Language and Other Cognitive Evaluations

  • Sylvie Moritz-GasserEmail author
  • Guillaume Herbet


Adults harboring a diffuse low-grade glioma (DLGG) present most of the time without evident cognitive disorders. Nevertheless, extensive and specific cognitive assessments often highlight disorders in cognitive functioning, especially concerning memory, attentional resources, and information processing speed, which may affect negatively quality of life. Therefore, whatever may be the chosen therapeutic option, cognitive functioning must be assessed longitudinally in all patients. Such a longitudinal assessment may provide significant information about tumor progression, on the one hand, and allow to put the bases of a cognitive rehabilitation program if needed, on the other hand.

We report here a proposal of language and other cognitive evaluations, these latter encompassing attention, memory, executive functioning, but also social cognition, in the context of patient care (perioperative evaluations) and in the context of longitudinal follow-up. This proposal is based on our clinical practice with DLGG patients, keeping in mind that cognitive functions interact with each other. Finally, we underline that a relevant cognitive evaluation should encompass both objective and subjective scales and be associated with a psychological support.


Diffuse low-grade glioma Cognitive functioning Assessments Quality of life 


  1. 1.
    Taphoorn MJB, Klein M. Cognitive deficits in adult patients with brain tumours. Lancet Neurol. 2004;3:159–68.PubMedCrossRefGoogle Scholar
  2. 2.
    Heimans JJ, Taphoorn MJB. Impact of brain tumour treatment on quality of life. J Neurol. 2002;249:955–60.PubMedCrossRefGoogle Scholar
  3. 3.
    Armstrong CL, Goldstein B, Shera D, Ledakis GE, Tallent EM. The predictive value of longitudinal neuropsychologic assessment in the early detection of brain tumor recurrence. Cancer. 2003;97:649–56.PubMedCrossRefGoogle Scholar
  4. 4.
    Meyers CA, Hess KR. Multifaceted end points in brain tumor clinical trials: cognitive deterioration precedes MRI progression. Neuro Oncol. 2003;5:89–95.PubMedGoogle Scholar
  5. 5.
    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;18:646–50.PubMedGoogle Scholar
  6. 6.
    Klein M, Postma TJ, Taphoorn MJB, et al. The prognostic value of cognitive functioning in the survival of patients with high-grade glioma. Neurology. 2003;61:1796–9.PubMedCrossRefGoogle Scholar
  7. 7.
    Baddeley AD, Hitch GJ. Developments in the concept of working memory. Neuropsychology. 1994;8:485–93.CrossRefGoogle Scholar
  8. 8.
    Tulving E. Episodic and semantic memory. In: Tulving E, Donalson W, editors. Organization of memory. New York: Academic; 1972. p. 381–403.Google Scholar
  9. 9.
    Van Zomeren AH, Brouwer WH. Clinical neuropsychology of attention. New York: Oxford University Press; 1994.Google Scholar
  10. 10.
    Funahashi S. Neuronal mechanisms of executive controls by the prefrontal cortex. Neurosci Res. 2001;39:147–65.PubMedCrossRefGoogle Scholar
  11. 11.
    Stuss DT, Benson DF. Neuropsychological studies of the frontal lobes. Psychol Bull. 1984;95:3–28.PubMedCrossRefGoogle Scholar
  12. 12.
    Premack D, Woodruff G. Does the chimpanzee have a theory of mind? Behav Brain Sci. 1978;4:515–26.CrossRefGoogle Scholar
  13. 13.
    Sanson D. Reading other people’s mind: insights from neuropsychology. J Neuropsychol. 2009;3:3–16.CrossRefGoogle Scholar
  14. 14.
    Singer T. The neural basis and ontogeny of empathy and mind reading: review of literature and implications for future research. Neurosci Biobehav Rev. 2006;30:855–63.PubMedCrossRefGoogle Scholar
  15. 15.
    De Vignemont F, Singer T. The empathic brain. Trends Cogn Sci. 2006;10:435–41.PubMedCrossRefGoogle Scholar
  16. 16.
    Baron-cohen S, Belmonte MK. Autism: a window onto the development of the social and the analytic brain. Annu Rev Neurosci. 2005;28:109–26.PubMedCrossRefGoogle Scholar
