Presurgical Identification of Patients With Glioblastoma at Risk for Cognitive Impairment at 3-Month Follow-up.

BACKGROUND: Pre- and postoperative cognitive deficits have repeatedly been demonstrated in patients with glioblastoma (GBM). OBJECTIVE: To identify presurgical risk factors that facilitate the identification of GBM patients at risk for postoperative cognitive impairment. METHODS: Patients underwent neuropsychological assessment using Central Nervous System Vital Signs 1 d before (T0) and 3 mo after surgery (T3). Patients' standardized scores on 7 cognitive domains were compared to a normative sample using one-sample z tests. Reliable change indices with correction for practice effects were calculated to assess cognitive changes in individual patients over time. Logistic regression models were performed to assess presurgical sociodemographic, clinical, psychological, and cognitive risk factors for postoperative cognitive impairments. RESULTS: At T0, 208 patients were assessed, and 136 patients were retested at T3. Patients showed significantly lower performance both prior to and 3 mo after surgery on all cognitive domains compared to healthy controls. Improvements and declines over time occurred respectively in 11% to 32% and 6% to 26% of the GBM patients over the domains. The regression models showed that low preoperative cognitive performance posits a significant risk factor for postoperative cognitive impairment on all domains, and female sex was a risk factor for postoperative impairments in Visual Memory. CONCLUSION: We demonstrated preoperative cognitive risk factors that enable the identification of GBM patients who are at risk for cognitive impairment 3 mo after surgery. This information can help to inform patients and clinicians at an early stage, and emphasizes the importance of recognizing, assessing, and actively dealing with cognitive functioning in the clinical management of GBM patients.

Evaluation of Normative Data of a Widely Used Computerized Neuropsychological Battery: Applicability and Effects of Sociodemographic Variables in a Dutch Sample.

Introduction: Central Nervous System Vital Signs (CNS VS) is a computerized neuropsychological battery that is translated into many languages. However, published CNS VS' normative data were established over a decade ago, are solely age-corrected, and collected in an American population only. Method: Mean performance of healthy Dutch participants on CNS VS was compared with the original CNS VS norms (N = 1,069), and effects of sociodemographic variables were examined. Results:z tests demonstrated no significant differences in performance on four out of seven cognitive domains; however, Dutch participants (N = 158) showed higher scores on processing and psychomotor speed, as well as on cognitive flexibility. Although the original CNS VS norms are solely age-corrected, effects of education and sex on CNS VS performance were also identified in the Dutch sample. Discussion: Users should be cautious when interpreting CNS VS performance based on the original American norms, and sociodemographic factors must also be considered.

Cognitive functioning in patients with low-grade glioma: effects of hemispheric tumor location and surgical procedure.

OBJECTIVE: The authors evaluated the cognitive performance of patients with low-grade glioma (LGG) before and after surgery, and specifically investigated 1) the effects of hemispheric tumor location and 2) the type of surgery (either with or without intraoperative stimulation mapping [ISM]). METHODS: Patients underwent neuropsychological assessment 1 day before (T0) and 3 months after (T3) surgery. ISM targeted motor and/or language functions, but no other cognitive functions. Using 2-way mixed ANOVAs, differences between groups (i.e., for patients with right- vs left-sided lesions and normative controls [NCs], and also for patients operated on with vs without ISM and NCs), effects over time (T0-T3), and interaction effects in cognitive functioning were explored. Individual changes over time were assessed with reliable change indices for each neuropsychological test. RESULTS: In total, 77 patients with LGG were included (38 and 39 patients with right- and left-sided lesions, respectively; and 42 patients with and 35 patients without ISM). The majority of patients who were operated on with ISM had left-sided lesions. Patients with right- and left-sided lesions scored significantly lower on 6 and 3 out of 8 tests, respectively, compared to NCs. No significant differences between hemispheric groups were found at T0 or at T3. Patients with left-sided lesions showed significant deterioration of performance on verbal memory and sustained attention over time. Patients who underwent operation with versus without ISM scored significantly lower on 6 and 3 out of 8 tests, respectively, compared to NCs. Patients in the ISM group scored significantly lower on the Stroop test, shifting attention test, and verbal fluency test than patients without ISM. Also, the ISM group showed a significant decline in mean cognitive flexibility and sustained attention performance over time. CONCLUSIONS: Cognitive impairments were found in patients irrespective of hemispheric tumor location, whereby patients who were operated on with ISM performed slightly worse after surgery than patients without ISM. The authors conclude that there is room for improvement of cognitive functioning in surgically treated patients with LGG. The use of specific tests for higher cognitive functions during surgery may potentially improve functional outcome, but that is to be determined in future studies and balanced against oncological outcome. Implementation of neuropsychological assessments into the clinical management of patients with LGG should be encouraged, to inform and alert patients and clinicians on the status of cognitive functioning.

