Journal of Neuro-Oncology

, Volume 114, Issue 1, pp 93–100 | Cite as

Cognitive rehabilitation for early post-surgery inpatients affected by primary brain tumor: a randomized, controlled trial

  • Chiara Zucchella
  • Annarita Capone
  • Valentina Codella
  • Alessandro Marco De Nunzio
  • Carmine Vecchione
  • Giorgio Sandrini
  • Andrea Pace
  • Francesco Pierelli
  • Michelangelo Bartolo
Clinical Study

Abstract

Cognitive impairment is one of the most common neurological disorders in neuro-oncological patients and exerts a deep negative impact on quality of life interfering with familiar, social and career-related activities. To test the effectiveness of early cognitive rehabilitation treatment for inpatients affected by primary brain tumors. Out of 109 consecutive patients enrolled in the study, 58 patients were randomly assigned to a rehabilitation group or to a control group. The rehabilitation consisted of 16 one-hour individual sessions of therapist-guided cognitive training, spread over 4 weeks, combining computer exercises and metacognitive training. Patients in the control group received usual care without cognitive training. All patients were evaluated by means of a comprehensive neuropsychological battery at the admission (T0) and after 4 weeks (T1). Patients in the rehabilitation group showed a significant improvement of cognitive functions. In particular, the domains that benefited most from the training were visual attention and verbal memory. The control group exhibited only a slightly, not statistically relevant, enhancement of cognitive performances. Cognitive rehabilitation for neuro-oncological inpatients resulted in a significant enhancement of cognitive performances after the training, also providing a foundation for early administration. Future research should be aimed to clarify the patients’ characteristics that predict neuropsychological improvement, to identify the most effective elements in rehabilitative programs and to study the effects of treatment extension to everyday life.

Keywords

Neuropsychology Cognitive rehabilitation Brain tumors Quality of life Neuro-oncology 

