMCID: PMC8070481 DOI: 10.3390/cancers13081846] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/04/2021] [Accepted: 04/07/2021] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Assessment of cognition is crucial in brain tumor care, and clinical outcome along this axis is frequently neglected. As a result, a patient’s quality of life seems more impacted than usually reported in clinical series. With this article, we review the current state of affairs and search for patient- and meningioma-related outcome predictors. We found a great variety in the number and types of neuropsychological tests used and in the dimensions of cognition studied. Furthermore, data mostly originate from a selected part of the globe and therefore may not reflect a global reality. Treatment has an early cognitive impact in the majority of meningioma patients. Further long-term conclusions are precluded by a mean follow-up time shorter than one year. Anticipating cognition outcomes prior to, during, and after treatment of meningiomas remains difficult. Future research should aim for a reliable and worldwide reproducible standard battery of tests. Abstract Clinical outcomes after surgery for intracranial meningiomas might be overvalued as cognitive dimensions and quality of life are probably underreported. This review aims to summarize the current state of cognitive screening and treatment-related outcomes after meningioma surgery. We present a systematic review (Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA-P) 2015-based) of cognitive outcomes after intracranial meningioma surgery. A total of 1572 patients (range 9–261) with a mean age of 58.4 years (range 23–87), and predominantly female (n = 1084, 68.9%) were identified. Mean follow-up time after treatment was 0.86 ± 0.3 years. Neuropsychological assessment was very heterogeneous, but five dimensions of cognition were described: memory (19/22); attention (18/22); executive functions (17/22); language (11/22); flexibility (11/22 studies). Cognitive abilities were impaired in 18 studies (81.8%), but only 1 showed deterioration in all dimensions simultaneously. Memory was the most affected. with significant post-therapy impairment in 9 studies (40.9%). Postoperatively, only 4 studies (18.2%) showed improvement in at least one dimension. Meningioma patients had significantly lower cognitive scores when compared to healthy subjects. Surgery and radiotherapy for meningiomas were associated with cognitive impairment, probably followed by a partial recovery. Cognition is poorly defined, and the assessment tools employed lack standardization. Cognitive impairment is probably underreported in meningioma patients.
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Affiliation(s)
- Renato Gondar
- Neurosurgical Division, Department of Neurosciences, Geneva University Hospitals, 1206 Geneva, Switzerland; (R.G.); (G.P.); (K.S.)
| | - Gildas Patet
- Neurosurgical Division, Department of Neurosciences, Geneva University Hospitals, 1206 Geneva, Switzerland; (R.G.); (G.P.); (K.S.)
| | - Karl Schaller
- Neurosurgical Division, Department of Neurosciences, Geneva University Hospitals, 1206 Geneva, Switzerland; (R.G.); (G.P.); (K.S.)
- Faculty of Medicine, University of Geneva, 1206 Geneva, Switzerland
| | - Torstein R. Meling
- Neurosurgical Division, Department of Neurosciences, Geneva University Hospitals, 1206 Geneva, Switzerland; (R.G.); (G.P.); (K.S.)
- Faculty of Medicine, University of Geneva, 1206 Geneva, Switzerland
- Correspondence: ; Tel.: +41-782-123-925
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15
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Task-evoked reconfiguration of the fronto-parietal network is associated with cognitive performance in brain tumor patients. Brain Imaging Behav 2021; 14:2351-2366. [PMID: 31456158 PMCID: PMC7647963 DOI: 10.1007/s11682-019-00189-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
In healthy participants, the strength of task-evoked network reconfigurations is associated with cognitive performance across several cognitive domains. It is, however, unclear whether the capacity for network reconfiguration also plays a role in cognitive deficits in brain tumor patients. In the current study, we examined whether the level of reconfiguration of the fronto-parietal (‘FPN’) and default mode network (‘DMN’) during task execution is correlated with cognitive performance in patients with different types of brain tumors. For this purpose, we combined data from a resting state and task-fMRI paradigm in patients with a glioma or meningioma. Cognitive performance was measured using the in-scanner working memory task, as well as an out-of-scanner cognitive flexibility task. Task-evoked changes in functional connectivity strength (defined as the mean of the absolute values of all connections) and in functional connectivity patterns within and between the FPN and DMN did not differ significantly across meningioma and fast (HGG) and slowly growing glioma (LGG) patients. Across these brain tumor patients, a significant and positive correlation was found between the level of task-evoked reconfiguration of the FPN and cognitive performance. This suggests that the capacity for FPN reconfiguration also plays a role in cognitive deficits in brain tumor patients, as was previously found for normal cognitive performance in healthy controls.
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16
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Rydelius A, Lätt J, Kinhult S, Engelholm S, Van Westen D, Pihlsgård M, Bengzon J, Sundgren PC, Lilja Å. Longitudinal study of cognitive function in glioma patients treated with modern radiotherapy techniques and standard chemotherapy. Acta Oncol 2020; 59:1091-1097. [PMID: 32847475 DOI: 10.1080/0284186x.2020.1778181] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Introduction: Cognitive function is an important outcome measure in patients with brain tumor, providing information about the patient's clinical situation, treatment effects and possible progressive disease. The aim of this longitudinal study was to evaluate effects of the currently used radiation and chemotherapy treatment on cognitive function and to investigate associations between cognitive function at baseline and progression as well as overall survival.Methods: 32 patients newly diagnosed with malignant glioma were evaluated at baseline with CNS Vital Signs (CNS-VS), a computerized standardized neuropsychological test battery, prior to arc-based radiotherapy and concomitant chemotherapy with Temozolomide. CNS-VS measures the cognitive functions known to be affected in patients with brain tumor, covering nine cognitive domains. Follow-up cognitive evaluations were performed in 26 patients after 3.5 months and in 13 patients 1 year after treatment start.Results: Overall cognitive scores were lower in the studied patient cohort at baseline compared to standardized domain scores. At 3.5 months follow-up cognitive functioning was slightly decreased, but only in 1/9 cognitive domains - visual memory - where significant changes were found compared to baseline test results. Similarly, at 12 months follow-up no significant changes in cognitive test results were seen compared to baseline examination, except for a decrease in the visual memory domain. In relation to early progression, the most significant cognitive deficits were dysfunctional visual memory and low executive functioning at baseline. Low executive function at baseline correlated most significantly with shorter overall survival.Conclusion: The present study suggests that the currently used arc-based radiotherapy and chemotherapy might affect cognitive function less negatively than previously described during treatment and in the first year after treatment in malignant glioma patients. In general, a high cognitive test score at baseline was associated with longer time to progression and with longer survival.
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Affiliation(s)
- Anna Rydelius
- Department of Clinical Sciences, Division of Neurology, Lund University, Lund, Sweden
| | - Jimmy Lätt
- Department of Medical Imaging and Physiology, Skåne University hospital Lund University, Lund, Sweden
| | - Sara Kinhult
- Department of Clinical Sciences, Division of Oncology, Lund University, Lund, Sweden
| | - Silke Engelholm
- Department of Clinical Sciences, Division of Oncology, Lund University, Lund, Sweden
| | - Danielle Van Westen
- Department of Medical Imaging and Physiology, Skåne University hospital Lund University, Lund, Sweden
- Department of Clinical Sciences, Division of Radiology, Lund University, Lund, Sweden
| | - Mats Pihlsgård
- Department of Clinical Sciences, Division of Geriatrics, Lund University, Malmö, Sweden
| | - Johan Bengzon
- Department of Clinical Sciences, Division of Neurosurgery, Lund University, Lund, Sweden
- Stem Cell Center, BMC B10, Lund University, Lund, Sweden
| | - Pia C. Sundgren
- Department of Medical Imaging and Physiology, Skåne University hospital Lund University, Lund, Sweden
- Department of Clinical Sciences, Division of Radiology, Lund University, Lund, Sweden
- Lund University BioImaging Center, Lund University, Lund, Sweden
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Åsa Lilja
- Department of Clinical Sciences, Division of Radiology, Lund University, Lund, Sweden
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17
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Rijnen SJM, Meskal I, Bakker M, De Baene W, Rutten GJM, Gehring K, Sitskoorn MM. Cognitive outcomes in meningioma patients undergoing surgery: individual changes over time and predictors of late cognitive functioning. Neuro Oncol 2020; 21:911-922. [PMID: 30753679 DOI: 10.1093/neuonc/noz039] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Meningioma patients are known to face cognitive deficits before and after surgery. We examined individual changes in cognitive performance over time and identified preoperative predictors of cognitive functioning 12 months after surgery in a large sample of meningioma patients. METHODS Patients underwent neuropsychological assessment (NPA) using CNS Vital Signs 1 day before (T0) and 3 (T3) and 12 (T12) months after surgery. Patients' sociodemographically corrected scores on 7 cognitive domains were compared with performance of a normative sample using one-sample z tests and chi-square tests of independence. Reliable change indices with correction for practice effects were calculated for individual patients. Linear mixed effects models were used to identify preoperative predictors of performance at T12. RESULTS At T0, 261 patients were assessed, and 229 and 82 patients were retested at T3 and T12, respectively. Patients showed impaired cognitive performance before and after surgery, and although performance improved on the group level, cognitive scores remained significantly lower than in the normative sample up to T12. On the individual level, performance remained stable in the majority of patients. Better preoperative performance, younger age, male sex, and higher educational level predicted better late cognitive performance. CONCLUSIONS Meningioma patients face serious and persistent pre- and postsurgical cognitive deficits. A preoperative NPA together with sociodemographic characteristics may provide valuable information on the late cognitive outcome of individual meningioma patients. These results can help to inform patients and clinicians on late cognitive outcomes at an early stage, and emphasizes the importance of presurgical NPA and timely cognitive rehabilitation.
