Journal of Neuro-Oncology

, Volume 97, Issue 1, pp 109–115 | Cite as

Neurocognitive training in patients with high-grade glioma: a pilot study

  • Marco Ronald Hassler
  • Katarzyna Elandt
  • Matthias Preusser
  • Johann Lehrner
  • Petra Binder
  • Karin Dieckmann
  • Andrea Rottenfusser
  • Christine MarosiEmail author
Clinical Study - Patient Study


Although their neurocognitive performance is one of the major concerns of patients with high-grade gliomas (HGG) and although neurocognitive deficits have been described to be associated with negative outcome, neurocognitive rehabilitation is usually not integrated into the routine care of patients with malignant gliomas. In this pilot trial, a weekly group training session for attention, verbal, and memory skills was offered to patients with HGG with pre and post-training evaluation. Eleven patients, six with glioblastoma multiforme and five with WHO grade III gliomas, median age 50 years, with a Karnofsky performance score of 80–100 participated in ten group training sessions of 90 min. For evaluation at baseline and after the training by a neuropsychologist not involved in care or training of the patients, Trail Making Tests A and B (TMTA and TMTB), Hopkins Verbal Learning Test (HVLT), and the Controlled Oral Word Association Test (COWA) were used. Comparison of mean group differences between baseline and at post-training evaluation after 12 weeks revealed improvement across all neurocognitive variables. The patients showed a great diversity in their performances, with worsening, improvement, and stabilization. However, a significant group difference was detected only for the HVLT (score 19.6 ± 8.9 at baseline, 23.6 ± 8.8 after 12 weeks, P = 0.04). This pilot study shows that neurocognitive training in patients with HGG is feasible as group training with weekly sessions and might be able to induce improvements in attention and memory skills.


