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Cognition in brain tumor patients

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Abstract

As effective treatment interventions have increased survival rates, there has been greater awareness that many brain tumor patients experience cognitive dysfunction despite adequate disease control. Cognitive difficulties often have an impact on quality of life and interfere with the patient’s ability to function at premorbid levels. A review of the literature indicates that whole-brain radiotherapy alone or in combination with chemotherapy results in more pronounced cognitive dysfunction than either partial radiotherapy or chemotherapy alone. Antiepileptic drugs and corticosteroids may also disrupt cognitive functioning. The cognitive domains suggested to be sensitive to treatment-induced cognitive dysfunction include attention and executive functions, memory, and psychomotor speed. Recent studies have proposed guidelines for the neuropsychological assessment of brain tumor patients and emphasized the importance of including sensitive measures in future clinical trials. This approach will increase our understanding of the incidence of cognitive dysfunction in this population and provide relevant information about therapy-related neurotoxicity.

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References and Recommended Reading

  1. Meyers CA, Wefel JS: The use of the Mini-Mental State Examination to assess cognitive functioning in cancer trials: no ifs, ands, buts, or sensitivity. J Clin Oncol 2003, 21:3557–3558.

    Article  PubMed  Google Scholar 

  2. Weitzner MA, Meyers CA: Cognitive functioning and quality of life in malignant glioma patients: a review of the literature. Psycho-oncology 1997, 6:169–177.

    Article  PubMed  CAS  Google Scholar 

  3. Correa DD, DeAngelis LM, Shi W, et al.: Cognitive functions in survivors of primary central nervous system lymphoma. Neurology 2004, 62:548–555.

    PubMed  CAS  Google Scholar 

  4. Meyers CA, Boake C: Neurobehavioral disorders in brain tumor patients: rehabilitation strategies. Cancer Bull 1993, 45:362–364.

    Google Scholar 

  5. Brain Tumor Progress Review Group: Report of the Brain Tumor Progress Review Group (BTPRG). Baltimore, MD: National Institutes of Health; 2000.

    Google Scholar 

  6. Regine WF, Schmitt FA, Scott CB, et al.: Feasibility of neurocognitive outcome evaluations in patients with brain metastases in a multi-institutional cooperative group setting: results of Radiation Therapy Oncology Group trial BR-0018. Int J Radiat Oncol 2004, 58:1346–1352.

    Article  Google Scholar 

  7. Meyers CA, Brown PD: Role and relevance of neurocognitive assessments in clinical trials of patients with CNS tumors. J Clin Oncol 2006, 24:1305–1309.

    Article  PubMed  Google Scholar 

  8. Correa DD, Maron L, Harder H, et al.: Cognitive functions in primary central nervous system lymphoma: literature review and assessment guidelines. Ann Oncol 2006, 18:1145–1151.

    Article  Google Scholar 

  9. Klein M, Taphoorn MJ, Heimans JJ, et al.: Neurobehavioral status and health-related quality of life in newly diagnosed high-grade glioma patients. J Clin Oncol 2001, 19:4037–4047.

    PubMed  CAS  Google Scholar 

  10. Klein M, Helmans JJ, Aaronson NK, et al.: Effect of radiotherapy and other treatment-related factors on midterm to long-term cognitive sequelae in low-grade gliomas: a comparative study. Lancet 2002, 360:1361–1368.

    Article  PubMed  CAS  Google Scholar 

  11. Correa DD, Anderson ND, Glass A, et al.: Cognitive functions in primary central nervous system lymphoma patients treated with chemotherapy and stem cell transplantation: preliminary findings. Clin Adv Hematol Oncol 2003, 1:490.

    PubMed  Google Scholar 

  12. Hom J, Reitan RM: Neuropsychological correlates of rapidly vs. slowly growing intrinsic cerebral neoplasms. J Clin Neuropsychol 1984, 6:309–324.

    Article  PubMed  CAS  Google Scholar 

  13. Kayl AE, Meyers CA: Does brain tumor histology influence cognitive function? Neurol Oncol 2003, 5:255–260.

    Article  Google Scholar 

  14. Duffau H: Lessons from brain mapping in surgery for lowgrade glioma: insights into association between tumour and brain plasticity. Lancet 2005, 4:476–486.

    Article  Google Scholar 

  15. Lupien SJ, Gillin CJ, Hauger RL: Working memory is more sensitive than declarative memory to the acute effects of corticosteroids: a dose-response study in humans. Behav Neurosci 1999, 113:420–430.

    Article  PubMed  CAS  Google Scholar 

  16. Wefel JS, Kayl AE, Meyers CA: Neuropsychological dysfunction associated with cancer and cancer therapies: a conceptual review of an emerging target. Br J Cancer 2004, 90:1691–1696.

    PubMed  CAS  Google Scholar 

  17. van Breemen MS, Wilms EB, Vecht CJ: Epilepsy in patients with brain tumors: epidemiology, mechanisms, and management. Lancet Neurol 2007, 6:421–430.