References

  1. 1.
    Jensen OM, Estève J, Moller H, Renard H (1990) Cancer in the European Community and its member states. Eur J Cancer 26(11–12):1167–1256PubMedGoogle Scholar
  2. 2.
    Radhakrishnan K, Bohnen NI, Kurland L (1994) Epidemiology of brain tumors. In: Morantz RA, Walsh JW (eds) Brain tumors: a comprehensive text. Marcel Dekker, New York, pp 1–18Google Scholar
  3. 3.
    Meyers CA, Rock EP, Fine HA (2012) Refining endpoints in brain tumor clinical trials. J Neurooncol 108:227–230PubMedCrossRefGoogle Scholar
  4. 4.
    Huang ME, Wartella JE, Kreutzer JS (2001) Functional outcomes and quality of life in patients with brain tumors: a preliminary report. Arch Phys Med Rehabil 82:1540–1546PubMedCrossRefGoogle Scholar
  5. 5.
    Mukand JA, Blackinton DD, Crincoli MG, Lee JJ, Santos BB (2001) Incidence of neurologic deficits and rehabilitation of patients with brain tumors. Am J Phys Med Rehabil 80:346–350PubMedCrossRefGoogle Scholar
  6. 6.
    Hottinger AF, Yoon H, Deangelis LM, Abrey LE (2009) Neurological outcome of long-term glioblastoma survivors. J Neurooncol 95:301–305PubMedCrossRefGoogle Scholar
  7. 7.
    Zucchella C, Bartolo M, Di Lorenzo C, Villani V, Pace A (2013) Cognitive impairment in primary brain tumors outpatients: a prospective cross-sectional survey. J Neurooncol 112(3):455–460PubMedCrossRefGoogle Scholar
  8. 8.
    Taphoorn MJ, Klein M (2004) Cognitive deficits in adult patients with brain tumours. Lancet Neurol 3(3):159–168PubMedCrossRefGoogle Scholar
  9. 9.
    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. Int J Radiat Oncol Biol Phys 55:992–999PubMedCrossRefGoogle Scholar
  10. 10.
    Giovagnoli AR, Silvani A, Colombo E, Boiardi A (2005) Facets and determinants of quality of life in patients with recurrent high grade glioma. J Neurol Neurosurg Psychiatry 76(4):562–568PubMedCrossRefGoogle Scholar
  11. 11.
    Gustaffson M, Edvardsson T, Ahlstrom G (2006) The relationship between function, quality of life and coping in patients with low-grade gliomas. Support Care Cancer 14:1205–1212CrossRefGoogle Scholar
  12. 12.
    Biegler KA, Chaoul MA, Cohen L (2009) Cancer, cognitive impairment, and meditation. Acta Oncol 48(1):18–26PubMedCrossRefGoogle Scholar
  13. 13.
    Giovagnoli AR (2012) Investigation of cognitive impairments in people with brain tumors. J Neuroncol 108(2):277–283CrossRefGoogle Scholar
  14. 14.
    Kim JH, Brown SL, Jenrow KA (2008) Mechanisms of radiation induced brain toxicity and implications for future trials. J Neurooncol 87:279–286PubMedCrossRefGoogle Scholar
  15. 15.
    Gehring K, Sitskoorn MM, Aaronson NK, Taphoorn MJ (2008) Interventions for cognitive deficits in adults with brain tumours. Lancet Neurol 7:548–560PubMedCrossRefGoogle Scholar
  16. 16.
    Levine B, Robertson IH, Clare L, Carter G, Hong J, Wilson BA, Duncan J, Stuss DT (2000) Rehabilitation of executive functioning: an experimental-clinical validation of goal management training. J Int Neuropsychol Soc 6:299–312PubMedCrossRefGoogle Scholar
  17. 17.
    Kaschel R, Della Sala S, Cantagallo A, Fahlböck A, Laaksonen R, Kazen M (2002) Imagery mnemonics for the rehabilitation of memory: a randomised group controlled trial. Neuropsychol Rehabil 12:127–153CrossRefGoogle Scholar
  18. 18.
    Sinforiani E, Banchieri L, Zucchella C, Pacchetti C, Sandrini G (2004) Cognitive rehabilitation in Parkinson’s disease. Arch Gerontol Geriatr Suppl 9:387–391PubMedCrossRefGoogle Scholar
  19. 19.
    Brissart H, Daniel F, Morele E, Leroy M, Debouverie M, Defer GL (2011) Cognitive rehabilitation in multiple sclerosis: a review of the literature. Rev Neurol (Paris) 167(4):280–290CrossRefGoogle Scholar
  20. 20.
    Cicerone KD, Langenbahn DM, Braden C et al (2011) Evidence-based cognitive rehabilitation: updated review of the literature from 2003 through 2008. Arch Phys Med Rehabil 92(4):519–530PubMedCrossRefGoogle Scholar
  21. 21.
