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Drijver AJ, Oort Q, Otten R, Reijneveld JC, Klein M. Is poor sleep quality associated with poor neurocognitive outcome in cancer survivors? A systematic review. J Cancer Surviv 2024; 18:207-222. [PMID: 35499803 PMCID: PMC10960780 DOI: 10.1007/s11764-022-01213-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 04/12/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Cancer-related neurocognitive impairment and poor sleep are prevalent in cancer survivors and have a negative impact on their quality of life. This systematic review studies the association between sleep disturbance and neurocognitive functioning, as well as the potential positive effects of sleep interventions on neurocognitive functioning in cancer survivors. In addition, we aimed at determining the potential positive effects of sleep interventions on neurocognitive functioning in this population. METHODS Following PRISMA guidelines for reporting systematic reviews and meta-analyses, a comprehensive PubMed, Embase, PsycINFO, and CINAHL search was performed. Inclusion criteria were adult cancer survivors, self-reported or objective measures of neurocognitive functioning and sleep quality, or reports on the association between sleep and neurocognitive functioning. RESULTS Of the 4,547 records retrieved, 17 studies were retained for this review. Twelve studies were correlational, and five reported on interventions aimed at improving sleep quality. All studies that included self-reported neurocognitive functioning found that poorer sleep was associated with worse neurocognitive functioning. In four out of eight studies, poorer sleep was associated with objective neurocognitive impairment. Three out of five interventional studies showed neurocognitive functioning improved with improved sleep. CONCLUSIONS While poor sleep in cancer survivors is associated with self-reported neurocognitive impairment, the association between poor sleep and objective neurocognitive impairment is less evident. IMPLICATIONS FOR CANCER SURVIVORS It is important that care providers are aware of the association between sleep and neurocognitive functioning and that improving sleep quality can be a way to decrease neurocognitive impairment in cancer survivors.
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Affiliation(s)
- A Josephine Drijver
- Department of Neurology and Brain Tumor Center Amsterdam at Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Quirien Oort
- Department of Neurology and Brain Tumor Center Amsterdam at Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - René Otten
- Medical Library, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jaap C Reijneveld
- Department of Neurology and Brain Tumor Center Amsterdam at Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Neurology, Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands
| | - Martin Klein
- Department of Medical Psychology and Brain Tumor Center Amsterdam at Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
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2
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Oort Q, Koekkoek J, Aaronson NK, Boele FW, Brannan C, Capela A, Hjermstad M, Klein M, Lips I, Narita Y, Pace A, Petranovic D, Pichler J, Reijneveld JC, Sato H, Seidel C, Shamieh O, Sikkes SAM, Talacchi A, Uitdehaag BMJ, Urbanic T, Young T, Taphoorn MJB, Dirven L. PL02.4.A International validation study of an EORTC instrument measuring instrumental activities of daily living (IADL) in patients with brain tumours: EORTC IADL-BN32. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Brain tumour patients often have neurocognitive deficits which can result in problems with activities in daily living that are cognitively complex. Currently, no valid and reliable brain tumour-specific instrument to measure these instrumental activities of daily living (IADL) is available, but such an instrument is being developed. This study aimed to validate the EORTC IADL-BN32 questionnaire, comprising five multi-item and two single item scales, in a large set of international brain tumour patients.
Material and Methods
This international study was conducted in 10 countries worldwide. Primary and metastatic brain tumour patients and their proxies were requested to complete the EORTC IADL-BN32 and a subjective cognitive questionnaire (MOS COG-R) at multiple time points. Several psychometric properties were evaluated with baseline data, including the structural validity (bi-factor confirmatory factor analysis [CFA]), reliability (internal consistency), construct validity (known groups comparisons) and patient-proxy congruency (intra-class correlation coefficients [ICC], Spearman's correlation).
Results
At baseline, 326 patients ( 30% low-grade glioma, 37% high-grade glioma (HGG) and 33% brain metastases) and 311 proxies completed the EORTC IADL-BN32. The bi-factor CFA was found to have a satisfactory model fit (CFI=0.92 and TLI=0.90), and other parameters indicated a good fit (RMSEA=0.08 and SRMR=0.05), thereby validating the preliminary scale structure, but also an IADL sum score. The multi-item scales showed good (0.9>α≥0.8) to excellent (α≥0.9) internal consistency (range α=0.86-0.97). Known groups comparisons analyses regarding patient’s cognitive status (indications vs. no cognitive impairment), subjective cognitive complaints (MOS COG-R ≤30 vs. >30), basic ADL (Barthel Index <100 vs. 100) and performance status (KPS <70 vs. ≥70) showed significant differences on all IADL outcome measures in line with a priori defined hypotheses. On a group level, patient and proxy ratings had moderate to strong correlations, however, proxies tended to report more problems on all scales. The ICCs showed moderate to good congruency between patients and proxies (range ICC: 0.63-0.81).
