Adverse long-term effects of brain radiotherapy in adult low-grade glioma patients.

OBJECTIVE: To study the long-term effects of radiotherapy on cognitive function in adult patients operated on for low-grade glioma. METHODS: A cohort of 160 patients who underwent surgery for low-grade gliomas of cerebral hemisphere between 1980 and 1992 in a single institution serving a defined population was studied. At a mean follow-up time of 7 years, 28 of the 101 patients who had postoperative irradiation (and no second surgery or chemotherapy) were still alive and eligible for MRI and neuropsychological study. Twenty-three of 59 patients who did not have radiotherapy, second surgery, or chemotherapy were alive and eligible at a mean of 10 years. RESULTS: The group that had postoperative irradiation performed significantly worse than the group that did not in cognitive tests. This difference was not accounted for by histologic diagnosis; location, extent of removal, or progression of the tumor; or any patient factor. Leukoencephalopathy was more severe in the group that had postoperative irradiation than in the group without radiotherapy, and correlated to poor memory performances only in the postoperative radiotherapy group. Average Karnofsky performance scale score was significantly lower in the group that had postoperative irradiation than in the group that did not. CONCLUSION: In adults with low-grade glioma, postoperative radiotherapy poses a significant risk of long-term leukoencephalopathy and cognitive impairment.

Event-related brain potentials reveal covert distractibility in closed head injuries.

Event-related brain potentials (ERPs) to auditory stimuli were recorded from 11 closed head injured (CHI) and 10 age-matched healthy adults. Auditory stimuli consisted of sequences of repetitive standard tones (600 Hz), occasionally replaced by deviant tones (660 Hz) or by natural novel sounds. Subjects were instructed to ignore auditory stimuli while concentrating on a demanding visuo-motor tracking task. CHI patients showed, in comparison to control subjects, significantly enhanced late P3a component in the ERPs to novel sounds. This suggests that novel stimuli cause greater distraction in CHI patients than in controls, demonstrating that ERPs provide a powerful tool to determine the physiological basis of attentional deficits in CHI patients.

Inaccurate prediction of retrieval in a face matrix learning task after right frontal lobe lesions.

This study partly supports the hypothesis that frontal lobe lesions cause impairment of metamemory. Fifty-nine patients with a focal brain lesion and 21 non-brain-damaged patients memorized a 4 X 4 matrix of 16 faces in 6 consecutive trials and predicted the number of locations of faces they would be able to remember before each retrieval. When age-related impairment of learning was adjusted, the patients with right posterior lesions were inferior to the controls and to the patients with right frontal lesions on the total number of correctly placed faces. The patients with right frontal lesions were less accurate than the patients with right posterior lesions or the controls in the prediction of retrieval. The inaccuracy of retrieval prediction in the face test was associated with that in a word-list learning task.

Word list learning and prediction of recall after frontal lobe lesions.

The effect of frontal lobe lesions on the accuracy of prediction of recall in a word list learning task was studied. Fifty-nine patients with a focal brain lesion and 21 non-brain-damaged control patients memorized a word list by selective reminding and predicted before each recall trial the number of words they would be able to recall. The patients with left frontal lesions, who were inferior to the patients with right frontal lesions and the control patients in word list recall, overpredicted their recall more than the other brain-damaged patients or the control patients, especially on the 1st trial. The patients with right frontal lesions were less accurate in the prediction of recall than the patients with right posterior lesions or the control patients.

Dual task performance after focal cerebral lesions and closed head injuries.

The aim of this study was to demonstrate that focal frontal lobe lesions and closed head injuries cause a deficit in the deliberate minimizing of dual task decrements that follow when two separate tasks should be done concurrently. In single tasks, subjects counted backwards and cancelled visual targets as quickly and accurately as possible on separate 1 min trials. In the dual task, they were required to do both tasks simultaneously, taking care that performance on neither task would be notably more impaired than on the other, as only the performance showing a larger percentage decrement from the corresponding single task performance was taken into account as the result of the test. Patients with acute closed head injury displayed more pronounced dual task decrement than the controls. This deficit was not secondary to inefficiency on the single tasks but was related to the depth of coma at admission, the acuteness of injury and age. Contrary to expectation, patients with focal frontal lobe lesions or patients with subacute closed head injury did not demonstrate abnormal dual task decrement.