Neurocognitive training Hopkins Verbal Learning Test High-grade glioma 


  1. 1.
    Correa DD, Shi W, Thaler HT, Cheung AM, DeAngelis LM, Abrey LE (2008) Longitudinal cognitive follow-up in low-grade gliomas. J Neurooncol 86(3):321–327CrossRefPubMedGoogle Scholar
  2. 2.
    Lebrun C, Fontaine D, Bourg V, Ramaioli A, Chanalet S, Vandenbos F, Lonjon M, Fauchon F, Paquis P, Frenay M (2007) Treatment of newly diagnosed symptomatic pure low-grade oligodendrogliomas with PCV chemotherapy. Eur J Neurol 14(4):391–398CrossRefPubMedGoogle Scholar
  3. 3.
    Shaw EG, Rosdhal R, D’Agostino RB Jr, Lovato J, Naughton MJ, Robbins ME, Rapp SR (2006) Phase II study of donepezil in irradiated brain tumor patients: effect on cognitive function, mood, and quality of life. J Clin Oncol 24(9):1415–1420CrossRefPubMedGoogle Scholar
  4. 4.
    Aarsen FK, Paquier PF, Reddingius RE, Streng IC, Arts WF, Evera-Preesman M, Catsman-Berrevoets CE (2006) Functional outcome after low-grade astrocytoma treatment in childhood. Cancer 106(2):396–402CrossRefPubMedGoogle Scholar
  5. 5.
    Brown PD, Buckner JC, O’Fallon JR, Iturria NL, O’Neill BP, Brown CA, Scheithauer BW, Dinapoli RP, Arusell RM, Curran WJ et al (2004) Importance of baseline mini-mental state examination as a prognostic factor for patients with low-grade glioma. Int J Radiat Oncol Biol Phys 59(1):117–125PubMedGoogle Scholar
  6. 6.
    Surma-aho O, Niemela M, Vilkki J, Kouri M, Brander A, Salonen O, Paetau A, Kallio M, Pyykkonen J, Jaaskelainen J (2001) Adverse long-term effects of brain radiotherapy in adult low-grade glioma patients. Neurology 56(10):1285–1290PubMedGoogle Scholar
  7. 7.
    Yule SM, Hide TA, Cranney M, Simpson E, Barrett A (2001) Low grade astrocytomas in the West of Scotland 1987-96: treatment, outcome, and cognitive functioning. Arch Dis Child 84(1):61–64CrossRefPubMedGoogle Scholar
  8. 8.
    Amiez C, Kostopoulos P, Champod AS, Collins DL, Doyon J, Del Maestro R, Petrides M (2008) Preoperative functional magnetic resonance imaging assessment of higher-order cognitive function in patients undergoing surgery for brain tumors. J Neurosurg 108(2):258–268CrossRefPubMedGoogle Scholar
  9. 9.
    Briere ME, Scott JG, McNall-Knapp RY, Adams RL (2008) Cognitive outcome in pediatric brain tumor survivors: delayed attention deficit at long-term follow-up. Pediatr Blood Cancer 50(2):337–340CrossRefPubMedGoogle Scholar
  10. 10.
    Beebe DW, Ris MD, Armstrong FD, Fontanesi J, Mulhern R, Holmes E, Wisoff JH (2005) Cognitive and adaptive outcome in low-grade pediatric cerebellar astrocytomas: evidence of diminished cognitive and adaptive functioning in National Collaborative Research Studies (CCG 9891/POG 9130). J Clin Oncol 23(22):5198–5204CrossRefPubMedGoogle Scholar
  11. 11.
    Docking KM, Ward EC, Murdoch BE (2005) Language outcomes subsequent to treatment of brainstem tumour in childhood. NeuroRehabilitation 20(2):107–124PubMedGoogle Scholar
  12. 12.
    Ater JL, Moore BD III, Francis DJ, Castillo R, Slopis J, Copeland DR (1996) Correlation of medical and neurosurgical events with neuropsychological status in children at diagnosis of astrocytoma: utilization of a neurological severity score. J Child Neurol 11(6):462–469CrossRefPubMedGoogle Scholar
  13. 13.
    Haggard P, Jenner J, Wing A (1994) Coordination of aimed movements in a case of unilateral cerebellar damage. Neuropsychologia 32(7):827–846CrossRefPubMedGoogle Scholar
  14. 14.
    Radcliffe J, Bunin GR, Sutton LN, Goldwein JW, Phillips PC (1994) Cognitive deficits in long-term survivors of childhood medulloblastoma and other noncortical tumors: age-dependent effects of whole brain radiation. Int J Dev Neurosci 12(4):327–334CrossRefPubMedGoogle Scholar
  15. 15.
    Akshoomoff NA, Courchesne E (1992) A new role for the cerebellum in cognitive operations. Behav Neurosci 106(5):731–738CrossRefPubMedGoogle Scholar