Subjective cognitive functioning in patients with a meningioma: Its course and association with objective cognitive functioning and psychological symptoms.

OBJECTIVE: Although meningioma patients show deficits in objective cognitive functioning (OCF) measured with neuropsychological tests, subjective cognitive functioning (SCF) has received little attention. We investigate SCF from pre- to postsurgery and its associations with OCF, psychological, sociodemographic, and clinical characteristics. METHODS: SCF was measured using the Cognitive Failures Questionnaire (CFQ) 1 day before (T0) and 3 (T3) and 12 months (T12) after surgery. Patients' scores were compared with normative data and changes over time were assessed. The neuropsychological battery CNS Vital Signs and the Hospital Anxiety and Depression Scale were administered. Correlations of SCF with OCF, psychological, sociodemographic, and clinical characteristics were explored. RESULTS: Patients reported significantly better SCF as compared with controls at T0 (N = 54) and T3 (N = 242), but not at T12 (N = 50). A significant decrease in group level SCF was observed from T0 to T12 (n = 24, P < .001). SCF was associated with anxiety at all time points (rs = -0.543 to -0.352) and with depression at T3 and T12 (r = -0.338 and -0.574), but not with OCF, sociodemographic, or clinical characteristics (rs = -0.202 to 0.288). CONCLUSIONS: Meningioma patients experienced better SCF as compared with controls before and 3 months after surgery, which might be the result of phenomena related to disease and recovery. As the findings suggest that cognitive symptoms might increase later on, future studies should further investigate the course of SCF in meningioma patients. In clinical practice, measurements of SCF should be combined with those of OCF and psychological distress in order to determine whether and which interventions are needed.

Cognitive outcomes in meningioma patients undergoing surgery: individual changes over time and predictors of late cognitive functioning.

BACKGROUND: Meningioma patients are known to face cognitive deficits before and after surgery. We examined individual changes in cognitive performance over time and identified preoperative predictors of cognitive functioning 12 months after surgery in a large sample of meningioma patients. METHODS: Patients underwent neuropsychological assessment (NPA) using CNS Vital Signs 1 day before (T0) and 3 (T3) and 12 (T12) months after surgery. Patients' sociodemographically corrected scores on 7 cognitive domains were compared with performance of a normative sample using one-sample z tests and chi-square tests of independence. Reliable change indices with correction for practice effects were calculated for individual patients. Linear mixed effects models were used to identify preoperative predictors of performance at T12. RESULTS: At T0, 261 patients were assessed, and 229 and 82 patients were retested at T3 and T12, respectively. Patients showed impaired cognitive performance before and after surgery, and although performance improved on the group level, cognitive scores remained significantly lower than in the normative sample up to T12. On the individual level, performance remained stable in the majority of patients. Better preoperative performance, younger age, male sex, and higher educational level predicted better late cognitive performance. CONCLUSIONS: Meningioma patients face serious and persistent pre- and postsurgical cognitive deficits. A preoperative NPA together with sociodemographic characteristics may provide valuable information on the late cognitive outcome of individual meningioma patients. These results can help to inform patients and clinicians on late cognitive outcomes at an early stage, and emphasizes the importance of presurgical NPA and timely cognitive rehabilitation.