    Article  PubMed  Google Scholar 

  18. Bosma I, Vos MJ, Heimans JJ, et al.: The course of neurocognitive functioning in high grade glioma patients. Neuro Oncol 2007, 9:53–62.

    Article  PubMed  Google Scholar 

  19. Meyers CA, Hess KR, Yung WK, Levin VA: Cognitive function as a predictor of survival in patients with recurrent malignant glioma. J Clin Oncol 2000, 18:646–650.

    PubMed  CAS  Google Scholar 

  20. Armstrong CL, Goldstein B, Shera D, et al.: The predictive value of longitudinal neuropsychologic assessment in the early detection of brain tumor recurrence. Cancer 2003, 97:649–656.

    Article  PubMed  Google Scholar 

  21. Meyers CA, Hess KR: Multifaceted end points in brain tumor clinical trials: cognitive deterioration precedes MRI progression. Neuro Oncol 2003, 5:89–95.

    Article  PubMed  Google Scholar 

  22. Brown PD, Jensen AW, Felten SJ, et al.: Detrimental effects of tumor progression on cognitive function of patients with high-grade glioma. J Clin Oncol 2006, 24:5427–5433.

    Article  PubMed  Google Scholar 

  23. Klein M, Postma TJ, Taphoorn MJ, et al.: The prognostic value of cognitive functioning in the survival of patients with high-grade glioma. Neurology 2003, 61:1796–1798.

    PubMed  CAS  Google Scholar 

  24. Tofilon PJ, Fike JR: The radioresponse of the central nervous system: a dynamic process. Radiat Res 2000, 153:357–370.

    Article  PubMed  CAS  Google Scholar 

  25. van der Maazen RW, Kleiboer BJ, Verhagen I, van der Kogel AJ: Repair capacity of adult rat glial progenitor cells determined by an in vitro clonogenic assay after in vitro or in vivo fractionated irradiation. Int J Radiat Biol 1993, 63:661–666.

    Article  PubMed  Google Scholar 

  26. Behin A, Delattre JY: Neurologic sequelae of radiotherapy on the nervous sytsem. In Cancer Neurology in Clinical Practice. Edited by Schiff D, Wen PY. Totowa, NJ: Humana Press; 2003:73–191.

    Google Scholar 

  27. Wen PY: Central nervous system complications of cancer therapy. In Cancer Neurology in Clinical Practice. Edited by Schiff D, Wen PY. Totowa, NJ: Humana Press; 2003:215–231.

    Google Scholar 

  28. DeAngelis LM, Shapiro WR: Drug/radiation interactions and central nervous system injury. In Radiation Injury to the Nervous System. Edited by Gutin PH, Leibel SA, Sheline GE. New York: Raven Press; 1991:361–382.

    Google Scholar 

  29. Keime-Guibert F, Napolitano M, Delattre JY: Neurological complications of radiotherapy and chemotherapy. J Neurol 1998, 245:695–708.

    Article  PubMed  CAS  Google Scholar 

  30. Gregor A, Cull A, Traynor E, et al.: Neuropsychometric evaluation of long-term survivors of adult brain tumours: relationship with tumours and treatment parameters. Radiother Oncol 1996, 41:55–59.

    PubMed  CAS  Google Scholar 

  31. Scheibel RS, Meyers CA, Levin VA: Cognitive dysfunction following surgery for intracerebral glioma: influence of histopathology, lesion location, and treatment. J Neurooncol 1996, 30:61–69.

    Article  PubMed  CAS  Google Scholar 

  32. Schmidinger M, Linzmayer L, Becherer A, et al.: Psychometric and quality of life assessment in long-term glioblastoma survivors. J Neurooncol 2003, 63:55–61.

    Article  PubMed  Google Scholar 

  33. Keime-Guibert F, Chinot O, Tailandier L, et al.: Radiotherapy for glioblastoma in the elderly. N Engl J Med 2007, 356:1527–1535.

    Article  PubMed  CAS  Google Scholar 

  34. Bradley KA, Mehta MP: Management of brain metastases. Semin Oncol 2004, 31:693–701.

    Article  PubMed  Google Scholar 

  35. Omuro AM, Abrey LE: Brain metastases. Curr Neurol Neurosci Rep 2004, 4:205–210.

    Article  PubMed  Google Scholar 

  36. Herman MA, Tremont-Lukats I, Meyers CA, et al.: Neurocognitive and functional assessment of patients with brain metastases. Am J Clin Oncol 2003, 26:273–279.

    Article  PubMed  Google Scholar 

  37. Meyers CA, Smith JA, Bezjak A, et al.: Neurocognitive function and progression in patients with brain metastases treated with whole-brain radiation and motexafin gadolinium: results of a randomized phase III trial. J Clin Oncol 2004, 22:157–165.

    Article  PubMed  CAS  Google Scholar 

  38. Chang EL, Wefel JS, Maor MH, et al.: A pilot study of neurocognitive function in patients with one to three new brain metastases initially treated with stereotactic radiosurgery alone. Neurosurgery 2007, 60:285–292.

