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Mild cognitive impairment in long-term brain tumor survivors following brain irradiation

  • Clinical Study
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Journal of Neuro-Oncology Aims and scope Submit manuscript

Abstract

Introduction

There is no accepted classification of cognitive impairment in cancer survivors. We assess the extent of mild cognitive impairment (MCI) syndrome in brain tumor survivors using criteria adapted from the National Institute on Aging and the Alzheimer’s Association (NIA-AA).

Methods

We retrospectively reviewed the cognitive data of brain tumor survivors post-radiation therapy (RT) enrolled from 2008 to 2011 in a randomized trial of donepezil versus placebo for cognitive impairment. One hundred and ninety eight adult survivors with primary or metastatic brain tumors who were ≥ 6 months post RT were recruited at 24 sites in the United States. Cognitive function was assessed at baseline, 12 and 24 weeks post-randomization. For this analysis, we used baseline data to identify MCI and possible dementia using adapted NIA-AA criteria. Cases were subtyped into four groups: amnestic MCI-single domain (aMCI-sd), amnestic MCI-multiple domain (aMCI-md), non-amnestic MCI-single domain (naMCI-sd), and non-amnestic MCI-multiple domain (naMCI-md).

Results

One hundred and thirty one of 197 evaluable patients (66%) met criteria for MCI. Of these, 13% were classified as aMCI-sd, 58% as aMCI-md, 19% as naMCI-sd, and 10% as naMCI-md. Patients with poorer performance status, less education, lower household income and those not working outside the home were more likely to be classified as MCI.

Conclusion

Two-thirds of post-RT brain tumor survivors met NIA-AA criteria for MCI. This taxonomy may be useful when applied to brain tumor survivors because it defines cognitive phenotypes that may be differentially associated with course, treatment response, and risk factor profiles.

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Funding

This study was supported by Grant No. 5R01NR009675-04 (PI Stephen R. Rapp) from the National Institute of Nursing Research, Grant No. 2 U10 CA 81851-09-13 from the National Cancer Institute Division of Cancer Prevention to the Wake Forest Clinical Community Oncology Program, Grant No. 1UG CA189824-01 from the National Institutes of Health/National Cancer Institute to the Wake Forest NCORP Research Base and Eisai Inc.

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Authors and Affiliations

  1. Department of Radiation Oncology, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC, 27157, USA

    Christina K. Cramer, Neil McKee & Michael D. Chan

  2. Department of Psychiatry and Behavioral Medicine, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA

    Stephen R. Rapp

  3. Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA

    L. Doug Case

  4. Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA

    Tiffany L. Cummings

  5. Department of Internal Medicine (Hematology and Oncology), Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA

    Glenn J. Lesser

  6. Department of Internal Medicine (Gerontology and Geriatrics), Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA

    Edward G. Shaw

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  1. Christina K. Cramer
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  2. Neil McKee
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  3. L. Doug Case
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  4. Michael D. Chan
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  7. Edward G. Shaw
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Contributions

All of the authors contributed substantial time and intellectual effort in producing this manuscript, including: experimental design (CKC, SRR, LDC, EGS, NM, MDC); data analysis and statistics (LDC, SRR, CKC, NM, TLC); data interpretation (CKC, SRR, TLC, GJL, EGS, MDC); manuscript writing (CKC, TLC, LDC, SRR, EGS, GJL, MDC, NM).

Corresponding author

Correspondence to Christina K. Cramer.

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Cramer, C.K., McKee, N., Case, L.D. et al. Mild cognitive impairment in long-term brain tumor survivors following brain irradiation. J Neurooncol 141, 235–244 (2019). https://doi.org/10.1007/s11060-018-03032-8

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  • DOI: https://doi.org/10.1007/s11060-018-03032-8

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