  17. 17.
    Brüne M. “Theory of mind” in schizophrenia. A review of the literature. Schizophr Bull. 2005;31:21–42.PubMedCrossRefGoogle Scholar
  18. 18.
    Raine A, Yang Y. Neural foundations to moral reasoning and antisocial behavior. Soc Cogn Affect Neurosci. 2006;1:203–13.PubMedCrossRefGoogle Scholar
  19. 19.
    Duffau H, Capelle L, Denvil D, et al. Usefulness of intraoperative electrical subcortical mapping during surgery for low-grade gliomas located within eloquent brain regions: functional results in a consecutive series of 103 patients. J Neurosurg. 2003;98:764–78.PubMedCrossRefGoogle Scholar
  20. 20.
    Duffau H, Capelle L, Denvil D, et al. Functional recovery after surgical resection of low grade gliomas in eloquent brain: hypothesis of brain compensation. J Neurol Neurosurg Psychiatry. 2003;74:901–7.PubMedCrossRefGoogle Scholar
  21. 21.
    Klein M, Heimans JJ, Aaronson NK, et al. Effect of radiotherapy and other treatment-related factors on mid-term to long-term cognitive sequelae in low-grade gliomas: a comparative study. Lancet. 2002;360:1361–8.PubMedCrossRefGoogle Scholar
  22. 22.
    Douw L, Klein M, Fagel SAA, et al. Cognitive and radiological effects of radiotherapy in patients with low-grade glioma: long-term follow-up. Lancet Neurol. 2009;8:810–8.PubMedCrossRefGoogle Scholar
  23. 23.
    Van den Bent MJ, Afra D, de Witte O, et al. Long-term efficacy of early versus delayed radiotherapy for low-grade astrocytoma and oligodendroglioma in adults: the EORTC 22845 randomised trial. Lancet. 2005;366:985–90.PubMedCrossRefGoogle Scholar
  24. 24.
    Duffau H, Taillandier L, Capelle L. Radical surgery after chemotherapy: a new therapeutic strategy to envision in grade II glioma. J Neurooncol. 2006;80:171–6.PubMedCrossRefGoogle Scholar
  25. 25.
    Blonski M, Taillandier L, Herbet G, Maldonado IL, Beauchesne P, Fabbro M, et al. Combination of neoadjuvant chemotherapy followed by surgical resection as a new strategy for WHO grade II gliomas: a study of cognitive status and quality of life. J Neurooncol. 2012;106:353–66.PubMedCrossRefGoogle Scholar
  26. 26.
    Soffietti R, Baumert BG, Bello L, Von Deimling A, Duffau H, Frénay M. Guidelines on management of low-grade gliomas: report of an EFNS-EANO Task Force. Eur J Neurol. 2010;17:1124–33.PubMedCrossRefGoogle Scholar
  27. 27.
    Duffau H. New concepts in surgery of WHO grade II gliomas: functional brain mapping, connectionism and plasticity – a review. J Neurooncol. 2006;79:77–115.PubMedCrossRefGoogle Scholar
  28. 28.
    Smith JS, Chang EF, Lamborn KR, et al. Role of extent of resection in the long-term outcome of low-grade hemispheric gliomas. J Clin Oncol. 2008;26:1338–45.PubMedCrossRefGoogle Scholar
  29. 29.
    Duffau H, Capelle L. Preferential brain locations of low-grade gliomas: comparison with glioblastomas and review of hypothesis. Cancer. 2004;100:2622–6.PubMedCrossRefGoogle Scholar
  30. 30.
    Vigneau M, Beaucousin V, Hervé PY, Duffau H, et al. Meta-analyzing left hemisphere language areas: ­phonology, semantics, and sentence processing. Neuroimage. 2006;30:1414–32.PubMedCrossRefGoogle Scholar
  31. 31.
    Duffau H, Gatignol P, Mandonnet E, Capelle L, Taillandier L. Intraoperative subcortical stimulation mapping of language pathways in a consecutive series of 115 patients with Grade II glioma in the left dominant hemisphere. J Neurosurg. 2008;109(3):461–71.PubMedCrossRefGoogle Scholar
  32. 32.
    Struik K, Klein M, Heimans JJ, Gielissen MF, Bleijenberg G, Taphoorn MJ, et al. Fatigue in low-grade glioma. J Neurooncol. 2009;92:73–8.PubMedCrossRefGoogle Scholar
  33. 33.
    Anderson SI, Taylor R, Whittle IR. Mood disorders in patients after treatment for primary intracranial tumours. Br J Neurosurg. 1999;13:480–5.PubMedGoogle Scholar
  34. 34.
