Localizing Memory Functions in Brain Tumor Patients: Anatomical Hotspots over 260 Patients

A common low dimensional structure of cognitive impairment in stroke and brain tumors

INTRODUCTION

Neuropsychological studies infer brain-behavior relationships from focal lesions like stroke and tumors. However, these pathologies impair brain function through different mechanisms even when they occur at the same brain's location. The aim of this study was to compare the profile of cognitive impairment in patients with brain tumors vs. stroke and examine the correlation with lesion location in each pathology.

METHODS

Patients with first time stroke (n = 77) or newly diagnosed brain tumors (n = 76) were assessed with a neuropsychological battery. Their lesions were mapped with MRI scans. Test scores were analyzed using principal component analysis (PCA) to measure their correlation, and logistic regression to examine differences between pathologies. Next, with ridge regression we examined whether lesion features (location, volume) were associated with behavioral performance.

RESULTS

The PCA showed a similar cognitive impairment profile in tumors and strokes with three principal components (PCs) accounting for about half of the individual variance. PC1 loaded on language, verbal memory, and executive/working memory; PC2 loaded on general performance, visuo-spatial attention and memory, and executive functions; and, PC3 loaded on calculation, reading and visuo-spatial attention. The average lesion distribution was different, and lesion location was correlated with cognitive deficits only in stroke. Logistic regression found language and calculation more affected in stroke, and verbal memory and verbal fluency more affected in tumors.

CONCLUSIONS

A similar low dimensional set of behavioral impairments was found both in stroke and brain tumors, even though each pathology caused some specific deficits in different domains. The lesion distribution was different for stroke and tumors and correlated with behavioral impairment only in stroke.

Deficits in naming pictures of objects are associated with glioma infiltration of the inferior longitudinal fasciculus: A study with diffusion MRI tractography, volumetric MRI, and neuropsychology

It has been suggested that the inferior longitudinal fasciculus (ILF) may play an important role in several aspects of language processing such as visual object recognition, visual memory, lexical retrieval, reading, and specifically, in naming visual stimuli. In particular, the ILF appears to convey visual information from the occipital lobe to the anterior temporal lobe (ATL). However, direct evidence proving the essential role of the ILF in language and semantics remains limited and controversial. The first aim of this study was to prove that patients with a brain glioma damaging the left ILF would be selectively impaired in picture naming of objects; the second aim was to prove that patients with glioma infiltrating the ATL would not be impaired due to functional reorganization of the lexical retrieval network elicited by the tumor. We evaluated 48 right-handed patients with neuropsychological testing and magnetic resonance imaging (MRI) before and after surgery for resection of a glioma infiltrating aspects of the left temporal, occipital, and/or parietal lobes; diffusion tensor imaging (DTI) was acquired preoperatively in all patients. Damage to the ILF, inferior frontal occipital fasciculus (IFOF), uncinate fasciculus (UF), arcuate fasciculus (AF), and associated cortical regions was assessed by means of preoperative tractography and pre-/pos-toperative MRI volumetry. The association of fascicles damage with patients' performance in picture naming and three additional cognitive tasks, namely, verbal fluency (two verbal non-visual tasks) and the Trail Making Test (a visual attentional task), was evaluated. Nine patients were impaired in the naming test before surgery. ILF damage was demonstrated with tractography in six (67%) of these patients. The odds of having an ILF damage was 6.35 (95% CI: 1.27-34.92) times higher among patients with naming deficit than among those without it. The ILF was the only fascicle to be significantly associated with naming deficit when all the fascicles were considered together, achieving an adjusted odds ratio of 15.73 (95% CI: 2.30-178.16, p = .010). Tumor infiltration of temporal and occipital cortices did not contribute to increase the odd of having a naming deficit. ILF damage was found to be selectively associated with picture naming deficit and not with lexical retrieval assessed by means of verbal fluency. Early after surgery, 29 patients were impaired in naming objects. The association of naming deficit with percentage of ILF resection (assessed by 3D-MRI) was confirmed (beta = -56.78 ± 20.34, p = .008) through a robust multiple linear regression model; no significant association was found with damage of IFOF, UF or AF. Crucially, postoperative neuropsychological evaluation showed that naming scores of patients with tumor infiltration of the anterior temporal cortex were not significantly associated with the percentage of ILF damage (rho = .180, p > .999), while such association was significant in patients without ATL infiltration (rho = -.556, p = .004). The ILF is selectively involved in picture naming of objects; however, the naming deficits are less severe in patients with glioma infiltration of the ATL probably due to release of an alternative route that may involve the posterior segment of the AF. The left ILF, connecting the extrastriatal visual cortex to the anterior region of the temporal lobe, is crucial for lexical retrieval on visual stimulus, such as in picture naming. However, when the ATL is also damaged, an alternative route is released and the performance improves.