Conclusion
The evaluated psychometric properties support the current scale structure of the EORTC IADL-BN32. Additional psychometric properties with longitudinal data are needed, such as test-retest reliability and responsiveness, to further validate the EORTC-IADL BN32 questionnaire.
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Affiliation(s)
- Q Oort
- Amsterdam University Medical Centers , Amsterdam , Netherlands
| | - J Koekkoek
- Leiden University Medical Center , Leiden , Netherlands
| | - N K Aaronson
- The Netherlands Cancer Institute , Amsterdam , Netherlands
| | - F W Boele
- Leeds Institute of Medical Research, St James’s University Hospital , Leeds , United Kingdom
| | - C Brannan
- East & North Hertfordshire NHS Trust incorporating Mount Vernon Cancer Centre , Northwood , United Kingdom
| | - A Capela
- Associação de Investigação de Cuidados de Suporte em Oncologia (AICSO) and Centro Hospitalar Vila Nova de Gaia , Espinho , Portugal
| | - M Hjermstad
- European Palliative Care Research Centre, Oslo University Hospital , Oslo , Norway
| | - M Klein
- Amsterdam University Medical Centers , Amsterdam , Netherlands
| | - I Lips
- Leiden University Medical Center , Leiden , Netherlands
| | - Y Narita
- National cancer center hospital , Tokyo , Japan
| | - A Pace
- IRCCS Regina Elena National Cancer Institute , Rome , Italy
| | - D Petranovic
- Clinical Hospital Center Rijeka , Rijeka , Croatia
| | - J Pichler
- Institut für Innere Medizin mit Neuroonkologie , Linz , Austria
| | - J C Reijneveld
- Amsterdam University Medical Centers , Amsterdam , Netherlands
| | - H Sato
- Leiden University Medical Center; Teikyo Heisei University , Tokyo , Japan
| | - C Seidel
- University of Leipzig , Leipzig , Germany
| | - O Shamieh
- King Hussein Cancer Center , Amman , Jordan
| | - S A M Sikkes
- Amsterdam University Medical Centers , Amsterdam , Netherlands
| | - A Talacchi
- Azienda Ospedaliera San Giovanni Addolorata , Rome , Italy
| | - B M J Uitdehaag
- Amsterdam University Medical Centers , Amsterdam , Netherlands
| | - T Urbanic
- Medical University of Graz , Graz , Austria
| | - T Young
- East & North Hertfordshire NHS Trust incorporating Mount Vernon Cancer Centre , Nothwood , United Kingdom
| | | | - L Dirven
- Leiden University Medical Center , Leiden , Netherlands
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Oort Q, Dirven L, Sikkes SAM, Aaronson N, Boele F, Brannan C, Egeter J, Grant R, Klein M, Lips IM, Narita Y, Sato H, Sztankay M, Stockhammer G, Talacchi A, Uitdehaag BMJ, Reijneveld JC, Taphoorn MJB. Do neurocognitive impairments explain the differences between brain tumour patients and their proxies when assessing the patient’s IADL? Neurooncol Pract 2022; 9:271-283. [PMID: 35855454 PMCID: PMC9290871 DOI: 10.1093/nop/npac016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Neurocognitive impairments are common among brain tumour patients, and may impact patient’s awareness of performance in instrumental activities in daily life (IADL). We examined differences between patient- and proxy-reported assessments of the patient’s IADL, and whether the level of (dis)agreement is associated with neurocognitive impairments.
Methods
Brain tumour patients and their proxies completed the phase 3 version of the EORTC IADL-BN32 questionnaire measuring IADL, and patients completed six neurocognitive measures. Patient-proxy difference scores in IADL were compared between patients who were defined as neurocognitively impaired (≥2 neurocognitive measures ≥2.0 standard deviations below healthy controls) and non-neurocognitively impaired. With multinomial logistic regression analyses we examined if neurocognitive variables were independently associated with patient-proxy disagreement in IADL ratings.
Results
Patients (n=81) did not systematically (p<0.01) rate IADL outcomes different than their proxies. Proxies did report more problems on 19/32 individual items and all five scales. This effect was more apparent in dyads with a neurocognitively impaired patient (n=37), compared to dyads with non-neurocognitively impaired patients (n=44). Multinomial logistic regression analyses showed that several neurocognitive variables (e.g., cognitive flexibility and verbal fluency) were independently associated with disagreement between patients and proxies on different scales.
Conclusion
Neurocognitive deficits seem to play a role in the discrepancies between brain tumour patients and their proxies assessment of patient’s level of IADL . Although replication of our results is needed, our findings suggests that caution is warranted in interpreting self-reported IADL by patients with neurocognitive impairment, and that such self-reports should be supplemented with proxy ratings.