    Teixidor P, Gatignol P, Leroy M, Masuet-Aumatell C, Capelle L, Duffau H. Assessment of verbal working memory before and after surgery for low-grade glioma. J Neurooncol. 2007;81:305–13.PubMedCrossRefGoogle Scholar
  35. 35.
    Tucha O, Smely C, Preier M, Lange KW. Cognitive deficits before treatment among patients with brain tumors. Neurosurgery. 2000;47:324–33.PubMedCrossRefGoogle Scholar
  36. 36.
    Oldfield RC. The assessment and analysis of handedness: the Edinburgh inventory. Neuropsychologia. 1971;9:97–113.PubMedCrossRefGoogle Scholar
  37. 37.
    Metz-Lutz MN, Kremin H, Deloche G. Standardisation d’un test de dénomination orale: contrôle des effets de l’âge, du sexe et du niveau de scolarité chez les sujets adultes normaux. Rev Neuropsychol. 1991;1:73–95.Google Scholar
  38. 38.
    Cardebat D, Doyon B, Puel M, Goulet P, Joanette Y. Formal and semantic lexical evocation in normal subjects. Performance and dynamics of production as a function of sex, age and educational level. Acta Neurol Belg. 1990;90:207–17.PubMedGoogle Scholar
  39. 39.
    Howard D, Patterson K. The pyramid and palm trees test. Bury St Edmunds: Thames Valley Test Company; 1991.Google Scholar
  40. 40.
    Mazaux JM, Orgogozo JM. Echelle d’évaluation de l’aphasie adaptée du Boston Diagnostic Aphasia Examination. E.A.P. Editions Psychotechniques; 1992.Google Scholar
  41. 41.
    Goodglass H, Kaplan E. Assessment of aphasia and related disorders. Philadelphia: Lea & Febiger; 1976.Google Scholar
  42. 42.
    Moritz-Gasser S, Herbet G, Maldonado I, Duffau H. Lexical access speed is significantly correlated with the return to professional activities after awake surgery for low-grade gliomas. J Neurooncol. 2012;107(3):633–41.PubMedCrossRefGoogle Scholar
  43. 43.
    Mesulam M. Spatial attention and neglect: parietal, frontal and cingulate contributions to the mental representation and attentional targeting of salient extrapersonal events. Phil Trans R Soc Lond B. 1999;354:1325–46.CrossRefGoogle Scholar
  44. 44.
    Keinman JT, Newhart M, Davis C, Heidler-Gary J, Gotessman RF, Hillis AE. Right hemispatial neglect: frequency and characterization following acute left hemisphere stroke. Brain Cogn. 2007;64:50–9.CrossRefGoogle Scholar
  45. 45.
    Thiebaut de Schotten M, Urbanski M, Duffau H, Volle E, Lévy R, Dubois B, et al. Direct evidence for a parietal-frontal pathway subserving spatial awareness in humans. Science. 2005;309:2226–8.PubMedCrossRefGoogle Scholar
  46. 46.
    Sallard E, Duffau H, Bonnetblanc F. Ultra-fast recovery from right neglect after ‘awake surgery’ for slow-growing tumor invalidating left parietal area. Neurocase. 2012;18:80–90.PubMedCrossRefGoogle Scholar
  47. 47.
    Gall C, Francke GH, Sabel BA. Vision-related quality of life in first stroke patients with homonymous visual field defects. Health Qual Life Outcomes. 2010;26:8–33.Google Scholar
  48. 48.
    Wang MK. Reading with a right homonymous hemianopia. Lancet. 2003;631:1138.CrossRefGoogle Scholar
  49. 49.
    Baddeley A, Della Sala S. Working memory and executive control. Philos Trans R Soc Lond B Biol Sci. 1996;351:1397–403.PubMedCrossRefGoogle Scholar
  50. 50.
    Hickok G, Poeppel D. Dorsal and ventral streams: a framework for understanding aspects of the functional anatomy of language. Cognition. 2004;92:67–99.PubMedCrossRefGoogle Scholar
  51. 51.
    Duffau H, Gatignol P, Mandonnet E, Peruzzi P, Tzourio-Mazoyer N, Capelle L. New insights into the anatomo-functional connectivity of the semantic system: a study using cortico-subcortical electrostimulations. Brain. 2005;128(Pt 4):797–810.PubMedCrossRefGoogle Scholar
  52. 52.
    Goldstein LH, Berbard S, Fenwick PB, Burgess PW, McNeil J. Unilateral frontal lobectomy can produce strategy application disorder. J Neurol Neurosurg Psychiatry. 1993;56:274–6.PubMedCrossRefGoogle Scholar
  53. 53.