    Rao SM, Bieliauskas LA (1983) Cognitive rehabilitation two and one-half years post right temporal lobectomy. J Clin Neuropsychol 5(4):313–320PubMedCrossRefGoogle Scholar
  22. 22.
    Sherer M, Meyers CA, Bergloff P (1997) Efficacy of postacute brain injury rehabilitation for patients with primary malignant brain tumors. Cancer 80(2):250–257PubMedCrossRefGoogle Scholar
  23. 23.
    Locke DE, Cerhan JH, Wu W, Malec JF, Clark MM, Rummans TA, Brown PD (2008) Cognitive rehabilitation and problem-solving to improve quality of life of patients with primary brain tumors: a pilot study. J Support Oncol 6(8):383–391PubMedGoogle Scholar
  24. 24.
    Duval J, Coyette F, Seron X (2008) Rehabilitation of the central executive component of working memory: a re-organisation approach applied to a single case. Neuropsychol Rehabil 18(4):430–460PubMedCrossRefGoogle Scholar
  25. 25.
    Gehring K, Sitskoorn MM, Gundy CM, Sikkes SA, Klein M, Postuma TJ, van den Bent MJ, Beute GN, Enting RH, Kappelle AC, Boogerd W, Veninga T, Twijnstra A, Boerman DH, Taphroon MJ, Aaronson NK (2009) Cognitive rehabilitation in patients with gliomas: a randomized, controlled trial. J Clin Oncol 27(22):3712–3722PubMedCrossRefGoogle Scholar
  26. 26.
    Hassler MR, Elandt K, Preusser M, Lehrner J, Binder P, Dieckmann K, Rottenfusser A, Marosi C (2010) Neurocognitive training in patients with high-grade glioma: a pilot study. J Neurooncol 97(1):109–115PubMedCrossRefGoogle Scholar
  27. 27.
    Folstein MF, Folstein SE, McHugh PR (1975) “Mini mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12:189–198PubMedCrossRefGoogle Scholar
  28. 28.
    Orsini A, Grossi D, Capitani E, Laiacona M, Papagno C, Vallar G (1987) Verbal and spatial immediate memory span: normative data from 1355 adults and 1112 children. J Neurol Sci 8(6):539–548Google Scholar
  29. 29.
    Carlesimo GA, Caltagirone C, Gainotti G (1996) The mental deterioration battery: normative data, diagnostic reliability and qualitative analyses of cognitive impairment. The Group for the standardization of the mental deterioration battery. Eur Neurol 36(6):378–384PubMedCrossRefGoogle Scholar
  30. 30.
    Carlesimo GA, Buccione I, Fadda L, Graceffa A, Mauri M, Lo Russo S, Bevilacqua G, Caltagirone C (2002) Standardizzazione di due test di memoria per uso clinico: Breve Racconto e Figura di Rey. Nuova Rivista Neurol 12:1–13Google Scholar
  31. 31.
    Basso A, Capitani E, Laiacona M (1987) Raven’s coloured progressive matrices and brain damage: normative values in 305 adult normal controls. Funct Neurol 2(2):189–194PubMedGoogle Scholar
  32. 32.
    Apollonio I, Leone M, Isella V, Piamarta F, Consoli T, Villa ML, Forapani E, Russo A, Nichelli P (2005) The frontal assessment battery (FAB): normative values in an Italian population sample. Neurol Sci 26:108–116CrossRefGoogle Scholar
  33. 33.
    Giovagnoli AR, Del Pesce M, Mascheroni S, Simoncelli M, Laiacona M, Capitani E (1996) Trail making test: normative values from 287 normal adults controls. Ital J Neurol Sci 17:305–309PubMedCrossRefGoogle Scholar
  34. 34.
    Spinnler H, Tognoni G (1987) Standardizzazione e taratura italiana di test neuropsicologici. Ital J Neurol Sci 6(Suppl.8):1–120Google Scholar
  35. 35.
    Caffarra P, Vezzadini G, Dieci F, Zonato F, Venneri A (2002) Rey-Osterrieth complex figure: normative values in an Italian population sample. Neurol Sci 22:443–447PubMedCrossRefGoogle Scholar
  36. 36.
    Novelli G, Papagno C, Capitani E, Laiacona M, Vallar G, Cappa S (1986) Tre test clinici di ricerca e produzione lessicale: taratura su soggetti normali. Archivio di Psicologia, Neurologia e Psichiatria 47:477–486Google Scholar
  37. 37.
    Capasso R, Miceli G (2001) Esame Neuropsicologico per l’Afasia (E.N.P.A.). Springer, MilanoGoogle Scholar
  38. 38.
    Lageman SK, Cerhan JH, Locke DEC, Anderson SK, Wu W, Brown PD (2010) Comparing neuropsychological tasks to optimize brief cognitive batteries for brain tumors clinical trials. J Neurooncol 96(2):271–276PubMedCrossRefGoogle Scholar
  39. 39.
