Abstract
Purpose
To date, little is known about neuropsychiatric symptoms in patients with tumors within the cerebellopontine angle (CPA). These, however, might be of clinical relevance. Aim of this study was thus to assess possible impairment in cognition, elevation in mood symptoms, and fatigue in this specific patient group.
Methods
Forty-five patients with an untreated CPA tumor (27 vestibularis schwannoma, 18 meningioma) were tested within a cross-sectional observational study in a single institution prior to neurosurgical treatment. Patients were administered a multifaceted battery comprising of widely-used tests for assessment of neuropsychiatric functioning.
Results
The majority of the included patients (69%) showed neurocognitive impairment, most frequently in the areas of attention and visuo-motor speed (e.g., alertness) (62%) as well as visuo-construction (44%). Impaired structural integrity of the brain stem was accompanied by more serious neurocognitive deficits. About one-third of the sample reported clinically relevant depression and/or anxiety and an even higher proportion (48%) described high levels of fatigue. Cognitive and affective symptoms as well as fatigue contributed significantly to patients’ Quality of Life, indicating the clinical relevance of neuropsychiatric symptoms in patients with CPA tumors.
Conclusions
Although patients with untreated CPA tumors often suffer from devastating and prominent physical symptoms, neuropsychiatric problems are also frequent. Including these aspects in the routine clinical assessment and initiating treatment accordingly might thus improve clinical management of the patients and improve Quality of Life.
References
Tos M, Charabi S, Thomsen J (1998) Clinical experience with vestibular schwannomas: epidemiology, symptomatology, diagnosis, and surgical results. Eur Arch Otorhinolaryngol 255:1–6. https://doi.org/10.1007/s004050050012
Foley RW, Shirazi S, Maweni RM et al (2017) Signs and symptoms of acoustic neuroma at initial presentation: an exploratory analysis. Cureus 9:e1846. https://doi.org/10.7759/cureus.1846
Carlson ML, Tveiten ØV, Driscoll CL et al (2015) What drives quality of life in patients with sporadic vestibular schwannoma? Laryngoscope 125:1697–1702. https://doi.org/10.1002/lary.25110
McLaughlin EJ, Bigelow DC, Lee JYK et al (2015) Quality of life in acoustic neuroma patients. Otol Neurotol 36:653–656. https://doi.org/10.1097/MAO.0000000000000674
Bateman N, Nikolopoulos TP, Robinson K et al (2000) Impairments, disabilities, and handicaps after acoustic neuroma surgery. Clin Otolaryngol 25:62–65. https://doi.org/10.1046/j.1365-2273.2000.00326.x
Ribeyre L, Frère J, Gauchard G et al (2015) Preoperative balance control compensation in patients with a vestibular schwannoma: does tumor size matter? Clin Neurophysiol 126:787–793. https://doi.org/10.1016/j.clinph.2014.07.022
Sandooram D, Grunfeld EA, McKinney C et al (2004) Quality of life following microsurgery, radiosurgery and conservative management for unilateral vestibular schwannoma. Clin Otolaryngol 29:621–627. https://doi.org/10.1111/j.1365-2273.2004.00881.x
Martin HC, Sethi J, Lang D et al (2001) Patient-assessed outcomes after excision of acoustic neuroma: postoperative symptoms and quality of life. J Neurosurg 94:211–216. https://doi.org/10.3171/jns.2001.94.2.0211
British Association of Otolaryngologists – Head & Neck Surgeons (ed) (2002) Clinical effectiveness guidelines on acoustic neuroma (vestibular schwannoma). http://www.dohns.org/DOHNS/Resources_files/Vestibular%20Schwannoma%20Guidelines.pdf
Tucha O, Smely C, Preier M et al (2000) Cognitive deficits before treatment among patients with brain tumors. Neurosurgery 47:324–334. https://doi.org/10.1097/00006123-200008000-00011
Goebel S, Stark AM, Kaup L et al (2011) Distress in patients with newly diagnosed brain tumours. Psychooncology 20:623–630. https://doi.org/10.1002/pon.1958