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Affiliation(s)
- Quirien Oort
- Department of Neurology and Brain Tumor Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Linda Dirven
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
| | - Sietske A M Sikkes
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Alzheimer Center, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Vrije Universiteit Amsterdam, Faculty of Behavioural and Movement Sciences (FGB), Department of Clinical Developmental & Clinical Neuropsychology, Amsterdam, The Netherlands
| | - Neil Aaronson
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Florien Boele
- Leeds Institute of Medical Research, St James’s University Hospital, Leeds, LS9 7TF, United Kingdom
- Leeds Institute of Health Sciences, Faculty of Medicine and Health, University of Leeds, Leeds, LS2 9JT, United Kingdom
| | - Christine Brannan
- East & North Hertfordshire NHS Trust incorporating Mount Vernon Cancer Centre, Northwood, United Kingdom
| | - Jonas Egeter
- Department for Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria
| | - Robin Grant
- Department of Clinical Neurosciences, Western General Hospital, Edinburgh, United Kingdom
| | - Martin Klein
- Department of Medical Psychology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Irene M Lips
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Yoshitaka Narita
- Department of Neurosurgery and Neuro-Oncology, National Cancer Center, Tokyo, Japan
| | - Hitomi Sato
- Department of Neurosurgery and Neuro-Oncology, National Cancer Center, Tokyo, Japan
- Department of Nursing, Teikyo Heisei University, Tokyo, Japan
| | - Monika Sztankay
- Department for Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Andrea Talacchi
- Department of Neurosurgery, Azienda Ospedaliera San Giovanni Addolorata, Roma, Italy
| | - Bernard M J Uitdehaag
- Department of Neurology and Brain Tumor Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jaap C Reijneveld
- Department of Neurology and Brain Tumor Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Neurology, Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands
| | - Martin J B Taphoorn
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
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4
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Oort Q, Zwinkels H, Koekkoek JAF, Vos MJ, Reijneveld JC, Taphoorn MJB, Dirven L. Is the EORTC QLQ-C30 emotional functioning scale appropriate as an initial screening measure to identify brain tumour patients who may possibly have a mood disorder? Psychooncology 2022; 31:995-1002. [PMID: 35083812 PMCID: PMC9303778 DOI: 10.1002/pon.5889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/22/2021] [Accepted: 12/20/2021] [Indexed: 11/12/2022]
Abstract
Background Screening glioma patients regularly for possible mood disorders may facilitate early identification and referral of patients at risk. This study evaluated if the EORTC QLQ‐C30 Emotional Functioning (EF) scale could be used as an initial screening measure to identify patients possibly having a mood disorder. Methods EORTC QLQ‐C30 EF and Hospital Anxiety and Depression Scale (HADS) scores were collected as part of a study assessing the impact of timing of patient‐reported outcome assessments on actual health‐related quality of life outcomes (N = 99). Spearman correlations and Mann‐Whitney U tests were used to determine the association between the EF and HADS (sub)scales. Receiver Operating Characteristic analyses were performed to determine optimal cut‐off EF scores to identify patients possibly having a mood disorder (i.e. HADS subscale score ≥8 points). Results EF and HADS (sub)scales correlated moderately (HADS‐A: r = −0.65; HADS‐D: r = −0.52). Significant EF score differences were found between patients with HADS ≥8 versus <8 points (HADS‐A: mean difference (MD) = 32 and HADS‐D: MD = 23). The EF scale had excellent (HADS‐A; AUC = 0.88) and borderline excellent (HADS‐D; AUC = 0.78) distinguishing capabilities. A statistically optimal (EF score <80) and a most inclusive (sensitivity of 100%, corresponding to an EF score <97) EF cut‐off score correctly identified 88.0% and 96.0% of patients with a possible mood disorder, respectively. Conclusion EORTC QLQ‐C30 EF scale seems to be an appropriate screening measure to identify glioma patients possibly having a mood disorder in need of further assessment.
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Affiliation(s)
- Quirien Oort
- Department of Neurology and Brain Tumor Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Hanneke Zwinkels
- Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
| | - Johan A F Koekkoek
- Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands.,Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Maaike J Vos
- Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
| | - Jaap C Reijneveld
- Department of Neurology and Brain Tumor Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Neurology, Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands
| | - Martin J B Taphoorn
- Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands.,Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Linda Dirven
- Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands.,Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
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5
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Oort Q, Dirven L, Sikkes S, Aaronson N, Boele F, Brannan C, Egeter J, Grant R, Klein M, Lips I, Narita Y, Sato H, Sztankay M, Stockhammer G, Talacchi A, Uitdehaag B, Reijneveld J, Taphoorn M. OS05.4.A Do neurocognitive deficits explain the differences between brain tumour patients and their proxies assessing the patient’s I-ADL? Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab180.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
Neurocognitive deficits are common among brain tumour patients, and may impact on patient awareness of deficits in instrumental activities in daily life (IADL). This study aimed to examine differences between patient-reported and proxy-reported assessments of the patient’s performance of IADL, and whether the level of (dis)agreement is associated with neurocognitive deficits.