Presurgical predictors of early cognitive outcome after brain tumor resection in glioma patients

Gliomas are commonly characterized by neurocognitive deficits that strongly impact patients' and caregivers' quality of life. Surgical resection is the mainstay of therapy, and it can also cause cognitive impairment. An important clinical problem is whether patients who undergo surgery will show post-surgical cognitive impairment above and beyond that present before surgery. The relevant rognostic factors are largely unknown. This study aims to quantify the cognitive impairment in glioma patients 1-week after surgery and to compare different pre-surgical information (i.e., cognitive performance, tumor volume, grading, and lesion topography) towards predicting early post-surgical cognitive outcome. We retrospectively recruited a sample of N = 47 patients affected by high-grade and low-grade glioma undergoing brain surgery for tumor resection. Cognitive performance was assessed before and immediately after (∼1 week) surgery with an extensive neurocognitive battery. Multivariate linear regression models highlighted the combination of predictors that best explained post-surgical cognitive impairment. The impact of surgery on cognitive functioning was relatively small (i.e., 85% of test scores across the whole sample indicated no decline), and pre-operative cognitive performance was the main predictor of early post-surgical cognitive outcome above and beyond information from tumor topography and volume. In fact, structural lesion information did not significantly improve the accuracy of prediction made from cognitive data before surgery. Our findings suggest that post-surgery neurocognitive deficits are only partially explained by preoperative brain damage. The present results suggest the possibility to make reliable, individualized, and clinically relevant predictions from relatively easy-to-obtain information.

Influences on cognitive outcomes in adult patients with gliomas: A systematic review

People with brain tumors, including those previously treated, are commonly affected by a range of neurocognitive impairments involving executive function, memory, attention, and social/emotional functioning. Several factors are postulated to underlie this relationship, but evidence relating to many of these factors is conflicting and does not fully explain the variation in cognitive outcomes seen in the literature and in clinical practice. To address this, we performed a systematic literature review to identify and describe the range of factors that can influence cognitive outcomes in adult patients with gliomas. A literature search was performed of Ovid MEDLINE, PsychINFO, and PsycTESTS from commencement until September 2021. Of 9,998 articles identified through the search strategy, and an additional 39 articles identified through other sources, 142 were included in our review. The results confirmed that multiple factors influence cognitive outcomes in patients with gliomas. The effects of tumor characteristics (including location) and treatments administered are some of the most studied variables but the evidence for these is conflicting, which may be the result of methodological and study population differences. Tumor location and laterality overall appear to influence cognitive outcomes, and detection of such an effect is contingent upon administration of appropriate cognitive tests. Surgery appears to have an overall initial deleterious effect on cognition with a recovery in most cases over several months. A large body of evidence supports the adverse effects of radiotherapy on cognition, but the role of chemotherapy is less clear. To contrast, baseline cognitive status appears to be a consistent factor that influences cognitive outcomes, with worse baseline cognition at diagnosis/pre-treatment correlated with worse long-term outcomes. Similarly, much evidence indicates that anti-epileptic drugs have a negative effect on cognition and genetics also appear to have a role. Evidence regarding the effect of age on cognitive outcomes in glioma patients is conflicting, and there is insufficient evidence for gender and fatigue. Cognitive reserve, brain reserve, socioeconomic status, and several other variables discussed in this review, and their influence on cognition and recovery, have not been well-studied in the context of gliomas and are areas for focus in future research.

Clinical relevance of the radiation dose bath in lower grade glioma, a cross-sectional pilot study on neurocognitive and radiological outcome

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Radiation-induced brain damage as a consequence of the RT dose bath was investigated.

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Multiple MRI-derived metrics and neurocognitive function domains were analysed.

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Our novel approach accounted for confounding effects associated with lower grade glioma.

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Higher RT dose to the left cerebrum was associated with poorer verbal memory performance.

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Higher RT dose correlated with hippocampal volume.

Aim

To investigate the clinical relevance of the radiotherapy (RT) dose bath in patients treated for lower grade glioma (LGG).

Methods

Patients (n = 17) treated with RT for LGG were assessed with neurocognitive function (NCF) tests and structural Magnetic Resonance Imaging (MRI) and categorized in subgroups based on tumour lateralisation. RT dose, volumetric results and cerebral microbleed (CMB) number were extracted for contralateral cerebrum, contralateral hippocampus, and cerebellum. The RT clinical target volume (CTV) was included in the analysis as a surrogate for focal tumour and other treatment effects. The relationships between RT dose, CTV, NCF and radiological outcome were analysed per subgroup.

Results

The subgroup with left-sided tumours (n = 10) performed significantly lower on verbal tests. The RT dose to the right cerebrum, as well as CTV, were related to poorer performance on tests for processing speed, attention, and visuospatial abilities, and more CMB.

