Journal of Neuro-Oncology

, Volume 103, Issue 3, pp 541–549 | Cite as

Cognitive effects of tumour and surgical treatment in glioma patients

  • Andrea TalacchiEmail author
  • Barbara Santini
  • Silvia Savazzi
  • Massimo Gerosa
Clinical Study – Patient Study


Quality of life in brain tumour patients is an emerging issue and has prompted neurosurgeons to reconsider the need for cognitive assessment in the course of treatment. In particular, to date there has been a lack of comprehensive neuropsychological assessment performed preoperatively and in the acute postoperative period. We examined 29 patients with glioma, analysing several functional domains—intelligence, executive functions, memory, language, praxis, gnosis and mood state—in order to establish the effect of tumour and surgery on cognition. At baseline, using test- and domain-based criteria, 79% and 38% of patients, respectively, were impaired, the former related to tumour factors such as oedema (P < 0.05), larger size (P < 0.05) and higher grade (P = 0.001). Verbal memory, visuospatial memory and word fluency were the most frequently affected functions, partly associated with depression. Postoperatively, again using test- and domain-based criteria, 38% and 55% of patients, respectively, were unchanged, 24% and 21% improved, and 38% and 24% worsened; 24% and 62% of patients were intact, respectively. The extent of removal did not influence the outcome. Improvement involved previously impaired functions and was correlated with high-grade tumours. Worsening regarded executive functions was related to tumour size and was partly explained by radiological findings on postoperative magnetic resonance imaging (MRI). This preliminary study, focussing on the effects of tumour and surgery, showed that tumour significantly affects cognitive functions, mainly due to the mass effect and higher grading. Surgical treatment improved the functions most frequently affected preoperatively and caused worsening of executive functions soon after operation, leaving the overall cognitive burden unchanged and capable of improvement prospectively.


Glioma Cognitive functions Surgical treatment Preoperative assessment Postoperative assessment 


Conflict of interest

The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.