MATERIAL AND METHODS
A phase III EORTC questionnaire measuring IADL in brain tumour patients (EORTC IADL-BN32) and six neurocognitive test measures were administered as part of a larger multicentre international study designed to develop a brain tumour specific IADL questionnaire. Bland-Altman plots and Mann-Whitney U tests were used to evaluated patient- and proxy-reported IADL on a group level. Subsequently, Mann-Whitney U tests were performed to compare patient-proxy difference scores (patient IADL score - their proxy IADL score) between patients who were considered clearly neurocognitively impaired (≥2 neurocognitive test measures; ≤2.0 SD below healthy controls) and patients who were not. Furthermore, multinomial logistic regression analyses were performed to examined which sociodemgraphic, clinical, and particularly neurocognitive variables were independently associated with patients and proxies differing in their evaluation of patient’s IADL.
RESULTS
Patients (N=81) and proxies (N=81), on group level, did not significantly differ on either the IADL individual item or scale scores. However, significant differences were found on patient-proxy difference scores between patients who were (N=37) and were not (N=44) considered clearly neurocognitively impaired for 10/32 individual items and one of the scales (i.e. Scale 4: Administrative tasks), all showing that the proxies of clearly neurocognitively impaired patients reported more problems relative to the patients themselves, compared to proxies of patients not clearly neurocognitively impaired. Furthermore, for each scale, a neurocognitive variable, either impaired information processing speed, cognitive flexibility, verbal fluency or the number of neurocognitive test measures impaired, was found to be independently associated with proxies reporting more problems. For 4/5 scales, a clinical variable was additionally independently associated with proxies reporting more problems. Only one variable was independently associated with patient reporting more problems, namely being in active treatment was found to be associated with patients reporting more problems on Scale 4: Administrative tasks.
CONCLUSION
Results imply a consistent trend of clearly neurocognitively impaired patients underreporting problems with IADL compared to their proxies. It would therefore be advised to administer both the patient- and proxy-version of the EORTC IADL-BN32, particularly if neurocognitive deficits are presumed.
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Affiliation(s)
- Q Oort
- Amsterdam UMC, Amsterdam, Netherlands
| | - L Dirven
- Leiden University Medical Center, Leiden, Netherlands
| | - S Sikkes
- Amsterdam UMC, Amsterdam, Netherlands
| | - N Aaronson
- The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - F Boele
- St James’s University Hospital/University of Leeds, Leeds, United Kingdom
| | - C Brannan
- East & North Hertfordshire NHS Trust incorporating Mount Vernon Cancer Centre, Northwood, United Kingdom
| | - J Egeter
- Medical University of Innsbruck, Innsbruck, Austria
| | - R Grant
- Western General Hospital, Edinburgh, United Kingdom
| | - M Klein
- Amsterdam UMC, Amsterdam, Netherlands
| | - I Lips
- Leiden University Medical Center, Leiden, Netherlands
| | - Y Narita
- National Cancer Center, Tokyo, Japan
| | - H Sato
- Teikyo Heisei University, Tokyo, Japan
| | - M Sztankay
- Medical University of Innsbruck, Innsbruck, Austria
| | | | - A Talacchi
- Azienda Ospedaliera San Giovanni Addolorata, Rome, Italy
| | | | | | - M Taphoorn
- Haaglanden Medical Center, The Hague, Netherlands
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Oort Q, Dirven L, Sikkes SAM, Aaronson N, Boele F, Brannan C, Egeter J, Grant R, Klein M, Lips I, Narita Y, Sato H, Sztankay M, Stockhammer G, Talacchi A, Uitdehaag BMJ, Reijneveld JC, Taphoorn MJB. Development of an EORTC questionnaire measuring instrumental activities of daily living (IADL) in patients with brain tumours: phase I-III. Qual Life Res 2021; 30:1491-1502. [PMID: 33496902 PMCID: PMC8068708 DOI: 10.1007/s11136-020-02738-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2020] [Indexed: 04/02/2024]
Abstract
PURPOSE Being able to function independently in society is an important aspect of quality of life. This ability goes beyond self-care, requires higher order cognitive functioning, and is typically measured with instrumental activities of daily living (IADL) questionnaires. Cognitive deficits are frequently observed in brain tumour patients, however, IADL is almost never assessed because no valid and reliable IADL measure is available for this patient group. Therefore, this measure is currently being developed. METHODS This international multicentre study followed European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Group module development guidelines. Three out of four phases are completed: phases (I) generation of items, (II) construction of the item list, and (III) pre-testing. This paper reports the item selection procedures and preliminary psychometric properties of the questionnaire. Brain tumour patients (gliomas and brain metastases), their informal caregivers, and health care professionals (HCPs) were included. RESULTS Phase I (n = 44 patient-proxy dyads and 26 HCPs) generated 59 relevant and important activities. In phase II, the activities were converted into items. In phase III (n = 85 dyads), the 59 items were pre-tested. Item selection procedures resulted in 32 items. Exploratory factor analysis revealed a preliminary dimensional structure consisting of five scales with acceptable to excellent internal consistency (α = 0.73-0.94) and two single items. For three scales, patients with cognitive impairments had significantly more IADL problems than patients without impairments. CONCLUSION A phase IV validation study is needed to confirm the psychometric properties of the EORTC IADL-BN32 questionnaire in a larger international sample.
