Abstract
BACKGROUND
Cognitive impairments are a common issue for individuals with primary brain tumors. Cognitive rehabilitation is a known effective treatment in other neurologic diseases, with emerging data in adults with brain tumors. However, there is a limited understanding of the clinical characteristics of the patients referred to cognitive rehabilitation in this population.
MATERIAL AND METHODS
We identified a cohort of adult primary brain tumor patients who were clinically referred for consideration of cognitive rehabilitation by their treating neuro-oncologist at the University of California San Francisco (UCSF) between 05/2018 - 07/2022. Baseline neurocognitive impairments were assessed both at the individual test and domain levels. We analyzed absolute impairments and incorporated relative impairments for a subset of patients using a word reading task (WTAR) for pre-morbid estimates. Absolute impairments were defined as a Z-score of -1.5 or below. Relative impairments were defined as a Z-score at least 1.5 standard deviations below the pre-morbid estimate. A two-sample test was used to assess differences between relative and absolute impairments.
RESULTS
We evaluated 136 patients with primary brain tumors. The median age was 53 years (range 21-78), with majority male (62.5%), white (61.8%), and at least 16 years of education (79.4%). Astrocytomas (36.0%) and oligodendrogliomas (27.2%) were the most common diagnoses with most tumors located in the frontal lobe (54.4%) and in the left hemisphere (52.2%). The mean time from pathologic diagnosis to testing was 3.12 years (range: -0.83 to 24.18) with 73.5% having prior radiation. Neuropsychological evaluation identified several impaired domains, with significantly more relative impairments based on premorbid estimates versus absolute (p=.01). The most commonly impaired domains for both relative and absolute impairments were processing speed at 90.6% and 43.4%; verbal learning and memory at 67.6% and 38.2%; and executive/frontal systems at 53.3% and 25%. Relative and absolute impairments for auditory attention/concentration at 46.8% and 14.1%; language abilities at 44.1% and 15.2%; and visuospatial learning and memory at 33. 3% and 21.2% were somewhat less common.
CONCLUSION
These results provide a landscape for baseline patient characteristics and cognitive function in a large cohort of primary brain tumor patients who were clinically referred for cognitive rehabilitation. Processing speed and verbal learning and memory were the most relatively affected cognitive domains in this population. We also highlight the importance of incorporating premorbid estimates in determining levels of impairment. Updated data assessing correlations among patient, tumor, treatment characteristics, and cognitive function will be presented.
Cognitive impairments are a common issue for individuals with primary brain tumors. Cognitive rehabilitation is a known effective treatment in other neurologic diseases, with emerging data in adults with brain tumors. However, there is a limited understanding of the clinical characteristics of the patients referred to cognitive rehabilitation in this population.
MATERIAL AND METHODS
We identified a cohort of adult primary brain tumor patients who were clinically referred for consideration of cognitive rehabilitation by their treating neuro-oncologist at the University of California San Francisco (UCSF) between 05/2018 - 07/2022. Baseline neurocognitive impairments were assessed both at the individual test and domain levels. We analyzed absolute impairments and incorporated relative impairments for a subset of patients using a word reading task (WTAR) for pre-morbid estimates. Absolute impairments were defined as a Z-score of -1.5 or below. Relative impairments were defined as a Z-score at least 1.5 standard deviations below the pre-morbid estimate. A two-sample test was used to assess differences between relative and absolute impairments.
RESULTS
We evaluated 136 patients with primary brain tumors. The median age was 53 years (range 21-78), with majority male (62.5%), white (61.8%), and at least 16 years of education (79.4%). Astrocytomas (36.0%) and oligodendrogliomas (27.2%) were the most common diagnoses with most tumors located in the frontal lobe (54.4%) and in the left hemisphere (52.2%). The mean time from pathologic diagnosis to testing was 3.12 years (range: -0.83 to 24.18) with 73.5% having prior radiation. Neuropsychological evaluation identified several impaired domains, with significantly more relative impairments based on premorbid estimates versus absolute (p=.01). The most commonly impaired domains for both relative and absolute impairments were processing speed at 90.6% and 43.4%; verbal learning and memory at 67.6% and 38.2%; and executive/frontal systems at 53.3% and 25%. Relative and absolute impairments for auditory attention/concentration at 46.8% and 14.1%; language abilities at 44.1% and 15.2%; and visuospatial learning and memory at 33. 3% and 21.2% were somewhat less common.
CONCLUSION
These results provide a landscape for baseline patient characteristics and cognitive function in a large cohort of primary brain tumor patients who were clinically referred for cognitive rehabilitation. Processing speed and verbal learning and memory were the most relatively affected cognitive domains in this population. We also highlight the importance of incorporating premorbid estimates in determining levels of impairment. Updated data assessing correlations among patient, tumor, treatment characteristics, and cognitive function will be presented.
| Original language | English |
|---|---|
| Journal | Neuro-oncology |
| DOIs | |
| Publication status | Published - 2023 |