    Google Scholar 

  39. Ghia A, Tome WA, Thomas S, et al.: Distribution of brain metastases in relation to the hippocampus: implications for neurocognitive functional preservation. Int J Radiat Oncol 2007, 68:971–977.

    Article  Google Scholar 

  40. Postma TJ, Klein M, Verstappen CC, et al.: Radiotherapy-induced cerebral abnormalities in patients with low-grade glioma. Neurology 2002, 59:121–123.

    PubMed  CAS  Google Scholar 

  41. Armstrong CL, Corn BW, Ruffer JE, et al.: Radiotherapeutic effects on brain function: double dissociation of memory systems. Neuropsychiatry Neuropsychol Behav Neurol 2000, 13:101–111.

    PubMed  CAS  Google Scholar 

  42. Surma-aho O, Niemela M, Vikki J, et al.: Adverse long-term effects of brain radiotherapy in adult low-grade glioma patients. Neurology 2001, 56:1285–1290.

    PubMed  CAS  Google Scholar 

  43. Taphoorn MJ, Schiphorst AK, Snoek FJ, et al.: Cognitive functions and quality of life in patients with low-grade gliomas: the impact of radiotherapy. Ann Neurol 1994, 36:48–54.

    Article  PubMed  CAS  Google Scholar 

  44. Laack NN, Brown PD, Furth A, et al.: Neurocognitive function after radiotherapy (RT) for supratentorial low-grade gliomas (LGG): results of a North Central Cancer Treatment Group (NCCTG) prospective study. Int J Radiation Oncol Biol Physics 2003, 57:S134.

    Article  Google Scholar 

  45. Torres IJ, Mundt AJ, Sweeney PJ, et al.: A longitudinal neuropsychological study of partial brain radiation in adults with brain tumors. Neurology 2003, 60:1113–1118.

    Article  PubMed  CAS  Google Scholar 

  46. Teixidor P, Gatignol P, Leroy M, et al.: Assessment of verbal working memory before and after surgery for low-grade glioma. J Neurooncol 2007, 81:305–313.

    Article  PubMed  Google Scholar 

  47. Armstrong CL, Stern CH, Corn BW: Memory performance used to detect radiation effects on cognitive functioning. Appl Neuropsychol 2001, 8:129–139.

    Article  PubMed  CAS  Google Scholar 

  48. Correa DD, DeAngelis LM, Shi W, et al.: Cognitive functions and APOE genotype in low grade glioma patients. Neuro Oncol 2007, 81:175–184.

    Google Scholar 

  49. Correa DD, Shi W, Thaler HT, et al.: Longitudinal cognitive follow-up in low grade gliomas. J Neurooncol 2008, 86:321–327.

    Article  PubMed  Google Scholar 

  50. Harder H, Holtel H, Bromberg JE, et al.: Cognitive status and quality of life after treatment for primary CNS lymphoma. Neurology 2004, 62:544–547.

    PubMed  CAS  Google Scholar 

  51. Neuwelt EA, Goldamn DA, Dahlborg SA, et al.: Primary CNS lymphoma treated with osmotic blood-brain barrier disruption: prolonged survival and preservation of cognitive function. J Clin Oncol 1991, 9:1580–1590.

    PubMed  CAS  Google Scholar 

  52. Crossen JR, Goldman DL, Dahlborg SA, Neuwelt EA: Neuropsychological assessment outcomes of nonacquired immunodeficiency syndrome patients with primary central nervous system lymphoma before and after blood-brain barrier disruption chemotherapy. Neurosurgery 1992, 30:23–29.

    Article  PubMed  CAS  Google Scholar 

  53. Dahlborg SA, Henner WD, Crossen JR, et al.: Non-AIDS primary CNS lymphoma: first example of a durable response in a primary brain tumor using enhanced chemotherapy delivery without cognitive loss and without radiotherapy. Cancer J Sci Am 1996, 2:166–174.

    PubMed  CAS  Google Scholar 

  54. McAllister LD, Doolittle ND, Guastadisegni PE, et al.: Cognitive outcomes and long-term follow-up results after enhanced chemotherapy delivery for primary central nervous system lymphoma. Neurosurgery 2000, 46:51–61.

    Article  PubMed  CAS  Google Scholar 

  55. Fliessbach K, Helmstaedter C, Urbach H, et al.: Neuropsychological outcome after chemotherapy for primary CNS lymphoma: a prospective study. Neurology 2005, 64:1184–1188.

    PubMed  CAS  Google Scholar 

  56. Schlegel U, Pels H, Glasmacher A, et al.: Combined systemic and intraventricular chemotherapy in primary CNS lymphoma: a pilot study. J Neurol Neurosurg Psychiatry 2001, 71:118–122.

    Article  PubMed  CAS  Google Scholar 

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Correspondence to Denise D. Correa.

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Correa, D.D. Cognition in brain tumor patients. Curr Neurol Neurosci Rep 8, 242–248 (2008). https://doi.org/10.1007/s11910-008-0037-7

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