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Affiliation(s)
- Sophie J M Rijnen
- Department of Neurosurgery, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands.,Department of Cognitive Neuropsychology, Tilburg University, Tilburg, the Netherlands
| | - Ikram Meskal
- Department of Cognitive Neuropsychology, Tilburg University, Tilburg, the Netherlands
| | - Marjan Bakker
- Department of Methodology and Statistics, Tilburg University, Tilburg, the Netherlands
| | - Wouter De Baene
- Department of Cognitive Neuropsychology, Tilburg University, Tilburg, the Netherlands
| | - Geert-Jan M Rutten
- Department of Neurosurgery, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands
| | - Karin Gehring
- Department of Neurosurgery, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands.,Department of Cognitive Neuropsychology, Tilburg University, Tilburg, the Netherlands
| | - Margriet M Sitskoorn
- Department of Cognitive Neuropsychology, Tilburg University, Tilburg, the Netherlands
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18
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Cognitive Ageing in Top-Level Female Soccer Players Compared to a Normative Sample from the General Population: A Cross-sectional Study. J Int Neuropsychol Soc 2020; 26:645-653. [PMID: 32098636 DOI: 10.1017/s1355617720000119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE There is an ongoing debate on the potential negative effect of contact sport participation on long-term neurocognitive performance due to inherent exposure to concussive and subconcussive head impacts. The aim of the present study was to investigate whether cognitive ageing is exacerbated in elite soccer players compared to the general population. METHOD Neurocognitive performance in 6 domains was compared between 240 elite soccer players and a normative sample from the general population (n = 585) using the computerised test battery CNS Vital Signs. We used two-way factorial ANOVA to analyse the interaction between age groups (15-19, 20-29, 30-39, 40-49 years) and study population (female soccer players vs. norm sample) in their effects on neurocognitive performance. RESULTS We found no significant interaction effect of age group and study population in five of six test domains. For processing speed, the effect of age was more pronounced in female soccer players (F = 16.89, p = .002). Further, there was a clear main effect of study population on neurocognitive performance with generally better scores in soccer players. CONCLUSIONS Elite female soccer players generally performed better than the norm sample on tests of cognitive function, and further, cognitive ageing effects were similar in elite soccer players and controls in all but one domain. A lifespan approach may facilitate insightful future research regarding questions related to long-term neurocognitive health in contact sport athletes.
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19
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Yu D, Liu B, Jiang G, Pei S, Pan H. Correlation of changes in serum S100β, NSE and inflammatory factor levels with MMSE and MoCA in intracranial tumor patients with cognitive impairment. Oncol Lett 2020; 20:1968-1972. [PMID: 32724442 PMCID: PMC7377172 DOI: 10.3892/ol.2020.11751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 12/17/2019] [Indexed: 11/06/2022] Open
Abstract
Changes in serum neuron-specific enolase (NSE) level, S100β protein concentration and inflammatory factor levels and their correlations with cognitive impairment Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) scores in intracranial tumor patients with cognitive impairment were explored. Seventy patients diagnosed with intracranial tumor based on clinical symptoms and computed tomography (CT) images were selected and divided into non-cognitive impairment group (MoCA score ≥26 points, n=44) and cognitive impairment group (MoCA score <26 points, n=26) in accordance with the comprehensive cognitive function evaluation scores. Next, the serum NSE level, S100β protein concentration and inflammatory factor levels were detected, and their relationships with MMSE and MoCA scores were analyzed via Pearsons correlation analysis. The MoCA and MMSE scores in non-cognitive impairment group were higher than those in cognitive impairment group (P<0.05). NSE and S100β levels were higher in non-cognitive impairment group compared with cognitive impairment group (P<0.05). In addition, the levels of interleukin-6 (IL-6), IL-8 and tumor necrosis factor-α (TNF-α) were higher in cognitive impairment group than those in non-cognitive impairment group (P<0.05). The levels of patient's serum NSE, S100β protein and inflammatory factors were negatively related to MMSE and MoCA scores (P<0.05). The changes in serum NSE, S100β protein and inflammatory factor levels in patients with cognitive impairment can reflect the severity of the disease to a certain extent and are directly related to cognitive impairment. Accurate and comprehensive assessment of cognitive function of patients and early development of effective and targeted cognitive interventions are of certain clinical practical value for the improvement of prognosis.
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Affiliation(s)
- Danfeng Yu
- Department of Critical Medicine, Shiyan Taihe Hospital, Shiyan, Hubei 442000, P.R. China
| | - Boyi Liu
- Department of Critical Medicine, Shiyan Taihe Hospital, Shiyan, Hubei 442000, P.R. China
| | - Guoquan Jiang
- Department of Neurosurgery, Wuhan Hanyang Hospital, Wuhan, Hubei 430050, P.R. China
| | - Shiwen Pei
- Department of Neurosurgery, The Third People's Hospital of Bengbu, Bengbu, Anhui 233000, P.R. China
| | - Huan Pan
- Department of Critical Medicine, Shiyan Taihe Hospital, Shiyan, Hubei 442000, P.R. China
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20
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Kang MJ, Pyun JM, Baek MJ, Hwang K, Han JH, Park YH, Kim CY, Kim S. Predictors of pre-operative cognitive impairment in meningioma patients over 60 years old. BMC Neurol 2020; 20:225. [PMID: 32493294 PMCID: PMC7268376 DOI: 10.1186/s12883-020-01806-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Accepted: 05/26/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study was to assess the cognitive function of patients over 60 years old with meningioma using a domain-specific neuropsychological test and to investigate the relevant factors affecting pre-operative cognitive decline in different subdomains. METHODS We retrospectively investigated 46 intracranial meningioma patients between the ages of 60 and 85 years. All patients underwent brain MRI and neuropsychological test. Tumor size, location, peritumoral edema, and medial temporal atrophy (MTA) were examined to determine the association with cognitive impairment. We performed a logistic regression analysis to examine the odds ratios (ORs) for cognitive decline of four subdomains: verbal memory, language, visuospatial, and executive functions. RESULTS Tumor size and age were associated with executive dysfunction (OR 1.083, 95% confidence interval (CI) 1.006-1.166, and OR 1.209, 95% CI 1.018-1.436, respectively). There was no statistically significant association in other cognitive domains (language, verbal memory, and visuospatial function) with variables in regression analysis. CONCLUSIONS We conclude that tumor size and age are positively related with executive function in pre-operative meningioma patients over 60 years old.
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Affiliation(s)
- Min Ju Kang
- Department of Neurology, Veterans Medical Research Institute, Veterans Health Service Medical Center, Seoul, Republic of Korea
| | - Jung-Min Pyun
- Department of Neurology, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
- Department of Neurology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Min Jae Baek
- Department of Neurology, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
| | - Kihwan Hwang
- Department of Neurosurgery, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jung Ho Han
- Department of Neurosurgery, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Young Ho Park
- Department of Neurology, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea.
- Department of Neurology, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Chae-Yong Kim
- Department of Neurosurgery, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea.
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - SangYun Kim
- Department of Neurology, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
- Department of Neurology, Seoul National University College of Medicine, Seoul, Republic of Korea
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Rijnen SJM, De Baene W, Rutten GJM, Gehring K, Sitskoorn MM. In reply to the letter to the editor regarding "Cognitive outcomes in meningioma patients undergoing surgery: individual changes over time and predictors of late cognitive functioning". Neuro Oncol 2020; 22:582-583. [PMID: 32002557 PMCID: PMC7158650 DOI: 10.1093/neuonc/noaa020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Sophie J M Rijnen
- Department of Cognitive Neuropsychology, Tilburg University, Tilburg, the Netherlands
| | - Wouter De Baene
- Department of Cognitive Neuropsychology, Tilburg University, Tilburg, the Netherlands
| | - Geert-Jan M Rutten
- Department of Neurosurgery, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands
| | - Karin Gehring
- Department of Cognitive Neuropsychology, Tilburg University, Tilburg, the Netherlands.,Department of Neurosurgery, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands
| | - Margriet M Sitskoorn
- Department of Cognitive Neuropsychology, Tilburg University, Tilburg, the Netherlands
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Guarracino I, Ius T, Skrap M, Tomasino B. Meningioma can lead to pre-operative cognitive alterations even if localized in sensorimotor areas: A multimodal MRI-neuropsychological study in a series of 46 patients. Neuropsychologia 2020; 137:107288. [PMID: 31790726 DOI: 10.1016/j.neuropsychologia.2019.107288] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 11/07/2019] [Accepted: 11/28/2019] [Indexed: 11/15/2022]
Abstract
Brain tumors are generally associated with cognitive changes. Little is known about cognition in patients with meningioma - a lesion that usually shifts and compresses the brain parenchyma with a low probability of infiltrate it. We investigated the cognitive functioning in a consecutive series of 46 patients with a meningioma in the sensorimotor area in the left (LH, N = 27) or in the right (RH, N = 19) hemisphere. All the patients underwent a pre-operative neuropsychological assessment and structural MRI. Clinical symptoms varied between LH and RH meningioma patients. Impaired performance was seen in naming (19.23% noun and 35% verb naming), short-term (18.18%) and working (14.24%) memory in the LH group, and in visuo-spatial tasks (25% neglect, 21.42% visuospatial planning) in the RH group. Both groups were impaired on a sensorimotor mental imagery task (LH, 66.66% of the LH 70% of the RH meningioma patients), while only the RH meningioma group was impaired on the visuo-spatial mental imagery task. The lesion MRI maximum overlap occurred in the postcentral and paracentral lobules. Edema was maximally localized on the left superior longitudinal fasciculus and the superior part of the right superior corona radiata. We found that only the meningioma mass, and not the edema, is a predictive variable in determining patients' performance. Patients with meningioma could present with cognitive alterations at pre-surgical evaluation even if the meningioma occurs in sensorimotor areas. In the present series, a large meningioma vs. a large edema is more relevant for cognitive performance.