    Wu AS, Wilgert ME, Lang FF, Xia L, Bekele BN, Meyers CA, et al. Neurocognitive function before and after surgery for insular gliomas. J Neurosurg. 2011;115:1115–25.PubMedCrossRefGoogle Scholar
  54. 54.
    Darrigand B, Mazaux JM. Echelle de communication verbale de Bordeaux. Eds Bordeaux, France: Université Victor Segalen; 2005.Google Scholar
  55. 55.
    De Renzi E, Vignolo LA. The token test: A sensitive test to detect receptive disturbances in aphasics. Brain. 1962;85:665–78.CrossRefGoogle Scholar
  56. 56.
    Weschler D. Wais-4 nouvelle version de l’échelle d’intelligence de Wechsler pour adultes – quatrième édition. Eds Paris: ECPA; 2011.Google Scholar
  57. 57.
    Joanette Y, Ska B, Côté H, Ferré P, Lamelin F. Protocole MEC – P Protocole Montréal d’Évaluation de la Communication. Eds Ortho Edition; Isbergues, France: 2011.Google Scholar
  58. 58.
    Rousseaux M, Delacourt A, Wyrzykowski N, Leveuvre M. Le Test Lillois de Communication-TLC. Eds Ortho Edition; Isbergues: 2000.Google Scholar
  59. 59.
    Bénaim C, Pélissier J, Petiot S, Bareil M, Ferrat E, Royer E, et al. Un outil francophone de mesure de la qualité de vie de l’aphasique: le SIP-65. Ann Readapt Med Phys. 2003;46:2–11.PubMedCrossRefGoogle Scholar
  60. 60.
    Bergner M, Bobbitt RA, Pollard WE, et al. The sickness Impact Profile: validation of a health status measure. Med Care. 1976;14:57–67.PubMedCrossRefGoogle Scholar
  61. 61.
    Jacobs BL, Praag H, Gage FH. Adult brain neurogenesis and psychiatry: a novel theory of depression. Mol Psychiatry. 2000;5:262–9.PubMedCrossRefGoogle Scholar
  62. 62.
    Campbell S, MacQueen G. The role of the hippocampus in the pathophysiology of major depression. J Psychiatry Neurosci. 2004;29:417–26.PubMedGoogle Scholar
  63. 63.
    Miller G. The magic number seven, plus or minus two: some limits to on our processing to processing information. Psychol Rev. 1956;63:81–97.PubMedCrossRefGoogle Scholar
  64. 64.
    Eris AM, Van der Linden M, Deweir B. L’exploration des troubles de la mémoire épisodique dans la maladie d’Alzheimer débuante au moyen d’une épreuve de rappel indicé. Rev Neuropsychol. 1994;4:47–68.Google Scholar
  65. 65.
    Lezak MD, Howieson DB, Loring DW, Hannay HJ, Fisher JS. Neuropsychological assessment. 4th ed. Oxford: Oxford University Press; 2004.Google Scholar
  66. 66.
    Vanier M, Gauthier L, Lambert J, Pepin EP, Robillard A, Dubouloz C, et al. Evaluation of left spatial neglect: norms and discrimination power of two tests. Neuropsychology. 1990;4:87–96.CrossRefGoogle Scholar
  67. 67.
    Zimmerman P, Fimm B. Tests d’évaluation de l’attention (TEA) – version 1.02-manuel d’utilisation. Herzogenrath, Germany: Psytest. 1994.Google Scholar
  68. 68.
    Stroop JR. Studies of interference in serial verbal reactions. J Exp Psychol. 1935;18:643–62.CrossRefGoogle Scholar
  69. 69.
    Godefroy O et greffex, éditeurs. Fonctions éxécutives et pathologies neurologiques et psychiatriques. Evaluation en pratique clinique. Marseille: Solal; 2008.Google Scholar
  70. 70.
    Rey A. L’examen psychologique dans le cas de lencephalopathie traumatique. Arch Psychol. 1941;28:286–340.Google Scholar
  71. 71.
    Ekman P, Friesen WV. Pictures of facial affect. Palo Acto: Consulting Psychologists Press; 1976.Google Scholar

Copyright information

© Springer-Verlag London 2013

Authors and Affiliations

  1. 1.National Institute for Health and Medical Research (INSERM), U1051, Team “Plasticity of the Central Nervous System, Human Stem Cells and Glial Tumors”, Institute for Neurosciences of MontpellierMontpellier University Medical CenterMontpellierFrance
  2. 2.Department of NeurologyCHRU Montpellier, Gui de Chauliac Hospital, Montpellier University Medical CenterMontpellierFrance
  3. 3.Department of NeurosurgeryGui de Chauliac Hospital, Montpellier University Medical CenterMontpellierFrance

Personalised recommendations