TY - JOUR
T1 - Cognitive outcomes after multimodal treatment in adult glioma patients
T2 - A meta-analysis
AU - de Roeck, Laurien
AU - Gillebert, C. line R.
AU - van Aert, Robbie C. M.
AU - Vanmeenen, Amber
AU - Klein, Martin
AU - Taphoorn, Martin J. B.
AU - Gehring, Karin
AU - Lambrecht, Maarten
AU - Sleurs, Charlotte
N1 - Funding Information: LDR is supported by a strategic basic research PhD fellowship from the Flemish Foundation of Scientific Research (FWO-Vlaanderen, SB/1SE5722N). CS was supported by a senior postdoctoral fellowship from the Flemish Foundation of Scientific Research (FWO-Vlaanderen, grant no. 12Y6122N) during the data acquisition and analysis phase of this work. Acknowledgments Publisher Copyright: © The Author(s) 2023.
PY - 2023/8/1
Y1 - 2023/8/1
N2 - BACKGROUND: Cognitive functioning is increasingly assessed as a secondary outcome in neuro-oncological trials. However, which cognitive domains or tests to assess, remains debatable. In this meta-analysis, we aimed to elucidate the longer-term test-specific cognitive outcomes in adult glioma patients. METHODS: A systematic search yielded 7098 articles for screening. To investigate cognitive changes in glioma patients and differences between patients and controls 1-year follow-up, random-effects meta-analyses were conducted per cognitive test, separately for studies with a longitudinal and cross-sectional design. A meta-regression analysis with a moderator for interval testing (additional cognitive testing between baseline and 1-year posttreatment) was performed to investigate the impact of practice in longitudinal designs. RESULTS: Eighty-three studies were reviewed, of which 37 were analyzed in the meta-analysis, involving 4078 patients. In longitudinal designs, semantic fluency was the most sensitive test to detect cognitive decline over time. Cognitive performance on mini-mental state exam (MMSE), digit span forward, phonemic and semantic fluency declined over time in patients who had no interval testing. In cross-sectional studies, patients performed worse than controls on the MMSE, digit span backward, semantic fluency, Stroop speed interference task, trail-making test B, and finger tapping. CONCLUSIONS: Cognitive performance of glioma patients 1 year after treatment is significantly lower compared to the norm, with specific tests potentially being more sensitive. Cognitive decline over time occurs as well, but can easily be overlooked in longitudinal designs due to practice effects (as a result of interval testing). It is warranted to sufficiently correct for practice effects in future longitudinal trials.
AB - BACKGROUND: Cognitive functioning is increasingly assessed as a secondary outcome in neuro-oncological trials. However, which cognitive domains or tests to assess, remains debatable. In this meta-analysis, we aimed to elucidate the longer-term test-specific cognitive outcomes in adult glioma patients. METHODS: A systematic search yielded 7098 articles for screening. To investigate cognitive changes in glioma patients and differences between patients and controls 1-year follow-up, random-effects meta-analyses were conducted per cognitive test, separately for studies with a longitudinal and cross-sectional design. A meta-regression analysis with a moderator for interval testing (additional cognitive testing between baseline and 1-year posttreatment) was performed to investigate the impact of practice in longitudinal designs. RESULTS: Eighty-three studies were reviewed, of which 37 were analyzed in the meta-analysis, involving 4078 patients. In longitudinal designs, semantic fluency was the most sensitive test to detect cognitive decline over time. Cognitive performance on mini-mental state exam (MMSE), digit span forward, phonemic and semantic fluency declined over time in patients who had no interval testing. In cross-sectional studies, patients performed worse than controls on the MMSE, digit span backward, semantic fluency, Stroop speed interference task, trail-making test B, and finger tapping. CONCLUSIONS: Cognitive performance of glioma patients 1 year after treatment is significantly lower compared to the norm, with specific tests potentially being more sensitive. Cognitive decline over time occurs as well, but can easily be overlooked in longitudinal designs due to practice effects (as a result of interval testing). It is warranted to sufficiently correct for practice effects in future longitudinal trials.
KW - Adult
KW - Cognition
KW - Cognitive evaluation
KW - Glioma
KW - Meta-analysis
UR - http://www.scopus.com/inward/record.url?scp=85166442431&partnerID=8YFLogxK
U2 - https://doi.org/10.1093/neuonc/noad045
DO - https://doi.org/10.1093/neuonc/noad045
M3 - Review article
C2 - 36809489
SN - 1522-8517
VL - 25
SP - 1395
EP - 1414
JO - Neuro-oncology
JF - Neuro-oncology
IS - 8
ER -