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Affiliation(s)
- Ilaria Guarracino
- Scientific Institute, IRCCS E. Medea, San Vito al Tagliamento, Pordenone, Italy
| | - Tamara Ius
- Unità Operativa di Neurochirurgia, Azienda Sanitaria Universitaria Integrata S. Maria della Misericordia, Udine, Italy
| | - Miran Skrap
- Unità Operativa di Neurochirurgia, Azienda Sanitaria Universitaria Integrata S. Maria della Misericordia, Udine, Italy
| | - Barbara Tomasino
- Scientific Institute, IRCCS E. Medea, San Vito al Tagliamento, Pordenone, Italy.
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Assessment of Executive Functioning in Patients with Meningioma and Low-Grade Glioma: A Comparison of Self-Report, Proxy-Report, and Test Performance. J Int Neuropsychol Soc 2020; 26:187-196. [PMID: 31699166 DOI: 10.1017/s1355617719001164] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE This study aimed to examine: (1) patient-proxy agreement on executive functioning (EF) of patients with primary brain tumors, (2) the relationships between patient- and proxy-report with performance-based measures of EF, and (3) the potential influence of performance-based measures on the level of agreement. METHODS Meningioma and low-grade glioma patients and their informal caregivers completed the Behavior Rating Inventory of Executive Function (BRIEF-A) 3 months after surgery. The two index scores of the BRIEF-A, Behavioral Regulation and Metacognition, were evaluated. Mean scores of patients and proxies were compared with normative values and with each other. Patient-proxy agreement was evaluated with Lin's concordance correlation coefficients (CCCs) and Bland-Altman plots. Pearson correlation coefficients between reported EF and performance-based measures of EF were calculated. Multiple regression analysis was used to evaluate the potential influence of test performance on differences in dyadic reports. RESULTS A total of 47 dyads were included. Patients reported significantly more problems on the Metacognition Index compared to norms, and also in comparison with their proxies. Effect sizes indicated small differences. Moderate to substantial agreement was observed between patients and proxies, with CCCs of 0.57 and 0.61 for Metacognition and Behavioral Regulation, respectively. Correlations between reported EF and test performance ranged between -0.37 and 0.10. Dyadic agreement was not significantly influenced by test performance. CONCLUSIONS Patient-proxy agreement was found to be moderate. No clear associations were found between reported EF and test performance. Future studies should further explore the existing and new methods to assess everyday EF in brain tumor patients.
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Solheim O, Jakola AS. Quality of life outcomes in meningioma surgery. HANDBOOK OF CLINICAL NEUROLOGY 2020; 170:311-321. [PMID: 32586504 DOI: 10.1016/b978-0-12-822198-3.00050-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Patient-reported quality of life measures hold the potential to capture the results of meningioma surgery in a more patient-centered and sensitive way than common morbidity measures. However, quality of life measures have not so far been used much in meningioma studies. Disease specific instruments are also lacking along with validation studies in patients with meningioma. While patient-reported quality of life measures may overestimate improvements and underestimate surgery-related deteriorations, quality of life studies still report worse outcomes than the common retrospective review of hospital records. A more widespread use of longitudinal assessment of quality of life would also have the benefit in moving meningioma research from retrospective to prospective, which would lead to superior data quality. Comparisons across studies would also be more valid as the assessment bias resulting from surgeons judging their own results would be avoided.
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Affiliation(s)
- Ole Solheim
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway; Department of Neurosurgery, St. Olavs University Hospital, Trondheim, Norway.
| | - Asgeir Store Jakola
- Institute of Neuroscience and Physiology, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden; Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden
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Elia G, Mayors Woods LE, Pantilat SZ. End of life care for patients with meningioma. HANDBOOK OF CLINICAL NEUROLOGY 2020; 170:333-348. [PMID: 32586506 DOI: 10.1016/b978-0-12-822198-3.00052-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Palliative care (PC) supports patient with serious illnesses and can help patients with meningioma through the phases of their clinical trajectory, from initial diagnosis through the last hours of life. The PC team implements a multimodal transdisciplinary approach to address physical, psychosocial, and spiritual suffering with patients and their families, while also fostering constructive communication with the many health care providers involved. To achieve these goals the PC core team is comprised of physicians, nurse practitioners, physician assistants, nurses, social workers, and spiritual care providers who are trained to take care of patients with serious illnesses and to provide support to their families. The PC intervention can be instituted concurrently with all other treatments including those with a curative intent, and symptom management can be implemented while at the same time addressing reversible causes of distress. PC is practiced in acute care centers and long-term care facilities, usually by a consulting team, but other settings include outpatient clinics and home. When patients experience recurrence of their tumor and their life expectancy is shortened to 6 months or less, a hospice can provide the same transdisciplinary support by focusing on quality of life and symptom management for the patient while assisting the family through the clinical course and providing professional bereavement services after the patient's death.
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Affiliation(s)
- Giovanni Elia
- Palliative Care Program, University of California San Francisco, San Francisco, CA, United States
| | - Laura E Mayors Woods
- Palliative Care Program, University of California San Francisco, San Francisco, CA, United States
| | - Steven Z Pantilat
- Palliative Care Program, University of California San Francisco, San Francisco, CA, United States.
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Gouttebarge V, Andersen TE, Cowie C, Goedhart E, Jorstad H, Kemp S, Königs M, Maas M, Orhant E, Rantanen J, Salo J, Serratosa L, Stokes K, Tol JL, Verhagen E, Weber A, Kerkhoffs G. Monitoring the health of transitioning professional footballers: protocol of an observational prospective cohort study. BMJ Open Sport Exerc Med 2019; 5:e000680. [PMID: 31908839 PMCID: PMC6937067 DOI: 10.1136/bmjsem-2019-000680] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2019] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Transitioning out of professional football is a challenging time in most players' lives. During these preretirement and postretirement years, professional footballers may struggle with their mental, musculoskeletal, neurocognitive and cardiovascular health. Currently, longitudinal data about these health conditions are lacking. This article presents the design of a prospective cohort study with the primary aim of gathering epidemiological evidence about the onset and course of mental, musculoskeletal, neurocognitive and cardiovascular health conditions in professional footballers during their preretirement and postretirement years and evaluating the associations between risk indicators and the health conditions under study in these players. METHODS AND ANALYSIS An observational prospective cohort study with repeated measurements over a follow-up period of 10 years will be conducted among at least 200 professional footballers (male; 27 (±1) years old). Mental health will be explored by assessing symptoms of distress, anxiety, depression, sleep disturbance, alcohol misuse, drug misuse and disordered eating. Musculoskeletal health will be explored by assessing severe joint injury and related surgery, clinical and radiological osteoarthritis, and joint function (hips, knees and ankles). Neurocognitive health will be explored by assessing the concussion, brain structure and functioning, and neurocognitive functioning. Cardiovascular health will be explored by assessing blood pressure, lipid profile and ECG abnormalities. ETHICS AND DISSEMINATION Ethical approval for the study was provided by the Medical Ethics Review Committee of the Amsterdam University Medical Centers. The results of the study will be submitted to peer-reviewed journals, will be presented at scientific conferences and will be released in the media (postpublication). TRIAL REGISTRATION NUMBER The Dutch Trial Registry (Drake Football Study NL7999).