Pringle A-M, Taylor R, Whittle IR (1999) Anxiety and depression in patients with an intracranial neoplasm before and after tumour surgery. Br J Neurosurg 13:46–51. https://doi.org/10.1080/02688699944177
Taphoorn MJB, Sizoo EM, Bottomley A (2010) Review on quality of life issues in patients with primary brain tumors. Oncologist 15(6):618–626. https://doi.org/10.1634/theoncologist.2009-0291
Hio S, Kitahara T, Uno A et al (2013) Psychological condition in patients with an acoustic tumor. Acta Otolaryngol 133:42–46. https://doi.org/10.3109/00016489.2012.709322
Kolb B, Whishaw IQ (2015) Fundamentals of human neuropsychology, 7th edn. Worth Publ, New York
Schmahmann J (1998) The cerebellar cognitive affective syndrome. Brain 121:561–579. https://doi.org/10.1093/brain/121.4.561
Mariën P, D’aes T (2015) “Brainstem cognitive affective syndrome” following disruption of the cerebrocerebellar network. Cerebellum 14:221–225. https://doi.org/10.1007/s12311-014-0624-x
Garrard P (2002) Cognitive dysfunction after isolated brain stem insult. An underdiagnosed cause of long term morbidity. J Neurol Neurosurg Psychiatry 73:191–194. https://doi.org/10.1136/jnnp.73.2.191
Kim TW, Kim Y-H, Kim KH et al (2014) White matter hyperintensities and cognitive dysfunction in patients with infratentorial stroke. Ann Rehabil Med 38:620–627. https://doi.org/10.5535/arm.2014.38.5.620
Meskal I, Gehring K, van der Linden SD et al (2015) Cognitive improvement in meningioma patients after surgery: clinical relevance of computerized testing. J Neurooncol 121:617–625. https://doi.org/10.1007/s11060-014-1679-8
Lezak MD, Howieson DB, Bigler ED, Tranel D (2012) Neuropsychological Assessment, 5th edn. University Press, Oxford
Armstrong CL, Goldstein B, Shera D et al (2003) The predictive value of longitudinal neuropsychologic assessment in the early detection of brain tumor recurrence. Cancer 97(3):649–656. https://doi.org/10.1002/cncr.11099
Talacchi A, d’Avella D, Denaro L et al (2012) Cognitive outcome as part and parcel of clinical outcome in brain tumor surgery. J Neurooncol 108(2):327–332. https://doi.org/10.1007/s11060-012-0818-3
Karnofsky DA, Burchenal JH (1949) The clinical evaluation of chemotherapeutic agents in cancer. In: MacLeod CM (ed) Evaluation of chemotherapeutic agents. Columbia University Press, New York, pp 191–205
Taphoorn MJB, Klein M (2004) Cognitive deficits in adult patients with brain tumours. Lancet Neurol 3:159–168. https://doi.org/10.1016/S1474-4422(04)00680-5
Barona ACRL (1986) An improved estimate of premorbid IQ for blacks and whites on the WAIS-R. Int J Clin Neuropsychol 8:169–173
Osterrieth PA (1944) Le test de copie d’une figure complexe; contribution à l’étude de la perception et de la mémoire. Arch Psychol 30:206–356
Warrington EK, James M (1992) Testbatterie für visuelle 584Objekt- und Raumwahrnehmung (VOSP). 585Thames Valley Test Company, Burry St Edmunds
Schenkenberg T, Bradford DC, Ajax ET (1980) Line bisection and unilateral visual neglect in patients with neurologic impairment. Neurology 30(5):509. https://doi.org/10.1212/WNL.30.5.509
Härting C, Markowitsch HJ, Neufeld H, Calabrese P, Deisinger K, Kessler J (eds) (2000) Wechsler Gedächtnistest - Revidierte Fassung (WMS-R). Huber, Bern
Tombaugh T (2004) Trail Making Test A and B: normative data stratified by age and education. Arch Clin Neuropsychol 19(2):203–214. https://doi.org/10.1016/S0887-6177(03)00039-8
Zimmermann P, Fimm B (1994) Testbatterie zur Aufmerksamkeitsprüfung. PSYTEST, Herzogenrath
Benton AL, Hamsher Kd (1989) Multilingual Aphasia Examination. AJA Associates, Iowa City
Goebel S, Fischer R, Ferstl R et al (2009) Normative data and psychometric properties for qualitative and quantitative scoring criteria of the Five-point Test. Clin Neuropsychol 23(4):675–690. https://doi.org/10.1080/13854040802389185
Helmstaedter C, Durwen HF (1990) VLMT: a useful tool to assess and differentiate verbal memory performance. Schweizer Archiv für Neurologie Neurochirurgie Psychiatrie 14(1):21–30