In the subgroup with right-sided tumours (n = 7), RT dose in the left cerebrum was related to lower verbal memory performance, (immediate and delayed recall, r = −0.821, p = 0.023 and r = −0.937, p = 0.002, respectively), and RT dose to the left hippocampus was related to hippocampal volume (r = −0.857, p = 0.014), without correlation between CTV and NCF.

Conclusion

By using a novel approach, we were able to investigate the clinical relevance of the RT dose bath in patients with LGG more specifically. We used combined MRI-derived and NCF outcome measures to assess radiation-induced brain damage, and observed potential RT effects on the left-sided brain resulting in lower verbal memory performance and hippocampus volume.

Rule Perseveration during Task-Switching in Brain Tumor: A Severe Form of Task-Setting Impairment

It has been proposed that at least two distinct processes are engaged during task-switching: reconfiguration of the currently relevant task-set and interference resolution arising from the competing task-set. Whereas in healthy individuals the two are difficult to disentangle, their disruption is thought to cause different impairments in brain-damaged patients. Yet, the observed deficits are inconsistent across studies and do not allow drawing conclusions regarding their independence. Forty-one brain tumor patients were tested on a task-switching paradigm. We compared their performance between switch and repeat trials (switch cost) to assess rule reconfiguration, and between trials requiring the same response (congruent) and a different response for the two tasks (incongruent) to assess interference control. In line with previous studies, we found the greatest proportion of errors on incongruent trials, suggesting an interference control impairment. However, a closer look at the distribution of errors between two task rules revealed a rule perseveration impairment: Patients with high error rate on incongruent trials often applied only one task rule throughout the task and less frequently switched to the alternative one. Multivariate lesion-symptom mapping analysis unveiled the relationship between lesions localized in left orbitofrontal and posterior subcortical regions and perseveration scores, measured as absolute difference in accuracy between two task rules. This finding points to a more severe task-setting impairment, not reflected as a mere switching deficit, but instead as a difficulty in creating multiple stable task representations, in line with recent accounts of OFC functions suggesting its critical role in representing task states.

Cognitive reserve protects language functions in patients with brain tumours

Cognitive reserve (CR) theory suggests that individual differences in general intelligence (IQ), occupational attainment or participation in leisure/recreational activities protect against cognitive decline. However the relationship between CR and cognitive functioning in patients with brain tumours has been very rarely investigated in past research. The present study systematically assesses whether CR concept can also be applied to cognitive functions of neurosurgical patients affected by brain tumours. We investigated the role of different CR proxies (education level, premorbid IQ, current IQ, working and leisure activity) in protecting language against brain tumours and surgery effects, considering interactions with demographic (sex/age), anatomical (hemisphere/lobe location of lesion) and clinical/biological variables (tumour type: High/Low Grade Glioma or Meningioma; lesion volume; lesion aggressiveness). One-hundred patients undergoing neuropsychological assessment before and immediately after surgery participated. A "Language Score" summarizing performance on all language tests was derived with Principal Component Analysis. Data were then analyzed with Multiple Regression and Classification and Regression Tree analyses to investigate possible relationships between predictors (CR proxies and clinical variables) and Language Score. We found that premorbid IQ was the best predictor of pre-operatory language integrity, above and beyond all clinical variables considered, also moderating lesion volume effects. Moreover, patients with lower pre-operatory language integrity and low-to-moderately aggressive tumours showed a mitigating effect of current IQ over surgery consequences. Results thus suggest that different CR proxies play a role in moderating cognitive decline following brain tumours and surgery.

Longitudinal association of subjective prospective and retrospective memory and depression among patients with glioma

PURPOSE

This study investigated the levels of depression, subjective prospective memory (PM), and subjective retrospective memory (RM) among Chinese glioma patients and explored the bi-directional relationships between depression and memory impairment, including subjective PM and RM.

METHODS

Seventy-one participants with glioma were assessed for depression, PM, and RM at two time points (Time 1: within 48 h of being hospitalized; Time 2: two weeks after surgery). A cross-lagged path analysis was conducted to examine the bi-directional relationships between depression and memory.

MAIN RESULTS

Depression at T1 predicted memory impairment total scores (β = 0.22, P = 0.011) and RM (β = 0.29, P < 0.001) at T2. However, depression at TI could not predict PM at T2 (β = 0.15, P = 0.090). Memory, whether PM or RM, at T1 could not predict depression at T2 (β = 0.07, P = 0.497; β = 0.00, P = 0.978; β = 0.06, P = 0.321).

CONCLUSIONS

Depression can affect RM memory impairment among glioma patients. Oncology nurses should preoperatively screen for depression in glioma patients to identify high-risk groups, for whom emotional interventions and memory training should be carried out to reduce postoperative RM memory impairment.