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Affiliation(s)
- Vincent Gouttebarge
- Amsterdam UMC, Univ of Amsterdam, Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, The Netherlands
- FIFPRO (Football Players Worldwide), Hoofddorp, The Netherlands
- Academic Center for Evidence based Sports medicine (ACES), Amsterdam Movement Sciences, Amsterdam, The Netherlands
- Amsterdam Collaboration on Health & Safety in Sports (ACHSS), Amsterdam UMC IOC Research Center of Excellence, Amsterdam, The Netherlands
- Division of Exercise Science and Sports Medicine, University of Cape Town, Cape Town, South Africa
| | - Thor Einar Andersen
- Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
- The Norwegian FA Medical Center, The Football Association of Norway, Oslo, Norway
| | - Charlotte Cowie
- The Football Association, National Football Centre, St George’s Park, Needwood, United Kingdom
| | - Edwin Goedhart
- Royal Netherlands Football Association (KNVB), FIFA Medical Center of Excellence, Zeist, The Netherlands
| | - Harald Jorstad
- Academic Center for Evidence based Sports medicine (ACES), Amsterdam Movement Sciences, Amsterdam, The Netherlands
- Amsterdam Collaboration on Health & Safety in Sports (ACHSS), Amsterdam UMC IOC Research Center of Excellence, Amsterdam, The Netherlands
- Amsterdam UMC, Univ of Amsterdam, Department of Cardiology, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, The Netherlands
| | | | - Marsh Königs
- Royal Netherlands Football Association (KNVB), FIFA Medical Center of Excellence, Zeist, The Netherlands
- Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Emma Neuroscience Group, Amsterdam, The Netherlands
| | - Mario Maas
- Academic Center for Evidence based Sports medicine (ACES), Amsterdam Movement Sciences, Amsterdam, The Netherlands
- Amsterdam Collaboration on Health & Safety in Sports (ACHSS), Amsterdam UMC IOC Research Center of Excellence, Amsterdam, The Netherlands
- Amsterdam UMC, Univ of Amsterdam, Department of Musculoskeletal Radiology, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, The Netherlands
| | - Emmanuel Orhant
- French Football Federation (FFF), Clairefontaine Medical Centre, FIFA Medical Center of Excellence, Clairefontaine, France
| | - Jussi Rantanen
- Orthopaedics and Sports Clinic, Mehiläinen NEO Hospital, Turku, Finland
| | - Jari Salo
- Sports Hospital Mehiläinen, Helsinki, Finland
| | - Luis Serratosa
- Ripoll & De Prado Sport Clinic, FIFA Medical Centre of Excellence, Madrid, Spain
- Hospital Universitario Quironsalud, Madrid, Spain
| | - Keith Stokes
- Rugby Football Union, Twickenham, UK
- Department for Health, University of Bath, Bath, United Kingdom
- Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, University of Bath, Bath, United Kingdom
| | - Johannes L Tol
- Amsterdam UMC, Univ of Amsterdam, Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, The Netherlands
- Academic Center for Evidence based Sports medicine (ACES), Amsterdam Movement Sciences, Amsterdam, The Netherlands
- Amsterdam Collaboration on Health & Safety in Sports (ACHSS), Amsterdam UMC IOC Research Center of Excellence, Amsterdam, The Netherlands
| | - Evert Verhagen
- Amsterdam Collaboration on Health & Safety in Sports (ACHSS), Amsterdam UMC IOC Research Center of Excellence, Amsterdam, The Netherlands
- Division of Exercise Science and Sports Medicine, University of Cape Town, Cape Town, South Africa
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Movement Sciences, de Boelelaan 1117, Amsterdam, The Netherlands
| | - Alexis Weber
- Fédération Internationale de Football Association (FIFA), Zurich, The Netherlands
| | - Gino Kerkhoffs
- Amsterdam UMC, Univ of Amsterdam, Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, The Netherlands
- Academic Center for Evidence based Sports medicine (ACES), Amsterdam Movement Sciences, Amsterdam, The Netherlands
- Amsterdam Collaboration on Health & Safety in Sports (ACHSS), Amsterdam UMC IOC Research Center of Excellence, Amsterdam, The Netherlands
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Butterbrod E, Gehring K, Voormolen EH, Depauw PRAM, Nieuwlaat WA, Rutten GJM, Sitskoorn MM. Cognitive functioning in patients with nonfunctioning pituitary adenoma before and after endoscopic endonasal transsphenoidal surgery. J Neurosurg 2019; 133:709-716. [PMID: 31443073 DOI: 10.3171/2019.5.jns19595] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 05/30/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Patients with nonfunctioning pituitary adenomas (NFPAs) can suffer from cognitive dysfunction. However, the literature on longitudinal cognitive follow-up of patients undergoing endoscopic endonasal transsphenoidal surgery (EETS) is limited. This study was performed to investigate perioperative cognitive status and course in patients with NFPAs. METHODS Patients underwent computerized neuropsychological assessment 1 day before (n = 45) and 3 months after (n = 36) EETS. Performance in 7 domains was measured with a computerized test battery (CNS Vital Signs) and standardized using data from a healthy control group. The authors conducted analyses of cognitive performance at both time points and changes pre- to post-ETSS on a group and an individual level. Linear multiple regression analyses were employed to investigate predictors of cognitive performance. RESULTS On average, patients scored significantly lower in 6 of 7 cognitive domains before and after surgery than controls. Impairment proportions were significantly higher among patients (56% before surgery, 63% after surgery) than among controls. Patients showed no change over time in group-level (mean) performance, but 28% of individual patients exhibited cognitive improvement and 28% exhibited cognitive decline after surgery. Hormonal deficiency showed a positive correlation with verbal memory before surgery. Postoperative performances in all cognitive domains were predicted by preoperative performances. CONCLUSIONS Cognitive impairment was present before and after EETS in over half of NFPA patients. Individual patients showed diverse postoperative cognitive courses. Monitoring of cognitive functioning in clinical trajectories and further identification of disease-related and psychological predictors of cognition are warranted.
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Affiliation(s)
- Elke Butterbrod
- 1Department of Cognitive Neuropsychology, Tilburg University; and
| | - Karin Gehring
- 1Department of Cognitive Neuropsychology, Tilburg University; and
- 2Departments of Neurosurgery and
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van Lonkhuizen PJ, Rijnen SJ, van der Linden SD, Rutten GM, Gehring K, Sitskoorn MM. Subjective cognitive functioning in patients with a meningioma: Its course and association with objective cognitive functioning and psychological symptoms. Psychooncology 2019; 28:1654-1662. [PMID: 31141624 PMCID: PMC6772142 DOI: 10.1002/pon.5136] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 05/17/2019] [Accepted: 05/22/2019] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Although meningioma patients show deficits in objective cognitive functioning (OCF) measured with neuropsychological tests, subjective cognitive functioning (SCF) has received little attention. We investigate SCF from pre- to postsurgery and its associations with OCF, psychological, sociodemographic, and clinical characteristics. METHODS SCF was measured using the Cognitive Failures Questionnaire (CFQ) 1 day before (T0) and 3 (T3) and 12 months (T12) after surgery. Patients' scores were compared with normative data and changes over time were assessed. The neuropsychological battery CNS Vital Signs and the Hospital Anxiety and Depression Scale were administered. Correlations of SCF with OCF, psychological, sociodemographic, and clinical characteristics were explored. RESULTS Patients reported significantly better SCF as compared with controls at T0 (N = 54) and T3 (N = 242), but not at T12 (N = 50). A significant decrease in group level SCF was observed from T0 to T12 (n = 24, P < .001). SCF was associated with anxiety at all time points (rs = -0.543 to -0.352) and with depression at T3 and T12 (r = -0.338 and -0.574), but not with OCF, sociodemographic, or clinical characteristics (rs = -0.202 to 0.288). CONCLUSIONS Meningioma patients experienced better SCF as compared with controls before and 3 months after surgery, which might be the result of phenomena related to disease and recovery. As the findings suggest that cognitive symptoms might increase later on, future studies should further investigate the course of SCF in meningioma patients. In clinical practice, measurements of SCF should be combined with those of OCF and psychological distress in order to determine whether and which interventions are needed.
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Affiliation(s)
- Pearl J.C. van Lonkhuizen
- Department of Cognitive NeuropsychologyTilburg UniversityTilburgthe Netherlands
- Department of NeurosurgeryElisabeth‐TweeSteden HospitalTilburgthe Netherlands
| | - Sophie J.M. Rijnen
- Department of Cognitive NeuropsychologyTilburg UniversityTilburgthe Netherlands
- Department of NeurosurgeryElisabeth‐TweeSteden HospitalTilburgthe Netherlands
| | - Sophie D. van der Linden
- Department of Cognitive NeuropsychologyTilburg UniversityTilburgthe Netherlands
- Department of NeurosurgeryElisabeth‐TweeSteden HospitalTilburgthe Netherlands
| | - Geert‐Jan M. Rutten
- Department of NeurosurgeryElisabeth‐TweeSteden HospitalTilburgthe Netherlands
| | - Karin Gehring
- Department of Cognitive NeuropsychologyTilburg UniversityTilburgthe Netherlands
- Department of NeurosurgeryElisabeth‐TweeSteden HospitalTilburgthe Netherlands
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Risk factors for neurocognitive impairment in patients with benign intracranial lesions. Sci Rep 2019; 9:8400. [PMID: 31182758 PMCID: PMC6557851 DOI: 10.1038/s41598-019-44466-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 05/15/2019] [Indexed: 11/27/2022] Open
Abstract
This study was designed to assess risk factors for neurocognitive impairment in patients with benign intracranial lesions including tumors and vascular lesions. 74 patients (29 m, 51 f, mean age 54.4 years) with surgery for benign intracranial lesions were included in this prospective single-center study. Extensive neuropsychological testing was performed preoperatively, including tests for attention, memory and executive functions. Furthermore, headache and depression were assessed using the german version of the HDI (IBK) and the BDI-II. Multiple linear regression analyses of the percentile ranks (adjusted for age, sex and education) including the parameters age, Karnofsky Performance Status Scale (KPS), mood, pain and lesion size were performed to identify risk factors for cognitive impairment. Using the Mann-Whitney U test, the influence of hemisphere and type of lesion (tumor/vascular) was assessed. Posthoc Bonferroni correction was performed. Poorer neurocognitive functions were observed only in the category attention in patients with higher age (divided attention, WMS) and reduced KPS (WMS). Lesion volume, mood, pain, hemisphere or the type of the lesion (tumor, vascular) were not identified as risk factors for poorer neurocognitive functions in patients with benign intracranial lesions. Age and KPS are the main risk factors for poorer neurocognitive functions in the category attention in patients with benign intracranial lesions. Knowledge of these risk factors might be important to find appropriate therapy regimes to improve cognitive functions and quality of life.