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Affiliation(s)
- Quirien Oort
- Department of Neurology and Brain Tumor Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, PO BOX 7057, 1007 MB, Amsterdam, The Netherlands.
| | - Linda Dirven
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
| | - Sietske A M Sikkes
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Alzheimer Center, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Clinical Developmental & Clinical Neuropsychology, Faculty of Behavioural and Movement Sciences (FGB), Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Neil Aaronson
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Florien Boele
- Leeds Institute of Medical Research, St James's University Hospital, Leeds, LS9 7TF, UK
- Faculty of Medicine and Health, Leeds Institute of Health Sciences, University of Leeds, Leeds, LS2 9JT, UK
| | - Christine Brannan
- East & North Hertfordshire NHS Trust Incorporating Mount Vernon Cancer Centre, Northwood, UK
| | - Jonas Egeter
- Department for Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria
| | - Robin Grant
- Department of Clinical Neurosciences, Western General Hospital, Edinburgh, UK
| | - Martin Klein
- Department of Medical Psychology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Irene Lips
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Yoshitaka Narita
- Department of Neurosurgery and Neuro-Oncology, National Cancer Center, Tokyo, Japan
| | - Hitomi Sato
- Department of Neurosurgery and Neuro-Oncology, National Cancer Center, Tokyo, Japan
- Department of Nursing, Teikyo Heisei University, Tokyo, Japan
| | - Monika Sztankay
- Department for Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Andrea Talacchi
- Department of Neurosurgery, Azienda Ospedaliera San Giovanni Addolorata, Rome, Italy
| | - Bernard M J Uitdehaag
- Department of Neurology and Brain Tumor Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, PO BOX 7057, 1007 MB, Amsterdam, The Netherlands
| | - Jaap C Reijneveld
- Department of Neurology and Brain Tumor Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, PO BOX 7057, 1007 MB, Amsterdam, The Netherlands
- Department of Neurology, Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands
| | - Martin J B Taphoorn
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
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7
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Oort Q, Dirven L, Boele F, Grant R, Sato H, Talacchi A, Young T, Reijneveld JC, Taphoorn MJB. OS3.3 Development of an EORTC questionnaire measuring instrumental activities of daily living (IADL) in patients with brain tumours: phase I-III. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz126.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
BACKGROUND
In brain tumour patients, impairments in every day functioning can impact quality of life, and are therefore an important outcome in both clinical trials and practice. One way to measure every day functioning is with an activities of daily living (ADL) questionnaire. Instrumental ADL (IADL) are the cognitively more complex activities, that are essential to function autonomously within society. Cognitive decline may therefore negatively impact IADL, making these activities particularly relevant to brain tumour patients. The aim of this study is to develop a reliable and valid questionnaire to measure IADL in primary malignant and metastatic brain tumour patients.
MATERIAL AND METHODS
The questionnaire development study followed the standard European Organisation for Research and Treatment of Cancer (EORTC) four phase methodology: (I) generation of activities list, (II) construction of item list, (III) pre-testing, and (IV) field testing. This report covers phases I-III. To ensure cross-cultural validity, participants were recruited from different countries (The Netherlands, United Kingdom, Italy, Austria and Japan). In phase I, potential activities were identified based on a literature review and in-depth interviews with patients, proxies and healthcare professionals. In phase II, activities were turned into items, and translated into all required languages by the EORTC Translation Unit. In phase III, the item list was pre-tested in patient-proxy dyads. In accordance with predetermined decision rules to reduce items, final items were selected, and preliminary psychometric properties (i.e. factor structure, validity, reliability) were assessed.