  1. 1.
    Meyers CA, Brown PD (2006) Role and relevance of neurocognitive assessment in clinical trials of patients with CNS tumors. J Clin Oncol 24(8):1305–1309PubMedCrossRefGoogle Scholar
  2. 2.
    Sanai N, Mirzadeh Z, Berger MS (2008) Functional outcome after language mapping for glioma resection. New Engl J Med 358(1):18–27PubMedCrossRefGoogle Scholar
  3. 3.
    Sherer M, Meyers CA, Bergloff P (1997) Efficacy of post acute brain injury rehabilitation for patients with primary malignant brain tumor. Cancer 80(2):250–257PubMedCrossRefGoogle Scholar
  4. 4.
    Bosma I, Vos MJ, Heimans JJ, Taphoorn MJB, Aaronson NK, Postma TJ, van der Ploeg HM, Muller M, Vandertop WP, Slotman BJ, Klein M (2007) The course of neurocognitive functioning in high-grade glioma patients. Neuro-Oncol 9:53–62PubMedCrossRefGoogle Scholar
  5. 5.
    Stummer W, Pichlmeier U, Meinel T, Wiestler OD, Zanella F, Reulen HJ, ALA-Glioma Study Group (2006) Fluorescence-guided with 5-aminovenulinic acid for resections of malignant glioma—a randomised controlled multicentre phase III trial. Lancet Oncol 7(5):392–401PubMedCrossRefGoogle Scholar
  6. 6.
    Beck TA (1972) Depression causes and treatment. University of Pennsylvania Press, PhiladelphiaGoogle Scholar
  7. 7.
    Spielberger CD (1970) STAI state-trait anxiety inventory Forma Y. Organizzazioni Speciali, FlorenceGoogle Scholar
  8. 8.
    Oldfield RC (1971) The assessment and analyses of handedness: the Edinburgh inventory. Neuropsychologia 9:97–113PubMedCrossRefGoogle Scholar
  9. 9.
    Caltagirone C, Perri R, Musicco M (2001) La fase preclinica della malattia di Alzheimer. Cortical Medicine, RomaGoogle Scholar
  10. 10.
    Giovagnoli AR, Del Pesce M, Mascheroni S, Simoncelli M, Laicona M, Capitani E (1996) Trail making test: normative values from 287 normal adult controls. Int J Neurol Sci 17:305–309CrossRefGoogle Scholar
  11. 11.
    Spinnler H, Tognoni G (1987) Standardizzazione e taratura italiana di test neurologici. Ital J Neurol Sci 7(suppl. 8):1–120Google Scholar
  12. 12.
    Rey A (1983) Reattivo della figura complessa. Manuale Organizzazioni Speciali, FlorenceGoogle Scholar
  13. 13.
    Laiacona M, Barbarotto R, Trivelli C, Capitani E (1993) Dissociazioni semantiche intercategoriali: descrizione di una batteria standardizzata e dati normativi. Archivio di Neurologia, Psichiatria e Psicologia 54:209–248Google Scholar
  14. 14.
    Bisiach E, Cappa S, Vallar G (1983) Guida all’esame neuropsicologico. Raffaello Cortina, MilanoGoogle Scholar
  15. 15.
    Hochberg FH, Slotnick B (1980) Neuropsychologic impairment in astrocytomas survivors. Neurology 30(2):172–177PubMedGoogle Scholar
  16. 16.
    Archibald YM, Lunn D, Ruttan LA, Macdonald DR, Del Maestro RF, Barr HWK, Pexman JHW, Fisher BJ, Gaspar LE, Cairncross JG (1994) Cognitive functioning in long term survivors of high-grade glioma. J Neurosurg 80:247–253PubMedCrossRefGoogle Scholar
  17. 17.
    Mackworth N, Fobair P, Prados M (1992) Quality of life self-reports from 200 brain tumor patients: comparisons with Karnofsky performance scores. J Neuro-Oncol 14:243–253CrossRefGoogle Scholar
  18. 18.
    Taphoorn MJ, Heimans JJ, Snoek FJ, Lindeboom J, Oosterink B, WOlberg JG, Karim ABM (1992) Assessment of quality of life in patients treated for low-grade glioma: a preliminary report. J Neurol Neurosur Psychiatry 55:372–376CrossRefGoogle Scholar
  19. 19.
    Giovagnoli AR, Boiardi A (1994) Cognitive impairment and quality of life in long-term survivors of malignant brain tumors. Ital J Neurol Sci 15:481–488PubMedCrossRefGoogle Scholar
  20. 20.
    Pålson A, Ek L, Ahlström G, Smita A (2003) Pitfalls in the assessment of disability in individual with low-grade gliomas. J Neuro-Oncol 65:149–158CrossRefGoogle Scholar
  21. 21.
    Klein M, Heimans JJ, Aaronson NK, van der Ploeg HM, Grit J, Muller M, Postma TJ, Mooji JJ, Boerman RH, Beute GN, Ossenkoppele GJ, van Imhoff GF, Dekker AW, Jolles J, Slotman BJ, Struikmans H, Taphoorn MJB (2002) Effect of radiotherapy and other treatment related factors on mid-term to long-term cognitive sequelae in low-grade gliomas: a comparative study. Lancet 360(2):1361–1368PubMedCrossRefGoogle Scholar
  22. 22.