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Prien A, Junge A, Brugger P, Straumann D, Feddermann-Demont N. Neurocognitive Performance of 425 Top-Level Football Players: Sport-specific Norm Values and Implications. Arch Clin Neuropsychol 2019; 34:575-584. [PMID: 30165564 DOI: 10.1093/arclin/acy056] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 06/07/2018] [Accepted: 07/04/2018] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Concussion diagnosis and management in sports largely relies on neurocognitive testing. In the absence of baseline assessment, only norm values of the general population are available for comparison with scores of concussed athletes. To evaluate whether (elite) sport specific norm values are needed, cognitive performance was compared between top-level football players and the general population. METHODS Cognitive performance of 425 top-level football players was evaluated using the computerized test battery CNS Vital Signs. Players were split into two age groups (15-19 and 20-29 years) and test results were compared with a norm sample (n = 268) by means of age-standardized scores using Cohen's d effect size statistics. RESULTS The younger age group outperformed the norm sample in all domains, with small to moderate effects on tests of processing speed (d = 0.58, 95% CI = 0.31,0.85), cognitive flexibility (d = 0.27, 95% CI = 0.01,0.53) and psychomotor speed (d = 0.97, 95% CI = 0.69,1.24). In the older age group, no differences were found on four out of six domains; a moderate positive effect was found for psychomotor speed (d = 0.74, 95% CI = 0.54,0.93), a small negative effect for reaction time (d = -0.47, 95% CI = -0.66,-0.28). Relative to the norm, older football players scored lower than younger football players on all test domains. CONCLUSION Cognitive performance of elite football players may be different from the general population. It is recommended to use football-specific norm scores for comparison with test results of concussed players, and to choose an adequate control group when investigating effects of contact sport on cognition. Studies with older/retired football players are needed to further analyze potential sport-specific age effects.
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Affiliation(s)
- Annika Prien
- Department of Prevention, Health Promotion and Sports Medicine, MSH Medical School Hamburg, Hamburg, Germany
- Amsterdam Collaboration on Health and Safety in Sports, Department of Public and Occupational Health, VU University Medical Center, Amsterdam, The Netherlands
| | - Astrid Junge
- Department of Prevention, Health Promotion and Sports Medicine, MSH Medical School Hamburg, Hamburg, Germany
- Schulthess Clinic, Zurich, Switzerland
- Swiss Concussion Centre (SCC), Zurich, Switzerland
| | - Peter Brugger
- Swiss Concussion Centre (SCC), Zurich, Switzerland
- Department of Neurology, University Hospital Zurich, University of Zurich, Switzerland
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
- Zurich Center for Integrative Human Physiology, ZIHP, University of Zurich, Switzerland
| | - Dominik Straumann
- Swiss Concussion Centre (SCC), Zurich, Switzerland
- Department of Neurology, University Hospital Zurich, University of Zurich, Switzerland
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
| | - Nina Feddermann-Demont
- Schulthess Clinic, Zurich, Switzerland
- Swiss Concussion Centre (SCC), Zurich, Switzerland
- Department of Neurology, University Hospital Zurich, University of Zurich, Switzerland
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
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Sinha R, Stephenson JM, Price SJ. A systematic review of cognitive function in patients with glioblastoma undergoing surgery. Neurooncol Pract 2019; 7:131-142. [PMID: 32626582 DOI: 10.1093/nop/npz018] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background Patients with glioblastoma (GB) are more likely to suffer cognitive deficits with poor quality of life as compared with lower-grade glioma patient groups, for whom cognition research is plentiful. The objective of this systematic review is to evaluate the cognitive function of patients with GB before and after surgery. Methods This review was prospectively registered with PROSPERO. PubMed and EMBASE searches were performed, most recently March 15, 2018. Inclusion criteria were adult patients, histologically confirmed GB, and cognitive tests conducted before and/or after surgery. Screening and data extraction were carried out independently by 2 authors. Results A total of 512 abstracts were screened. Nineteen studies were included with 902 participants, of whom only 423 had histologically confirmed GB. Only 11 studies tested cognitive function both before and after surgery. A total of 114 different cognitive tests were used. The most common test was used in only 9 studies; 82 tests were used only once. Follow-up time ranged from 1 week to 16 months with extremely high dropout rates. Eighteen of 19 studies reported cognitive deficits in their samples, with prevalence ranging from 22% to 100% (median 64%, interquartile range 42%). Only 1/11 longitudinal studies reported normal cognitive function, 3/11 reported initial deficits with improvement after surgery, 3/11 reported static deficits, and 4/11 reported deterioration. Conclusion There is a consistently high risk of cognitive deficit for patients with GB undergoing surgery. The included studies showed marked heterogeneity in study design, case-mix of included diagnoses, and the type and timing of cognitive tests used. We highlight considerations for the design of future studies to avoid such bias.
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Functional connectivity changes in core resting state networks are associated with cognitive performance in systemic lupus erythematosus. J Comp Neurol 2019; 527:1837-1856. [DOI: 10.1002/cne.24656] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 12/29/2018] [Accepted: 01/17/2019] [Indexed: 12/23/2022]
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Proctor DT, Ramachandran S, Lama S, Sutherland GR. Towards Molecular Classification of Meningioma: Evolving Treatment and Diagnostic Paradigms. World Neurosurg 2018; 119:366-373. [PMID: 30138732 DOI: 10.1016/j.wneu.2018.08.019] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 08/01/2018] [Accepted: 08/02/2018] [Indexed: 01/20/2023]
Abstract
Meningioma, a common primary brain tumor in adults, is graded based on World Health Organization criteria that rely on histology alone. This approach is unable to determine conclusively which tumors, especially benign or atypical, will recur. Molecular characterization of meningioma has identified genetic biomarkers that can predict tumor behavior. Only a few genetic changes are known to classify >85% of all meningioma and clinical trials using targeted therapy to genetic subtypes of meningioma are under way. Immunotherapy is also being trialed in treating high-grade and recurrent meningioma. This review summarizes recent developments characterizing meningioma using genetic and immunologic biomarkers and how these molecular tools may be integrated into existing care together with current World Health Organization grading to improve diagnosis, prognosis, and therapy.
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Affiliation(s)
- Dustin T Proctor
- Project neuroArm, Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Arnie Charbonneau Cancer Institute, University of Calgary, Calgary, Alberta, Canada
| | - Sudheesh Ramachandran
- Project neuroArm, Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Arnie Charbonneau Cancer Institute, University of Calgary, Calgary, Alberta, Canada
| | - Sanju Lama
- Project neuroArm, Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Arnie Charbonneau Cancer Institute, University of Calgary, Calgary, Alberta, Canada
| | - Garnette R Sutherland
- Project neuroArm, Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Arnie Charbonneau Cancer Institute, University of Calgary, Calgary, Alberta, Canada.
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Goebel S, Mehdorn HM. A missing piece? Neuropsychiatric functioning in untreated patients with tumors within the cerebellopontine angle. J Neurooncol 2018; 140:145-153. [PMID: 29982872 DOI: 10.1007/s11060-018-2944-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Accepted: 06/27/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE To date, little is known about neuropsychiatric symptoms in patients with tumors within the cerebellopontine angle (CPA). These, however, might be of clinical relevance. Aim of this study was thus to assess possible impairment in cognition, elevation in mood symptoms, and fatigue in this specific patient group. METHODS Forty-five patients with an untreated CPA tumor (27 vestibularis schwannoma, 18 meningioma) were tested within a cross-sectional observational study in a single institution prior to neurosurgical treatment. Patients were administered a multifaceted battery comprising of widely-used tests for assessment of neuropsychiatric functioning. RESULTS The majority of the included patients (69%) showed neurocognitive impairment, most frequently in the areas of attention and visuo-motor speed (e.g., alertness) (62%) as well as visuo-construction (44%). Impaired structural integrity of the brain stem was accompanied by more serious neurocognitive deficits. About one-third of the sample reported clinically relevant depression and/or anxiety and an even higher proportion (48%) described high levels of fatigue. Cognitive and affective symptoms as well as fatigue contributed significantly to patients' Quality of Life, indicating the clinical relevance of neuropsychiatric symptoms in patients with CPA tumors. CONCLUSIONS Although patients with untreated CPA tumors often suffer from devastating and prominent physical symptoms, neuropsychiatric problems are also frequent. Including these aspects in the routine clinical assessment and initiating treatment accordingly might thus improve clinical management of the patients and improve Quality of Life.
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Affiliation(s)
- Simone Goebel
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Christian-Albrechts University, Olshausenstraße 62, 24118, Kiel, Germany.