Lesion symptom mapping at the regional level in patients with a meningioma.

OBJECTIVE: The majority of meningioma patients suffer from presurgical cognitive deficits. Since meningiomas do not directly damage the brain, this is presumably caused by a functional integrity reduction of the surrounding brain tissue through perilesional edema and/or mass effect of the tumor. Tumor location is a key feature in determining neurological symptoms in brain tumor patients, but the relationship between meningioma location and cognitive performance remains unclear. This study aimed to identify brain areas where the presence of a meningioma forms a potential risk factor for worse cognitive performance as compared to meningiomas at other locations. METHOD: Neuropsychological data (CNS Vital Signs) and MRI were collected in 224 meningioma patients one day before surgery. Sociodemographically corrected scores were calculated for 7 cognitive domains. Tumors were semiautomatically segmented and mapped into MNI-space for use in Statistical Region of Interest analyses. For each cognitive domain, we tested whether larger proportions of tumor overlap with each of the 150 defined regions were associated with worse performance. RESULTS: After multiple comparison (Bonferroni) and lesion volume correction, larger proportions of tumor overlap with both the left middle and superior frontal gyrus were associated with worse complex attention scores. Larger proportions of tumor overlap with the left middle frontal gyrus were associated with worse cognitive flexibility scores. For the other domains, no association between tumor overlap with a region and cognitive performance was found. CONCLUSIONS: The current results suggest that, compared to patients with a meningioma at other locations, patients with a meningioma at the left middle frontal gyrus are at potential risk for worse performance on cognitive flexibility and complex attention whereas patients with a meningioma at the left superior frontal gyrus are at potential risk for worse performance on complex attention. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Test-retest reliability and practice effects of a computerized neuropsychological battery: A solution-oriented approach.

This study examined test-retest reliabilities and (predictors of) practice effects of the widely used computerized neuropsychological battery CNS Vital Signs. The sample consisted of 158 Dutch healthy adults. At 3 and 12 months follow-up, 131 and 77 participants were retested. Results revealed low to high test-retest reliability coefficients for CNS VS' test and domain scores. Participants scored significantly higher on the domains of Cognitive Flexibility, Processing Speed, and Reaction Time at the 3-month retest. No significant differences in performance were found over the second interval. Age, education, and retest-interval were not significantly associated with practice effects. These results highlight the need for methods that evaluate performance over time while accounting for imperfect test-retest reliabilities and practice effects. We provided RCI-formulae for determining reliable change, which may be possible solution for future work facing the methodological issues of retesting. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Group Changes in Cognitive Performance After Surgery Mask Changes in Individual Patients with Glioblastoma.

BACKGROUND: There is a growing interest to include evaluations of cognitive performance in the clinical management of patients with glioblastoma (GBM). However, as changes in cognitive performance of a group may mask changes in individual patients, study results are often difficult to transfer into clinical practice. We focused on the comparison of group versus individual changes in neuropsychological performance of patients with GBM after initial surgical treatment. METHODS: Patients underwent neuropsychological evaluation using CNS Vital Signs 1 day prior to and 3 months after surgery. Two-tailed paired-samples t tests were conducted to assess changes on the group level. Reliable change indices (RCIs) that correct for practice effects and imperfect test-retest reliabilities were used to examine changes in individual patients. RESULTS: Cognitive dysfunction was common (>80%) both before and 3 months after surgery in this sample of 82 patients with GBM. Whereas group analyses revealed minimal changes in performance over time, RCIs demonstrated that most patients (89%) showed changes in performance in at least 1 cognitive domain. Half of these individual patients solely showed improvements, a quarter solely showed declines, and another quarter showed both improvements and declines. CONCLUSIONS: This study clearly demonstrates that important individual changes in performance are masked when looking only at group results. Future studies should more often use an individual patient approach to enhance knowledge transfer into clinical practice.