Hubert W, Poeck K, Willmes-von-Hinckeldey K et al (1983) Aachener aphasie test. Hogrefe Verlag GmbH & Co., Göttingen
Hermann-Lingen C, Buss U, Snaith RP (2011) HADS-D Hospital Anxiety and Depression Scale-German Version: Deutsche Adaptation der Hospital Anxiety and Depression Scale (HADS) von R. P. Snaith und A. S. Zigmond
Grulke N, Bailer H, Schmutzer G et al (2006) Standardization of the German short version of “profile of mood states” (POMS) in a representative sample—short communication. Psychother Psychosom Med Psychol 56(9–10):403–405. https://doi.org/10.1055/s-2006-940129
Aaronson NK, Ahmedzai S, Bergman B et al (1993) The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. JNCI J Natl Cancer Inst 85(5):365–376. https://doi.org/10.1093/jnci/85.5.365
Smet HJ de, Paquier P, Verhoeven J et al (2013) The cerebellum: its role in language and related cognitive and affective functions. Brain Lang 127(3):334–342. https://doi.org/10.1016/j.bandl.2012.11.001
Bodranghien F, Bastian A, Casali C et al (2016) Consensus paper: revisiting the symptoms and signs of cerebellar syndrome. Cerebellum 15(3):369–391. https://doi.org/10.1007/s12311-015-0687-3
Kansal K, Yang Z, Fishman AM et al (2017) Structural cerebellar correlates of cognitive and motor dysfunctions in cerebellar degeneration. Brain 140(3):707–720. https://doi.org/10.1093/brain/aww327
Kopelman MD (2002) Disorders of memory. Brain 125(10):2152–2190. https://doi.org/10.1093/brain/awf229
Jacobson S, Marcus EM, Pugsley S (2018) Brain stem functional localization. In: Jacobson S, Marcus EM, Pugsley S (eds) Neuroanatomy for the neuroscientist, vol 5. Springer, Cham, pp 169–204
Perciavalle V, Apps R, Bracha V et al (2013) Consensus paper: current views on the role of cerebellar interpositus nucleus in movement control and emotion. Cerebellum 12(5):738–757. https://doi.org/10.1007/s12311-013-0464-0
Cronin T, Arshad Q, Seemungal BM (2017) Vestibular deficits in neurodegenerative disorders: balance, dizziness, and spatial disorientation. Front Neurol 8:538. https://doi.org/10.3389/fneur.2017.00538
Karnath H-O, Dieterich M (2006) Spatial neglect—a vestibular disorder? Brain 129(Pt 2):293–305. https://doi.org/10.1093/brain/awh698
Kralj-Hans I, Baizer JS, Swales C et al (2007) Independent roles for the dorsal paraflocculus and vermal lobule VII of the cerebellum in visuomotor coordination. Exp Brain Res 177(2):209–222. https://doi.org/10.1007/s00221-006-0661-x
Carrera E, Tononi G (2014) Diaschisis: past, present, future. Brain 137(Pt 9):2408–2422. https://doi.org/10.1093/brain/awu101
Obrador S (1975) Brain stem vascular lesions affecting alertness and responsiveness. J Neurosurg Sci 19(4):211–214
Sturm W, Willmes K (2001) On the functional neuroanatomy of intrinsic and phasic alertness. Neuroimage 14(1 Pt 2):S76–S84. https://doi.org/10.1006/nimg.2001.0839
Rooney AG, Carson A, Grant R (2011) Depression in cerebral glioma patients: a systematic review of observational studies. J Natl Cancer Inst 103(1):61–76. https://doi.org/10.1093/jnci/djq458
Bunevicius A, Tamasauskas S, Deltuva V et al (2014) Predictors of health-related quality of life in neurosurgical brain tumor patients: Focus on patient-centered perspective. Acta Neurochir (Wien) 156(2):367–374. https://doi.org/10.1007/s00701-013-1930-7
Acknowledgements
The authors are grateful to Maren Hinck for valuable support during manuscript preparation.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent
Informed consent was obtained from all individual participants included in the study.
Rights and permissions
About this article
Cite this article
Goebel, S., Mehdorn, H.M. A missing piece? Neuropsychiatric functioning in untreated patients with tumors within the cerebellopontine angle. J Neurooncol 140, 145–153 (2018). https://doi.org/10.1007/s11060-018-2944-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11060-018-2944-z