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van Loenen IS, Rijnen SJM, Bruijn J, Rutten GJM, Gehring K, Sitskoorn MM. Group Changes in Cognitive Performance After Surgery Mask Changes in Individual Patients with Glioblastoma. World Neurosurg 2018; 117:e172-e179. [PMID: 29886297 DOI: 10.1016/j.wneu.2018.05.232] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 05/29/2018] [Accepted: 05/30/2018] [Indexed: 10/14/2022]
Abstract
BACKGROUND There is a growing interest to include evaluations of cognitive performance in the clinical management of patients with glioblastoma (GBM). However, as changes in cognitive performance of a group may mask changes in individual patients, study results are often difficult to transfer into clinical practice. We focused on the comparison of group versus individual changes in neuropsychological performance of patients with GBM after initial surgical treatment. METHODS Patients underwent neuropsychological evaluation using CNS Vital Signs 1 day prior to and 3 months after surgery. Two-tailed paired-samples t tests were conducted to assess changes on the group level. Reliable change indices (RCIs) that correct for practice effects and imperfect test-retest reliabilities were used to examine changes in individual patients. RESULTS Cognitive dysfunction was common (>80%) both before and 3 months after surgery in this sample of 82 patients with GBM. Whereas group analyses revealed minimal changes in performance over time, RCIs demonstrated that most patients (89%) showed changes in performance in at least 1 cognitive domain. Half of these individual patients solely showed improvements, a quarter solely showed declines, and another quarter showed both improvements and declines. CONCLUSIONS This study clearly demonstrates that important individual changes in performance are masked when looking only at group results. Future studies should more often use an individual patient approach to enhance knowledge transfer into clinical practice.
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Affiliation(s)
- Inge S van Loenen
- Department of Cognitive Neuropsychology, Tilburg University, Tilburg, The Netherlands
| | - Sophie J M Rijnen
- Department of Cognitive Neuropsychology, Tilburg University, Tilburg, The Netherlands; Department of Neurosurgery, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands.
| | - Jimme Bruijn
- Department of Cognitive Neuropsychology, Tilburg University, Tilburg, The Netherlands; Department of Neurosurgery, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - Geert-Jan M Rutten
- Department of Neurosurgery, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - Karin Gehring
- Department of Cognitive Neuropsychology, Tilburg University, Tilburg, The Netherlands; Department of Neurosurgery, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - Margriet M Sitskoorn
- Department of Cognitive Neuropsychology, Tilburg University, Tilburg, The Netherlands
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Abete Fornara G, Di Cristofori A, Bertani GA, Carrabba G, Zarino B. Constructional Apraxia in Older Patients with Brain Tumors: Considerations with an Up-To-Date Review of the Literature. World Neurosurg 2018; 114:e1130-e1137. [DOI: 10.1016/j.wneu.2018.03.159] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 03/21/2018] [Accepted: 03/22/2018] [Indexed: 01/15/2023]
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Pranckevičienė A, Jurkuvėnas V, Deltuva VP, Tamašauskas A, Bunevičius A. Preoperative verbal memory problems and their clinical prognostic value in meningioma patients: A prospective study. APPLIED NEUROPSYCHOLOGY-ADULT 2018; 26:503-512. [PMID: 29617166 DOI: 10.1080/23279095.2018.1450750] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
This study aimed to evaluate clinical utility of The Hopkins Verbal Learning Test-Revised (HVLT-R) for assessment of preoperative memory function in meningioma patients and to investigate prognostic value of memory assessment in predicting outcomes after meningioma excision surgery. A total of 93 meningioma patients were assessed 2-3 days preoperatively using HVLT-R, and EORTC QLQ-30 and QLQ-BN20. Functional outcome at discharge was evaluated using The Glasgow Outcome Scale. A sample of 95 healthy controls was matched to patients according to age, gender, and education. Meningioma patients demonstrated impaired working memory, delayed recall and recognition, flatter learning slope, and less effective acquisition. Location of meningioma was not related to any of the studied memory scores. Patients with left sided meningiomas more often produced false positive recognitions and demonstrated worse delayed recall when compared to patients with right sided, but not bilateral meningiomas. Verbal memory impairment was not associated with perceived health status. Functional outcome at discharge was predicted by tumor side, global health status score, and HVLT-R Cumulative learning score. Cumulative verbal learning impairment was associated with greater risk for poor functional outcome, indicating that cognitive impairment has added prognostic value beyond established prognostic indicators of meningioma patients.
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Affiliation(s)
- Aistė Pranckevičienė
- Neuroscience Institute, Lithuanian University of Health Sciences , Kaunas , Lithuania
| | | | | | - Arimantas Tamašauskas
- Neuroscience Institute, Lithuanian University of Health Sciences , Kaunas , Lithuania
| | - Adomas Bunevičius
- Neuroscience Institute, Lithuanian University of Health Sciences , Kaunas , Lithuania
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Cannerfelt B, Nystedt J, Jönsen A, Lätt J, van Westen D, Lilja A, Bengtsson A, Nilsson P, Mårtensson J, Sundgren PC. White matter lesions and brain atrophy in systemic lupus erythematosus patients: correlation to cognitive dysfunction in a cohort of systemic lupus erythematosus patients using different definition models for neuropsychiatric systemic lupus erythematosus. Lupus 2018. [DOI: 10.1177/0961203318763533] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Aim The aim of this study was to evaluate the extent of white matter lesions, atrophy of the hippocampus and corpus callosum, and their correlation with cognitive dysfunction (CD), in patients diagnosed with systemic lupus erythematosus (SLE). Methods Seventy SLE patients and 25 healthy individuals (HIs) were included in the study. To evaluate the different SLE and neuropsychiatric SLE (NPSLE) definition schemes, patients were grouped both according to the American College of Rheumatology (ACR) definition, as well as the more stringent ACR-Systemic Lupus International Collaborating Clinics definition. Patients and HIs underwent a 3 Tesla brain MRI and a standardized neuropsychological test. MRI data were evaluated for number and volume of white matter lesions and atrophy of the hippocampus and corpus callosum. Differences between groups and subgroups were evaluated for significance. Number and volume of white matter lesions and atrophy of the hippocampus and corpus callosum were correlated to cognitive dysfunction. Results The total volume of white matter lesions was significantly larger in SLE patients compared to HIs ( p = 0.004). However, no significant differences were seen between the different SLE subgroups. Atrophy of the bilateral hippocampus was significantly more pronounced in patients with NPSLE compared to those with non-NPSLE (right: p = 0.010; left p = 0.023). Significant negative correlations between cognitive test scores on verbal memory and number and volume of white matter lesions were present. Conclusion SLE patients have a significantly larger volume of white matter lesions on MRI compared to HIs and the degree of white matter lesion volume correlates to cognitive dysfunction, specifically to verbal memory. No significant differences in the number or volume of white matter lesions were identified between subgroups of SLE patients regardless of the definition model used.
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Affiliation(s)
- B Cannerfelt
- Department of Clinical Sciences Lund, Radiology, Lund University, Lund, Sweden
| | - J Nystedt
- Department of Clinical Sciences Lund, Neurology, Lund University, Lund, Sweden
- Department of Clinical Sciences, Center for Imaging and Function, Skåne University hospital, Lund, Sweden
- Department of Clinical Sciences Lund, Neurology, Lund University, Lund, Sweden
| | - A Jönsen
- Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden
| | - J Lätt
- Department of Medical Imaging and Physiology, Skåne University Hospital, Lund, Sweden
| | - D van Westen
- Department of Clinical Sciences Lund, Radiology, Lund University, Lund, Sweden
- Department of Clinical Sciences, Center for Imaging and Function, Skåne University hospital, Lund, Sweden
| | - A Lilja
- Department of Clinical Sciences Lund, Radiology, Lund University, Lund, Sweden
| | - A Bengtsson
- Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden
| | - P Nilsson
- Department of Clinical Sciences Lund, Neurology, Lund University, Lund, Sweden
| | - J Mårtensson
- Department of Clinical Sciences Lund, Radiology, Lund University, Lund, Sweden
| | - P C Sundgren
- Department of Clinical Sciences Lund, Radiology, Lund University, Lund, Sweden
- Department of Clinical Sciences, Center for Imaging and Function, Skåne University hospital, Lund, Sweden
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Altered white matter microstructure in lupus patients: a diffusion tensor imaging study. Arthritis Res Ther 2018; 20:21. [PMID: 29415762 PMCID: PMC5803933 DOI: 10.1186/s13075-018-1516-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 01/10/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The purpose of this study was to investigate whether white matter microstructure is altered in patients suffering from systemic lupus erythematosus (SLE), and if so, whether such alterations differed between patients with and without neuropsychiatric symptoms. METHODS Structural MRI and diffusion tensor imaging (DTI) were performed in 64 female SLE patients (mean age 36.9 years, range 18.2-52.2 years) and 21 healthy controls (mean age 36.7 years, range 23.3-51.2 years) in conjunction with clinical examination, laboratory tests, cognitive evaluation, and self-assessment questionnaires. The patients were subgrouped according to the American College of Rheumatology Neuropsychiatric Systemic Lupus Erythematosus case definitions into non-neuropsychiatric SLE (nonNPSLE) and neuropsychiatric SLE (NPSLE). RESULTS Comparisons between the SLE group and healthy controls showed that the mean fractional anisotropy (FA) was significantly reduced in the right rostral cingulum (p = 0.038), the mid-sagittal corpus callosum (CC) (p = 0.050), and the forceps minor of the CC (p = 0.015). The mean diffusivity (MD) was significantly increased in the left hippocampal cingulum (p = 0.017). No significant differences in MD or FA values were identified between NPSLE and nonNPSLE patients. Disease duration among all SLE patients correlated significantly with reduced FA in the CC (p < 0.05). No correlations were found between DTI parameters and white matter hyperintensities, SLE Disease Activity Index-2000, Systemic Lupus International Collaborating Clinical/ACR Organ Damage Index, or Montgomery Asberg Depression Rate Score Self-report. CONCLUSIONS We found alterations of white matter microstructure in SLE patients that were related to disease duration and fatigue. Our results indicate that cerebral involvement in SLE is not isolated to the NPSLE subgroup.