RESULTS
Phase I (N=44 dyads) resulted in 59 IADL activities which were converted into 59 items in phase II. In phase III, N=85 dyads completed and reviewed this item list. The item list was subsequently reduced to 32 items. An exploratory factor analysis indicated several items measuring similar underlying constructs (e.g. domestic life and using computer/smartphone) showing acceptable to good (α≥0.7) internal consistency (range α=0.69–0.89). Seven items were less related to these underlying constructs (e.g. work or managing your own medication), and therefore single items. Construct validity, measured with known-group comparisons analyses between cognitively impaired and unimpaired patients, showed significant differences in scores between the two groups on some scales and several single items.
CONCLUSION
The currently developed EORTC IADL-BN32 questionnaire can be a valuable asset in assessing IADL functioning in brain tumour patients, but further validation in phase IV is required and is planned.
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Affiliation(s)
- Q Oort
- Amsterdam University Medical Center, Amsterdam, Netherlands
| | - L Dirven
- Leiden University Medical Center, Leiden, Netherlands
| | - F Boele
- Leeds Institute of Cancer and Pathology, Leeds, United Kingdom
| | - R Grant
- Western General Hospital, Edinburgh, United Kingdom
| | - H Sato
- Chiba University, Chiba, Japan
| | - A Talacchi
- University Hospital of Verona, Verona, Italy
| | - T Young
- Mount Vernon Hospital, Northwood, United Kingdom
| | - J C Reijneveld
- Amsterdam University Medical Center, Amsterdam, Netherlands
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Oort Q, Taphoorn MJB, Sikkes SAM, Uitdehaag BMJ, Reijneveld JC, Dirven L. Evaluation of the content coverage of questionnaires containing basic and instrumental activities of daily living (ADL) used in adult patients with brain tumors. J Neurooncol 2019; 143:1-13. [PMID: 30887244 PMCID: PMC6482128 DOI: 10.1007/s11060-019-03136-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Accepted: 02/26/2019] [Indexed: 11/15/2022]
Abstract
Background Everyday functioning can be assessed using measures of basic activities of daily living (BADL) or instrumental activities of daily living (IADL). The aim of this review was to provide an overview of the scope and specific content of BADL and/or IADL covered by currently used questionnaires in adult brain tumor patient studies. Methods Electronic databases were searched up to April 2017 to identify all eligible questionnaires with items regarding BADL/IADL in studies with adult brain tumor patients. Articles were selected using predetermined in- and exclusion criteria. Items with similar content were clustered into domains based on type of activity. Results Thirty-one unique questionnaires containing at least one BADL and/or IADL item were identified; 21 and 29 questionnaires containing ≥ 1 BADL or IADL item, respectively. The percentage of ADL items in these questionnaires ranged from 4 to 100%. Only two questionnaires were specifically developed to measure BADL (Barthel Index and Katz-ADL) and two specifically for IADL (Lawton-Brody IADL and preliminary IADL-BN). Content clustering revealed that IADL had a larger variation in content (31 domains, e.g. work or leisure time activities) compared to BADL (15 domains, e.g. mobility or bathing/washing). Conclusion Thirty-one questionnaires previously used in brain tumor studies contained items on BADL and/or IADL and covered a wide range of content, in particular for IADL. It is currently unclear which BADL/IADL are most relevant for brain tumor patients, and this should therefore be evaluated. Next, existing questionnaires could be adapted or validated, or new measures can be developed to meet these needs. Electronic supplementary material The online version of this article (10.1007/s11060-019-03136-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Quirien Oort
- Department of Neurology and Brain Tumor Center Amsterdam, Amsterdam University Medical Centers (Location VUmc), PO BOX 7057, 1007 MB, Amsterdam, The Netherlands.