    Klein M, Engelberts NHJ, van der Ploeg HM, Kasteleijn-Nolst Trenitè DGH, Aaronson NK, Taphoorn MJB, Baijen H, Vandertop WP, Muller M, Postma TJ, Heimans JJ (2003) Epilepsy in low-grade gliomas: the impact on cognitive function and quality of life. Ann Neurol 54:514–520PubMedCrossRefGoogle Scholar
  23. 23.
    Correa DD, DeAngelis MM, Shi W, Thaler HT, Lin M, Abrey LE (2007) Cognitive functions in low-grade gliomas: disease and treatment effect. J Neurooncol 81(2):175–184PubMedCrossRefGoogle Scholar
  24. 24.
    Starkman MN, Giordani B, Berent S, Schork A, Schteingart DE (2001) Elevated cortisol levels in Cushing’s disease are associated with cognitive decrements. Psychosom Med 63:985–993PubMedGoogle Scholar
  25. 25.
    Jagaroo V, Rogers MP, Black McLP (2000) Allocentric visuospatial processing in patients with cerebral gliomas: a neurocognitive assessment. J Neuro-Oncol 49:235–248CrossRefGoogle Scholar
  26. 26.
    Hahn CA, Dunn RH, Logue PE, King JH, Edwards CL, Halperin EC (2003) Prospective study of neuropsychologic testing and quality of life assessment of adults with primary malignant brain tumors. IJRB 55(4):992–999Google Scholar
  27. 27.
    Budrukkar A, Jalali R, Dutta D, Sarin R, Devlekar R, Parab S, Kakde A (2008) Prospective assessment of quality of life in adult patients with primary brain tumors in routine neurooncology practice. J Neuro-Oncol 90(3):413–419Google Scholar
  28. 28.
    Costello A, Shallice T, Gullan R, Beaney R (2004) The early effects of radiotherapy on intellectual and cognitive functioning in patients with frontal brain tumors: the use of a new neuropsychological methodology. J Neuro-Oncol 67:351–359CrossRefGoogle Scholar
  29. 29.
    Taphoorn MJB, Klein M (2004) Cognitive deficits in adult patients with brain tumors. Lancet Neurol 66(3):159–168CrossRefGoogle Scholar
  30. 30.
    Yoshii Y, Tominaga D, Sugimoto K, Tsuchida Y, Hyodo A, Yonaha H, Kushi S (2008) Cognitive function of patients with brain tumor in pre- and postoperative stage. Surg Neurol 69:51–61PubMedCrossRefGoogle Scholar
  31. 31.
    Tucha O, Smely C, Preier M, Lange KW (2000) Cognitive deficits before treatment among patients with brain tumors. Neurosurgery 47:324–333PubMedCrossRefGoogle Scholar
  32. 32.
    Pringle A-M, Taylor R, Whittle JR (1999) Anxiety and depression in patients with an intracranial neoplasm before and after tumor surgery. Br J Neurosurg 13(1):46–51PubMedCrossRefGoogle Scholar
  33. 33.
    Anderson SW, Damasio H, Tranel D (1990) Neuropsychological impairments associated with lesions caused by tumor or stroke. Arch Neurol 47:397–405PubMedGoogle Scholar
  34. 34.
    Grant R, Slattery J, Gregor A, Whittle IR (1994) Recording neurological impairment in clinical trials of glioma. J Neuro-Oncol 19:37–49CrossRefGoogle Scholar
  35. 35.
    Broglio PS, Puetz TW (2008) The effect of sport concussion on neurocognitive function, self-report symptoms and postural control. Sports Med 38(1):53–67PubMedCrossRefGoogle Scholar
  36. 36.
    Keith JR, Puente AE, Malcolmson KL, Tartt S, Coleman AE (2002) Assessing postoperative cognitive change after cardiopulmonary bypass surgery. Neuropsychology 16(3):411–421PubMedCrossRefGoogle Scholar
  37. 37.
    Duffau H, Lopes M, Arthuis F, Bitar A, Sichez JP, Van Effenterre R, Capelle L (2005) Contribution of intraoperative electrical stimulations in surgery of low grade gliomas: a comparative study between two series without (1985–96) and (1996–2003) functional mapping in the same institution. J Neurol Neurosurg Psychiatry 76:845–851PubMedCrossRefGoogle Scholar
  38. 38.
    Teixidor P, Gatignol P, Leroy M, Aumatell C, Capelle L, Duffau H (2007) Assessment of verbal working memory before and after surgery for low-grade glioma. J Neuro-Oncol 81:305–313CrossRefGoogle Scholar
  39. 39.
    Kaleita TA, Wellish DK, Cloughesy TF, Ford JM, Freeman D, Belin TR, Goldman J (2004) Prediction of neurocognitive outcome in adult brain tumor patients. J Neuro-Oncol 67:245–253CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC. 2010

Authors and Affiliations

  • Andrea Talacchi
    • 1
    Email author
  • Barbara Santini
    • 1
  • Silvia Savazzi
    • 2
  • Massimo Gerosa
    • 1
  1. 1.Section of Neurosurgery, Department of Neurological Sciences and VisionUniversity of VeronaVeronaItaly
  2. 2.Section of Physiology, Department of Neurological Sciences and VisionUniversity of VeronaVeronaItaly

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