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Di Cristofori A, Zarino B, Bertani G, Locatelli M, Rampini P, Carrabba G, Caroli M. Surgery in elderly patients with intracranial meningioma: neuropsychological functioning during a long term follow-up. J Neurooncol 2018; 137:611-619. [DOI: 10.1007/s11060-018-2754-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 01/07/2018] [Indexed: 10/18/2022]
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Isenberg-Grzeda E, Huband H, Lam H. A review of cognitive screening tools in cancer. Curr Opin Support Palliat Care 2018; 11:24-31. [PMID: 28009651 DOI: 10.1097/spc.0000000000000257] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE OF REVIEW Cancer-related cognitive impairment (CRCI) is highly prevalent, and assessment of cognition is crucial in providing optimal cancer care. Neuropsychological assessment (NPA) can be lengthy and expensive. Cognitive screening tools are plenty but validity has not been thoroughly studied for use in cancer patients. RECENT FINDINGS Our search of the recent literature revealed that the Montreal Cognitive Assessment, Mini-Mental State Examination, and Clock Draw Test were the most frequently studied objective screening tools. The Functional Assessment of Cancer Therapy-Cognitive Function and the Cognitive Symptom Checklist-Work 21 were the most commonly studied subjective measures of perceived cognitive impairment. Evidence supports using the Montreal Cognitive Assessment or the Clock Draw Test over the Mini-Mental State Examination to screen for cognitive impairment within specific patient populations. In addition, adding a subjective measure of cognitive impairment (e.g., Functional Assessment of Cancer Therapy-Cognitive Function) may increase diagnostic sensitivity. SUMMARY These suggest that cognitive screening tools may have a role in screening for CRCI, particularly when full NPA is not feasible. Researchers must continue to conduct high-quality studies to build an evidence to guide best practices in screening for CRCI.
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Affiliation(s)
- Elie Isenberg-Grzeda
- aDepartment of Psychiatry, University of Toronto bOdette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario cDalhousie University, Halifax, Nova Scotia dLibrary Services, Sunnybrook Health Sciences Centre, Toronto, Ontario
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Association between psychological distress, subjective cognitive complaints and objective neuropsychological functioning in brain tumor patients. Clin Neurol Neurosurg 2017; 163:18-23. [PMID: 29035741 DOI: 10.1016/j.clineuro.2017.10.007] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 09/23/2017] [Accepted: 10/09/2017] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Psychological distress and cognitive impairment are common complications in patients with brain tumors that are associated with poor quality of life and worse prognosis. This pilot study aimed to evaluate the associations between psychological distress, subjective cognitive complaints and baseline neuropsychological performance of brain tumor patients before neurosurgery. PATIENTS AND METHODS Sixty-two patients with various brain tumors referred for routine neuropsychological assessment 2-3days before neurosurgery participated in the study. Short neuropsychological assessment battery was used to evaluate attention and executive functions, memory and verbal fluency. Presence of cognitive complaints was evaluated during neuropsychological interview using standardized symptoms checklist. Level of psychological distress was assessed using the Hospital Anxiety and Depression Scale. RESULTS Various attention and executive function problems were reported by 13-58% patients; memory problems by 8-63%; language problems by 10-58% of patients. 36-57% of patients scored below 5th percentile on objective memory measures; 32-45% on attention measures and 11-27% on verbal fluency. However, correlation between objective neuropsychological findings and subjective cognitive complaints was weak, ranging from 0.0 to 0.3. 45% of patients met criteria for increased psychological distress. Psychological distress was associated with subjective cognitive complaints but failed to predict objective neuropsychological findings. Brain tumor histological diagnosis, side and location were not related to neuropsychological functioning. CONCLUSION Cognitive impairment and psychological distress are highly prevalent in BT patients before neurosurgery. Although depression and distress may adversely impact quality of life and prognosis of BT patients, our current findings do not confirm that distress has strong negative impact on objective preoperative cognitive functioning. However, it is related to worse subjective evaluation of one's cognitive abilities. Therefore, objective neuropsychological assessment of cognitive functions is highly recommended despite concern.
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Changes in Cognition and Decision Making Capacity Following Brain Tumour Resection: Illustrated with Two Cases. Brain Sci 2017; 7:brainsci7100122. [PMID: 28946652 PMCID: PMC5664049 DOI: 10.3390/brainsci7100122] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 09/13/2017] [Accepted: 09/19/2017] [Indexed: 12/15/2022] Open
Abstract
Changes in cognition, behaviour and emotion frequently occur in patients with primary and secondary brain tumours. This impacts the ability to make considered decisions, especially following surgical resection, which is often overlooked in the management of patients. Moreover, the impact of cognitive deficits on decision making ability affects activities of daily living and functional independence. The assessment process to ascertain decision making capacity remains a matter of debate. One avenue for evaluating a patient’s ability to make informed decisions in the context of brain tumour resection is neuropsychological assessment. This involves the assessment of a wide range of cognitive abilities on standard measurement tools, providing a robust approach to ascertaining capacity. Evidence has shown that a comprehensive and tailored neuropsychological assessment has greater sensitivity than brief cognitive screening tools to detect subtle and/or specific cognitive deficits in brain tumours. It is the precise nature and severity of any cognitive deficits that determines any implications for decision making capacity. This paper focuses on cognitive deficits and decision making capacity following surgical resection of both benign and malignant, and primary and secondary brain tumours in adult patients, and the implications for patients’ ability to consent to future medical treatment and make decisions related to everyday activities.
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Rijnen SJM, Meskal I, Emons WHM, Campman CAM, van der Linden SD, Gehring K, Sitskoorn MM. Evaluation of Normative Data of a Widely Used Computerized Neuropsychological Battery: Applicability and Effects of Sociodemographic Variables in a Dutch Sample. Assessment 2017; 27:373-383. [PMID: 28895436 PMCID: PMC6990455 DOI: 10.1177/1073191117727346] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction: Central Nervous System Vital Signs (CNS VS) is a computerized neuropsychological battery that is translated into many languages. However, published CNS VS’ normative data were established over a decade ago, are solely age-corrected, and collected in an American population only. Method: Mean performance of healthy Dutch participants on CNS VS was compared with the original CNS VS norms (N = 1,069), and effects of sociodemographic variables were examined. Results:z tests demonstrated no significant differences in performance on four out of seven cognitive domains; however, Dutch participants (N = 158) showed higher scores on processing and psychomotor speed, as well as on cognitive flexibility. Although the original CNS VS norms are solely age-corrected, effects of education and sex on CNS VS performance were also identified in the Dutch sample. Discussion: Users should be cautious when interpreting CNS VS performance based on the original American norms, and sociodemographic factors must also be considered.
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Affiliation(s)
- Sophie J M Rijnen
- Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands.,Tilburg University, Tilburg, The Netherlands
| | | | | | | | - Sophie D van der Linden
- Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands.,Tilburg University, Tilburg, The Netherlands
| | - Karin Gehring
- Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands.,Tilburg University, Tilburg, The Netherlands
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Butts AM, Weigand S, Brown PD, Petersen RC, Jack CR, Machulda MM, Cerhan JH. Neurocognition in individuals with incidentally-identified meningioma. J Neurooncol 2017; 134:125-132. [PMID: 28547588 PMCID: PMC5544551 DOI: 10.1007/s11060-017-2495-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 05/14/2017] [Indexed: 11/24/2022]
Abstract
Meningiomas are primary intracranial tumors that are often asymptomatic. To our knowledge, no study has attempted to describe neurocognitive function in patients with incidentally-discovered meningioma. We utilized the Mayo Clinic Study of Aging (MCSA), which is a population-based sample of Olmsted County, Minnesota residents that includes neuropsychological testing and brain MRI approximately every 15 months. Using a text search of radiologists' notes of 2402 MCSA individuals (mean age 77 years, scanned between 2004 and 2014) we identified 48 eligible subjects (2%) who had at least one meningioma. Most meningiomas were small (90% <3 cm). We matched each of the 48 subjects to 5 non-demented MCSA controls (n = 240) on age, sex, and education. Cognitive domains assessed included memory, attention-executive function, language, and visuospatial. More women (67%) had a meningioma than men (33%). Groups did not differ on prevalence of Mild Cognitive Impairment (Meningioma = 19%, Controls = 13%). Across cognitive domains, we observed similar performance for the two groups (p's ≥ 0.21). Subtle differences emerged in memory and language domains (p = 0.05 and p = 0.11) when we divided the Meningioma group by tumor location, wherein the small group with an infratentorial tumor performed more poorly than controls globally as well as on select memory and language measures. Our findings suggest that small meningiomas are generally cognitively benign, but that may change as the tumor evolves, and might be impacted by other factors such as meningioma location.