| | - Martin J B Taphoorn
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
| | - Sietske A M Sikkes
- Department of Epidemiology and Biostatistics, Amsterdam University Medical Centers (Location VUmc), Amsterdam, The Netherlands.,Alzheimer Center, Amsterdam University Medical Centers (Location VUmc), Amsterdam, The Netherlands
| | - Bernard M J Uitdehaag
- Department of Neurology and Brain Tumor Center Amsterdam, Amsterdam University Medical Centers (Location VUmc), PO BOX 7057, 1007 MB, Amsterdam, The Netherlands
| | - Jaap C Reijneveld
- Department of Neurology and Brain Tumor Center Amsterdam, Amsterdam University Medical Centers (Location VUmc), PO BOX 7057, 1007 MB, Amsterdam, The Netherlands.,Department of Neurology, Amsterdam University Medical Centers (Location AMC), Amsterdam, The Netherlands
| | - Linda Dirven
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
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Oort Q, Taphoorn M, Sikkes S, Uitdehaag B, Reijneveld J, Dirven L. NCOG-08. DETERMINING THE CONTENT VALIDITY OF MEASURES OF BASIC AND INSTRUMENTAL ACTIVITIES OF DAILY LIVING (ADL) IN PATIENTS WITH BRAIN TUMORS: A SYSTEMATIC REVIEW. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy148.723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Quirien Oort
- VU University Medical Center, Amsterdam, Netherlands
| | | | - Sietske Sikkes
- Alzheimer Center, VU University Medical Center, Amsterdam, Netherlands
| | - Bernard Uitdehaag
- Department of Neurology and Brain Tumor Center Amsterdam, VU University Medical Center, Amsterdam, Netherlands
| | | | - Linda Dirven
- Department of Neurology, Leiden University Medical Center, Leiden, Netherlands
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Oort Q, Taphoorn M, Sikkes S, Uitdehaag B, Reijneveld J, Dirven L. P01.079 Determining the content validity of measures of basic and instrumental activities of daily living (ADL) in patients with brain tumours, a systematic review. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy139.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Q Oort
- VU University Medical Center, Amsterdam, Netherlands
| | - M Taphoorn
- Haaglanden Medical Center, The Hague, Netherlands
| | - S Sikkes
- VU University Medical Center, Amsterdam, Netherlands
| | - B Uitdehaag
- VU University Medical Center, Amsterdam, Netherlands
| | - J Reijneveld
- VU University Medical Center, Amsterdam, Netherlands
| | - L Dirven
- Leiden University Medical Center, Leiden, Netherlands
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Ten Brink AF, Biesbroek JM, Oort Q, Visser-Meily JMA, Nijboer TCW. Peripersonal and extrapersonal visuospatial neglect in different frames of reference: A brain lesion-symptom mapping study. Behav Brain Res 2018; 356:504-515. [PMID: 29940260 DOI: 10.1016/j.bbr.2018.06.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 05/28/2018] [Accepted: 06/11/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Visuospatial neglect can occur in peripersonal and extrapersonal space. The dorsal visual pathway is hypothesized to be associated with peripersonal, and the ventral pathway with extrapersonal neglect. We aimed to evaluate neural substrates of peripersonal versus extrapersonal neglect, separately for egocentric and allocentric frames of reference. METHODS This was a retrospective study, including stroke patients admitted for inpatient rehabilitation. Approximately 1 month post-stroke onset, computerized cancellation (egocentric) and bisection tasks (egocentric and allocentric) were administered at 30 cm and 120 cm. We collected CT or MRI scans and performed voxel-based lesion-symptom mapping for the cancellation, and subtraction analyses for the line bisection task. RESULTS We included 98 patients for the cancellation and 129 for the bisection analyses. The right parahippocampal gyrus, hippocampus, and thalamus were associated with egocentric peripersonal neglect as measured with cancellation. These areas were also associated with extrapersonal neglect, together with the right superior parietal lobule, angular gyrus, supramarginal gyrus, lateral occipital cortex, planum temporale and superior temporal gyrus. Lesions in the right parietal, temporal and frontal areas were associated with both peripersonal and extrapersonal egocentric neglect as measured with bisection. For allocentric neglect no clear pattern of associated brain regions was observed. DISCUSSION We found right hemispheric anatomical correlates for peripersonal and extrapersonal neglect. However, no brain areas were uniquely associated with peripersonal neglect, meaning we could not conclusively verify the ventral/dorsal hypothesis. Several areas were uniquely associated with egocentric extrapersonal neglect, suggesting that these brain areas can be specifically involved in extrapersonal, but not in peripersonal, attention processes.
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Affiliation(s)
- Antonia F Ten Brink
- Center of Excellence in Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands; Department of Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, The Netherlands
| | - J Matthijs Biesbroek
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Quirien Oort
- Center of Excellence in Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Johanna M A Visser-Meily
- Center of Excellence in Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands; Department of Rehabilitation, Physical Therapy Science & Sports, Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands
| | - Tanja C W Nijboer
- Center of Excellence in Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands; Department of Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, The Netherlands.