    Papagno C, Casarotti A, Comi A, Gallucci M, Riva M, Bello L (2012) Measuring clinical outcomes in neuro-oncology. A battery to evaluate low-grade gliomas (LGG). J Neurooncol 108(2):269–275PubMedCrossRefGoogle Scholar
  40. 40.
    Powell T, Malia K (2009) Training di riabilitazione cognitiva, Erickson edn. Trento, ItaliaGoogle Scholar
  41. 41.
    Gollin D, Ferrari A, Peruzzi A (2011) Una palestra per la mente. Erickson, TrentoGoogle Scholar
  42. 42.
    Kim YH, Yoo WK, Ko MH, Park CH, Kim ST, Na DL (2009) Plasticity of the attentional network after brain injury and cognitive rehabilitation. Neurorehabil Neural Repair 23:468–477PubMedCrossRefGoogle Scholar
  43. 43.
    Petersen SE, van Mier H, Fiez JA, Raichle ME (1998) The effects of practice on the functional anatomy of task performance. Proc Natl Acad Sci USA 95:853–860PubMedCrossRefGoogle Scholar
  44. 44.
    Solberg MM, Mater CA (2001) Improving attention and managing attentional problems. Adapting rehabilitation techniques to adults with ADD. Ann N. Y. Acad Sci 931:359–375CrossRefGoogle Scholar
  45. 45.
    Robertson IH (2005) The rehabilitation of attention. In: Stuss DT, Winocur G, Robertson IH (eds) Cognitive neurorehabilitation. Cambridge University Press, New York, pp 302–313Google Scholar
  46. 46.
    Kolb B (1999) Synaptic plasticity and the organization of behaviour after early and late brain injury. Can J Exp Psychol 53:62–76PubMedCrossRefGoogle Scholar
  47. 47.
    Giordana MT, Clara E (2006) Functional rehabilitation and brain tumor patients. A review of outcome. Neurol Sci 27:240–244PubMedCrossRefGoogle Scholar
  48. 48.
    Geler-Kulcu D, Gulsen G, Buyukbaba E, Ozkan D (2009) Functional recovery of patients with brain tumor or acute stroke after rehabilitation: a comparative study. J Clin Neurosci 16:74–78PubMedCrossRefGoogle Scholar
  49. 49.
    Bartolo M, Zucchella C, Pace A, Lanzetta G, Vecchione C, Bartolo M, Grillea G, Serrao M, Tassorelli C, Sandrini G, Pierelli F (2012) Early rehabilitation after surgery improves functional outcome in inpatients with brain tumours. J Neurooncol 107(3):537–544PubMedCrossRefGoogle Scholar
  50. 50.
    Verhagen AP, de Vet HC, de Bie RA, Kessels AG, Boers M, Bouter LM, Knipschild PG (1998) The Delphi list: a criteria list for quality assessment of randomized clinical trials for conducting systematic reviews developed by Delphi consensus. J Clin Epidemiol 51:1235–1241PubMedCrossRefGoogle Scholar
  51. 51.
    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
  52. 52.
    Gehring K, Aaronson NK, Gundy CM, Taphoorn MJB, Sitskoorn MM (2011) Predictors of neuropsychological improvement following cognitive rehabilitation in patients with gliomas. J Int Neuropsychol Soc 17:256–266PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Chiara Zucchella
    • 1
    • 2
  • Annarita Capone
    • 1
  • Valentina Codella
    • 1
  • Alessandro Marco De Nunzio
    • 3
  • Carmine Vecchione
    • 4
    • 5
  • Giorgio Sandrini
    • 6
    • 7
  • Andrea Pace
    • 8
  • Francesco Pierelli
    • 1
    • 9
  • Michelangelo Bartolo
    • 1
    • 3
  1. 1.Neurorehabilitation UnitIRCCS Neurological Mediterranean Institute NEUROMEDPozzilliItaly
  2. 2.Department of Brain and Behavioral SciencesUniversity of PaviaPaviaItaly
  3. 3.Neurorehabilitation UnitLaboratory of Multifactorial Biomechanics, IRCCS Neurological Mediterranean Institute NEUROMEDPozzilliItaly
  4. 4.Laboratory of Vascular Pathophysiology, IRCCS Neurological Mediterranean Institute NEUROMEDPozzilliItaly
  5. 5.Department of MedicineUniversity of SalernoBaronissiItaly
  6. 6.Neurorehabilitation UnitIRCCS National Neurological Institute C. Mondino FoundationPaviaItaly
  7. 7.Department of Neurological SciencesUniversity of PaviaPaviaItaly
  8. 8.Neurology UnitRegina Elena National Cancer InstituteRomeItaly
  9. 9.Department of Medical-Surgical Sciences and BiotechnologyUniversity of Rome “La Sapienza”LatinaItaly

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