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Affiliation(s)
- Alissa M Butts
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA.
| | - Stephen Weigand
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Paul D Brown
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Mary M Machulda
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Jane H Cerhan
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
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de Almeida AN, Pereira BJA, Pires Aguiar PH, Paiva WS, Cabrera HN, da Silva CC, Teixeira MJ, Marie SKN. Clinical Outcome, Tumor Recurrence, and Causes of Death: A Long-Term Follow-Up of Surgically Treated Meningiomas. World Neurosurg 2017; 102:139-143. [DOI: 10.1016/j.wneu.2017.03.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 03/02/2017] [Accepted: 03/03/2017] [Indexed: 10/20/2022]
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Abstract
Meningiomas are common, usually benign intracranial tumors. They grow slowly and can remain asymptomatic for many years. Meningiomas can present as mental disorders rather than with neurologic signs or symptoms. In this case report we describe a middle-aged man with a 2-year history of depressive disorder who was diagnosed with a large olfactory fossa meningioma after he developed mental status changes and urinary incontinence. After the tumor was removed, the patient's depressive symptoms resolved and his neurocognitive functions improved. We discuss the patient's neuropsychological and psychiatric profiles to identify symptoms and other clues that could expedite identification of meningiomas in patients with psychiatric disorders. Because olfactory fossa meningiomas can present as depressive disorder, we recommend brain imaging to rule out organic brain lesions in middle-aged and older patients with new-onset psychiatric symptoms. Although tumor removal brought improvement of our patient's mental state and neurocognitive functions, patients may not be able to recover their cognitive functions completely.
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Hendrix P, Hans E, Griessenauer CJ, Simgen A, Oertel J, Karbach J. Neurocognitive Function Surrounding the Resection of Frontal WHO Grade I Meningiomas: A Prospective Matched-Control Study. World Neurosurg 2016; 98:203-210. [PMID: 27989970 DOI: 10.1016/j.wneu.2016.10.095] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Revised: 10/19/2016] [Accepted: 10/20/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Patients with intracranial meningiomas can experience neurocognitive dysfunctions in specific cognitive domains depending on tumor location and size. The literature regarding cognitive function surrounding the resection of frontal meningiomas is sparse. METHODS We performed a prospective matched-control study to investigate the cognitive performance of frontal meningioma patients undergoing resection. The neurocognitive status 1 week and 2 months after resection was compared with the preoperative status and matched-controls. Matching was performed for age, sex, handedness, education, and profession. An extensive test battery was used to assess perceptual speed, executive function, visual-spatial and verbal working memory, short- and long-term memory, verbal fluency, fluid intelligence, anxiety, and depression. RESULTS Twelve patients with frontal World Health Organization grade I meningioma and 12 matched-controls underwent cognitive testing. Macroscopically, complete removal was achieved in all cases. Comparison of patients and controls revealed significant cognitive impairments in perceptual speed, executive function, short-term memory, and verbal fluency preoperatively and postoperatively. At 2 months' follow-up, perceptual speed and verbal fluency were still significantly impaired, whereas executive function and short-term memory were equal to that in the control group. None of the patients experienced cognitive deterioration after surgical therapy. CONCLUSION Patients with frontal meningiomas display preoperative and postoperative deficits in perceptual speed, executive function, short-term memory, and verbal fluency. The risk for cognitive deterioration owing to surgical resection is low. Within the first two months after surgery, executive function and short-term memory appear to recover.
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Affiliation(s)
- Philipp Hendrix
- Department of Neurosurgery, Saarland University Medical Center, Saarland University Faculty of Medicine, Homburg (Saar), Germany.
| | - Elisa Hans
- Department of Neurosurgery, Saarland University Medical Center, Saarland University Faculty of Medicine, Homburg (Saar), Germany
| | - Christoph J Griessenauer
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA; Department of Neurosurgery, Geisinger Health System, Danville, Pennsylvania, USA
| | - Andreas Simgen
- Department of Neuroradiology, Saarland University Medical Center, Saarland University Faculty of Medicine, Homburg (Saar), Germany
| | - Joachim Oertel
- Department of Neurosurgery, Saarland University Medical Center, Saarland University Faculty of Medicine, Homburg (Saar), Germany
| | - Julia Karbach
- Department of Psychology, Goethe University, Frankfurt, Germany
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Lyon DE, Cohen R, Chen H, Kelly DL, Starkweather A, Ahn HC, Jackson-Cook CK. The relationship of cognitive performance to concurrent symptoms, cancer- and cancer-treatment-related variables in women with early-stage breast cancer: a 2-year longitudinal study. J Cancer Res Clin Oncol 2016; 142:1461-74. [PMID: 27102492 DOI: 10.1007/s00432-016-2163-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 04/11/2016] [Indexed: 12/30/2022]
Abstract
PURPOSE Cognitive dysfunction in women with breast cancer continues to be an area of intense research interest. The prevalence, severity, timing, and cognitive domains that are most affected, as well as the contribution of cancer and its treatments to cognition, remain unresolved. Thus, longitudinal studies are needed that examine cognitive function during different stages of breast cancer treatment and survivorship. This longitudinal trial followed women with early-stage breast cancer, prior to chemotherapy through 2 years survivorship. METHODS In women with early-stage breast cancer (N = -75), performance-based assessment of nine cognitive domains was performed at five time points beginning prior to chemotherapy and finishing 24 months after initial chemotherapy. Linear mixed effects models were used to examine the temporal changes in cognitive performance domains, while adjusting for cofactors, including those related to individuals, tumor attributes, chemotherapy (adjuvant or neoadjuvant), radiation, endocrine therapy, and concurrent symptoms. RESULTS At baseline, scores on reaction time, complex attention, cognitive flexibility, executive function, and visual memory were lower than 90. At 2 years, all domains improved except for the memory domains (verbal, visual, and composite). Scores on six domains (psychomotor speed, reaction time, complex attention, cognitive flexibility, and visual memory) remained lower than 100 at 2 years. Neoadjuvant chemotherapy and fatigue had strong inverse relationship with cognitive functioning at multiple time points. CONCLUSION The low performance-based cognitive scores at baseline and over time warrant further study. Although most scores improved over time, memory did not improve. In all, the level of cognitive function is lower than expected for a majority college-educated sample. Thus, future studies are warranted to replicate these findings and to develop methods for identifying women with cognitive dysfunction pretreatment and into survivorship.
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Affiliation(s)
| | | | | | | | - Angela Starkweather
- University of Connecticut, Storrs Hall, Room 112B, 231 Glenbrook Road, Unit 4026, Storrs, CT, 06269, USA
| | | | - Colleen K Jackson-Cook
- School of Medicine, Virginia Commonwealth University, 1101 E. Marshall Street, Richmond, VA, 23298-0662, USA
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Meskal I, Gehring K, Rutten GJM, Sitskoorn MM. Cognitive functioning in meningioma patients: a systematic review. J Neurooncol 2016; 128:195-205. [PMID: 27048208 PMCID: PMC4882357 DOI: 10.1007/s11060-016-2115-z] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 03/22/2016] [Indexed: 11/28/2022]
Abstract
This systematic review evaluates relevant findings and methodologic aspects of studies on cognitive functioning in meningioma patients prior to and/or following surgery with or without adjuvant radiotherapy. PubMed and Web of Science electronic databases were searched until December 2015. From 1012 initially identified articles, 11 met the inclusion criteria for this review. Multiple methodological limitations were identified which include the lack of pre-treatment assessments, variations in the number and types of neuropsychological tests used, the normative data used to identify patients with cognitive deficits, and the variety of definitions for cognitive impairment. Study results suggest that most of meningioma patients are faced with cognitive deficits in several cognitive domains prior to surgery. Following surgery, most of these patients seem to improve in cognitive functioning. However, they still have impairments in a wide range of cognitive functions compared to healthy controls. Suggestions are given for future research. Adequate diagnosis and treatment of cognitive deficits may ultimately lead to improved outcome and quality of life in meningioma patients.
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Affiliation(s)
- Ikram Meskal
- Department of Cognitive Neuropsychology, Tilburg University, Warandelaan 2, PO Box 90153, 5000 LE, Tilburg, The Netherlands
| | - Karin Gehring
- Department of Cognitive Neuropsychology, Tilburg University, Warandelaan 2, PO Box 90153, 5000 LE, Tilburg, The Netherlands. .,Department of Neurosurgery, St Elisabeth Hospital, Tilburg, The Netherlands.
| | - Geert-Jan M Rutten
- Department of Neurosurgery, St Elisabeth Hospital, Tilburg, The Netherlands
| | - Margriet M Sitskoorn
- Department of Cognitive Neuropsychology, Tilburg University, Warandelaan 2, PO Box 90153, 5000 LE, Tilburg, The Netherlands
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