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Oort Q, Dirven L, Meijer W, Sikkes SAM, Uitdehaag BMJ, Reijneveld JC, Taphoorn MJB. Development of a questionnaire measuring instrumental activities of daily living (IADL) in patients with brain tumors: a pilot study. J Neurooncol 2017; 132:145-153. [PMID: 28150189 PMCID: PMC5352794 DOI: 10.1007/s11060-016-2352-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 12/23/2016] [Indexed: 12/04/2022]
Abstract
Both dementia and brain tumor patients exhibit cognitive decline during the course of their disease. They might therefore experience similar problems with cognitively complex daily activities (i.e., instrumental activities of daily living (IADL)). The study's objective is to evaluate if the Amsterdam IADL Questionnaire© (A-IADL-Q), a 70-item IADL questionnaire developed for and validated in early dementia patients, is also applicable to glioma patients. The evaluation consisted of three steps. Predetermined decision rules defined which activities were retained, altered, added or excluded. In the first step, 6 neuro-oncology health care professionals (HCP) and 10 glioma patient-proxy dyads were asked to evaluate the 70 A-IADL-Q activities. In the second step, in-depth interviews were conducted with 6 HCPs and 6 other patient-proxy dyads to generate relevant activities specific to glioma patients not covered by the A-IADL-Q. In the third step, 6 new patient-proxy dyads were cognitively debriefed with the list of activities constructed in the previous steps. Results indicated that in step 1, after alterations and exclusions, 28/70 activities could be retained. Nine newly generated activities were subsequently added in step 2. In step 3, the 37 activities were presented to the patient-proxy dyads. Based on their input, several additional alterations and exclusions were made resulting in a list of 32 activities. In conclusion, this evaluation of the A-IADL-Q showed that dementia-specific IADL activities are only partly applicable to glioma patients, and that the addition of glioma specific IADL activities is necessary to capture the IADL construct. This underlines the need for a disease-specific IADL questionnaire for brain tumor patients.
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Affiliation(s)
- Q Oort
- Department of Neurology and Brain Tumor Center Amsterdam, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands.
| | - L Dirven
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - W Meijer
- Department of Neurology and Brain Tumor Center Amsterdam, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - S A M Sikkes
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands.,Alzheimer Center, VU University Medical Center, Amsterdam, The Netherlands
| | - B M J Uitdehaag
- Department of Neurology and Brain Tumor Center Amsterdam, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - J C Reijneveld
- Department of Neurology and Brain Tumor Center Amsterdam, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands.,Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands
| | - M J B Taphoorn
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Neurology, Medical Center Haaglanden, The Hague, The Netherlands
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Ten Brink AF, Biesbroek JM, Kuijf HJ, Van der Stigchel S, Oort Q, Visser-Meily JM, Nijboer TC. Corrigendum to “The right hemisphere is dominant in organization of visual search—A study in stroke patients” [Behav. Brain Res. 304 (2016) 71–79]. Behav Brain Res 2017; 319:234. [DOI: 10.1016/j.bbr.2016.11.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Oort Q, Dirven L, Meijer W, Sikkes SA, Uitdehaag BM, Reijneveld JC, Taphoorn MJ. P03.01 Evaluation of the relevance of an Instrumental Activities of Daily Living (IADL) questionnaire developed for dementia patients in glioma patients. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now188.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Ten Brink AF, Biesbroek JM, Kuijf HJ, Van der Stigchel S, Oort Q, Visser-Meily JMA, Nijboer TCW. The right hemisphere is dominant in organization of visual search-A study in stroke patients. Behav Brain Res 2016; 304:71-9. [PMID: 26876010 DOI: 10.1016/j.bbr.2016.02.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 01/14/2016] [Accepted: 02/04/2016] [Indexed: 11/18/2022]
Abstract
Cancellation tasks are widely used for diagnosis of lateralized attentional deficits in stroke patients. A disorganized fashion of target cancellation has been hypothesized to reflect disturbed spatial exploration. In the current study we aimed to examine which lesion locations result in disorganized visual search during cancellation tasks, in order to determine which brain areas are involved in search organization. A computerized shape cancellation task was administered in 78 stroke patients. As an index for search organization, the amount of intersections of paths between consecutive crossed targets was computed (i.e., intersections rate). This measure is known to accurately depict disorganized visual search in a stroke population. Ischemic lesions were delineated on CT or MRI images. Assumption-free voxel-based lesion-symptom mapping and region of interest-based analyses were used to determine the grey and white matter anatomical correlates of the intersections rate as a continuous measure. The right lateral occipital cortex, superior parietal lobule, postcentral gyrus, superior temporal gyrus, middle temporal gyrus, supramarginal gyrus, inferior longitudinal fasciculus, first branch of the superior longitudinal fasciculus (SLF I), and the inferior fronto-occipital fasciculus, were related to search organization. To conclude, a clear right hemispheric dominance for search organization was revealed. Further, the correlates of disorganized search overlap with regions that have previously been associated with conjunctive search and spatial working memory. This suggests that disorganized visual search is caused by disturbed spatial processes, rather than deficits in high level executive function or planning, which would be expected to be more related to frontal regions.
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Affiliation(s)
- Antonia F Ten Brink
- Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - J Matthijs Biesbroek
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Hugo J Kuijf
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Stefan Van der Stigchel
- Department of Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, The Netherlands
| | - Quirien Oort
- Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Johanna M A Visser-Meily
- Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Tanja C W Nijboer
- Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands; Department of Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, The Netherlands.
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