  16. 16.
    Conder RL, Zasler ND (1990) Psychogenic seizures in brain injury: diagnosis, treatment and case study. Brain Inj 4(4):391–397CrossRefPubMedGoogle Scholar
  17. 17.
    Mauer ME, Taphoorn MJ, Bottomley A, Coens C, Efficace F, Sanson M, Brandes AA, van der Rijt CC, Bernsen HJ, Frenay M et al (2007) Prognostic value of health-related quality-of-life data in predicting survival in patients with anaplastic oligodendrogliomas, from a phase III EORTC brain cancer group study. J Clin Oncol 25(36):5731–5737CrossRefPubMedGoogle Scholar
  18. 18.
    Bosma I, Vos MJ, Heimans JJ, Taphoorn MJ, Aaronson NK, Postma TJ, van der Ploeg HM, Muller M, Vandertop WP, Slotman BJ et al (2007) The course of neurocognitive functioning in high-grade glioma patients. Neuro Oncol 9(1):53–62CrossRefPubMedGoogle Scholar
  19. 19.
    Bosma I, Reijneveld JC, Douw L, Vos MJ, Postma TJ, Aaronson NK, Muller M, Vandertop WP, Slotman BJ, Taphoorn MJ et al (2009) Health-related quality of life of long-term high-grade glioma survivors. Neuro Oncol 11(1):51–58CrossRefPubMedGoogle Scholar
  20. 20.
    Klein M, Engelberts NH, van der Ploeg HM, Kasteleijn-Nolst Trenite DG, Aaronson NK, Taphoorn MJ, Baaijen H, Vandertop WP, Muller M, Postma TJ et al (2003) Epilepsy in low-grade gliomas: the impact on cognitive function and quality of life. Ann Neurol 54(4):514–520CrossRefPubMedGoogle Scholar
  21. 21.
    Klein M, Postma TJ, Taphoorn MJ, Aaronson NK, Vandertop WP, Muller M, van der Ploeg HM, Heimans JJ (2003) The prognostic value of cognitive functioning in the survival of patients with high-grade glioma. Neurology 61(12):1796–1798PubMedGoogle Scholar
  22. 22.
    Meyers CA, Hess KR, Yung WK, Levin VA (2000) Cognitive function as a predictor of survival in patients with recurrent malignant glioma. J Clin Oncol 18(3):646–650PubMedGoogle Scholar
  23. 23.
    Corn BW, Wang M, Fox S, Michalski J, Purdy J, Simpson J, Kresl J, Curran WJ Jr, Diaz A, Mehta M et al (2009) Health related quality of life and cognitive status in patients with glioblastoma multiforme receiving escalating doses of conformal three dimensional radiation on RTOG 98-03. J Neurooncol. doi: 10.1007/s11060-009-9923-3
  24. 24.
    Hottinger AF, Yoon H, Deangelis LM, Abrey LE (2009) Neurological outcome of long-term glioblastoma survivors. J Neurooncol. doi: 10.1007/s11060-009-9946-9
  25. 25.
    Bahr O, Herrlinger U, Weller M, Steinbach JP (2009) Very late relapses in glioblastoma long-term survivors. J Neurol. doi: 10.1007/s00415-009-5167-6
  26. 26.
    Steinbach JP, Blaicher HP, Herrlinger U, Wick W, Nagele T, Meyermann R, Tatagiba M, Bamberg M, Dichgans J, Karnath HO et al (2006) Surviving glioblastoma for more than 5 years: the patient’s perspective. Neurology 66(2):239–242CrossRefPubMedGoogle Scholar
  27. 27.
    Schmidinger M, Linzmayer L, Becherer A, Fazeny-Doemer B, Fakhrai N, Prayer D, Killer M, Ungersboeck K, Dieckmann K, Marosi C (2003) Psychometric- and quality-of-life assessment in long-term glioblastoma survivors. J Neurooncol 63(1):55–61CrossRefPubMedGoogle Scholar
  28. 28.
    Archibald YM, Lunn D, Ruttan LA, Macdonald DR, Del Maestro RF, Barr HW, Pexman JH, Fisher BJ, Gaspar LE, Cairncross JG (1994) Cognitive functioning in long-term survivors of high-grade glioma. J Neurosurg 80(2):247–253CrossRefPubMedGoogle Scholar
  29. 29.
    Gregor A, Cull A, Traynor E, Stewart M, Lander F, Love S (1996) Neuropsychometric evaluation of long-term survivors of adult brain tumours: relationship with tumour and treatment parameters. Radiother Oncol 41(1):55–59CrossRefPubMedGoogle Scholar
  30. 30.
    Kaleita TA, Wellisch DK, Cloughesy TF, Ford JM, Freeman D, Belin TR, Goldman J (2004) Prediction of neurocognitive outcome in adult brain tumor patients. J Neurooncol 67(1–2):245–253CrossRefPubMedGoogle Scholar
  31. 31.
    Davies E, Hall S, Clarke C (2003) Two year survival after malignant cerebral glioma: patient and relative reports of handicap, psychiatric symptoms and rehabilitation. Disabil Rehabil 25(6):259–266CrossRefPubMedGoogle Scholar
  32. 32.
    Kayl AE, Meyers CA (2003) Does brain tumor histology influence cognitive function? Neuro Oncol 5(4):255–260CrossRefPubMedGoogle Scholar
  33. 33.
    Stengel E (1958) Reflections on the teaching of psychiatry. J Ment Sci 104(436):772–782PubMedGoogle Scholar
  34. 34.
    Herman MA, Tremont-Lukats I, Meyers CA, Trask DD, Froseth C, Renschler MF, Mehta MP (2003) Neurocognitive and functional assessment of patients with brain metastases: a pilot study. Am J Clin Oncol 26(3):273–279CrossRefPubMedGoogle Scholar
  35. 35.
    Taphoorn MJ, Heimans JJ, Snoek FJ, Lindeboom J, Karim AB (1994) Quality of life and neuropsychological functions in long-term low-grade glioma survivors. Int J Radiat Oncol Biol Phys 29(5):1201–1202PubMedGoogle Scholar
  36. 36.
    Taphoorn MJ (2003) Neurocognitive sequelae in the treatment of low-grade gliomas. Semin Oncol 30(6 Suppl 19):45–48CrossRefPubMedGoogle Scholar
  37. 37.
    Packer RJ, Meadows AT, Rorke LB, Goldwein JL, D’Angio G (1987) Long-term sequelae of cancer treatment on the central nervous system in childhood. Med Pediatr Oncol 15(5):241–253CrossRefPubMedGoogle Scholar
  38. 38.
    Kramer J, Moore IM (1989) Late effects of cancer therapy on the central nervous system. Semin Oncol Nurs 5(1):22–28CrossRefPubMedGoogle Scholar
  39. 39.
    Roman DD, Sperduto PW (1995) Neuropsychological effects of cranial radiation: current knowledge and future directions. Int J Radiat Oncol Biol Phys 31(4):983–998PubMedGoogle Scholar
  40. 40.
    van Oosterhout AG, Boon PJ, Houx PJ, ten Velde GP, Twijnstra A (1995) Follow-up of cognitive functioning in patients with small cell lung cancer. Int J Radiat Oncol Biol Phys 31(4):911–914PubMedGoogle Scholar
  41. 41.
    Meyers CA, Geara F, Wong PF, Morrison WH (2000) Neurocognitive effects of therapeutic irradiation for base of skull tumors. Int J Radiat Oncol Biol Phys 46(1):51–55CrossRefPubMedGoogle Scholar
  42. 42.
    Wefel JS, Lenzi R, Theriault R, Buzdar AU, Cruickshank S, Meyers CA (2004) ‘Chemobrain’ in breast carcinoma?: a prologue. Cancer 101(3):466–475CrossRefPubMedGoogle Scholar
  43. 43.
    Byrne TN (2005) Cognitive sequelae of brain tumor treatment. Curr Opin Neurol 18(6):662–666CrossRefPubMedGoogle Scholar
  44. 44.
    Shilling V, Jenkins V (2007) Self-reported cognitive problems in women receiving adjuvant therapy for breast cancer. Eur J Oncol Nurs 11(1):6–15CrossRefPubMedGoogle Scholar
  45. 45.
    Schagen SB, Boogerd W, Muller MJ, Huinink WT, Moonen L, Meinhardt W, Van Dam FS (2008) Cognitive complaints and cognitive impairment following BEP chemotherapy in patients with testicular cancer. Acta Oncol 47(1):63–70CrossRefPubMedGoogle Scholar
  46. 46.
    Taphoorn MJ, Klein M (2004) Cognitive deficits in adult patients with brain tumours. Lancet Neurol 3(3):159–168CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC. 2009

Authors and Affiliations

  • Marco Ronald Hassler
    • 1
  • Katarzyna Elandt
    • 1
  • Matthias Preusser
    • 1
  • Johann Lehrner
    • 2
  • Petra Binder
    • 3
  • Karin Dieckmann
    • 4
  • Andrea Rottenfusser
    • 4
  • Christine Marosi
    • 1
    Email author
  1. 1.Department of Internal Medicine I, Clinical Division of OncologyMedical University ViennaViennaAustria
  2. 2.Department of NeurologyMedical University ViennaViennaAustria
  3. 3.Department of Internal Medicine III, Clinical Division of PulmonologyMedical University ViennaViennaAustria
  4. 4.Department of Radiotherapy and RadiobiologyMedical University ViennaViennaAustria

Personalised recommendations