Factors associated with health-related quality of life in patients with glioma: impact of symptoms and implications for rehabilitation.

OBJECTIVE: The factors associated with health-related quality of life in patients with glioma remain unclear; particularly, the impact of symptoms on quality of life has not been studied comprehensively. This study aims to document the quality of life of patients with glioma and clarify the impact of symptoms. METHODS: In this cross-sectional study, participants were recruited from patients at The University of Tokyo Hospital and from patients who were registered at the Japan Brain Tumor Alliance. We included adult patients with World Health Organization grade II-IV glioma and excluded those with disturbances of consciousness or aphasia. We used the European Organization for Research and Treatment of Cancer QLQ-C30 and BN20 to evaluate quality of life and the symptoms. Multiple regression analyses were performed to investigate the impact of symptoms on European Organization for Research and Treatment of Cancer global health status and QLQ-C30 social functioning. In addition, we performed univariate subgroup analyses classified by World Health Organization grade and history of chemotherapy. RESULTS: This study included 76 patients. Seven symptoms occurred in more than 50% of the patients: fatigue, future uncertainty, drowsiness, communication deficit, financial difficulties, motor dysfunction and weakness of legs. Multiple regression analyses showed that insomnia affected their global health status, and appetite loss, financial difficulties and motor dysfunction were significantly related to their social functioning. In subgroup analysis, the number of symptom subscales that were significantly related to global health status and social functioning was larger in World Health Organization grade II patients compared with grade III/IV patients. CONCLUSIONS: In addition to neurological deficits, symptoms were associated with poor quality of life in patients with glioma. This study provided the basis on further investigation of usefulness of symptom evaluation on quality of life improvement.

[The logopenic variant of primary progressive aphasia].

The logopenic variant of primary progressive aphasia [also referred to as logopenic progressive aphasia (LPA)] is the most recently identified variant of primary progressive aphasia (PPA). This disorder, characterized by a unique speech and language profile, occurs due to damage to specific anatomical areas. An international panel of experts has established a set of diagnostic criteria for PPA and its clinical variants. The clinical diagnostic criteria for the logopenic variant include core features such as impaired single-word retrieval in spontaneous speech and impaired repetition of sentences and phrases. Additional features, of which at least 3 are essential for diagnosing the logopenic variant, include phonological errors in speech, spared single-word comprehension and object knowledge, spared motor speech, and lack of frank agrammatism. For a next imaging-supported diagnosis, the aforementioned clinical features must be accompanied by imaging findings revealing atrophy, hypoperfusion, or hypometabolism in the left temporo-parietal junction area. Finally, a pathology-confirmed case of the logopenic variant requires a clinical diagnosis of the syndrome accompanied by histopathological data or the presence of a known pathogenic mutation. Studies have clarified the clinical phenotype of this disorder, suggesting a prominent impairment of the phonological working memory. Several studies have provided evidences of a possible link between the logopenic phenotype and the specific pathological and genetic correlates. The diagnostic guidelines will enable a more accurate identification of the individuals with the logopenic variant, thus facilitating the documentation of the course of illness and, ultimately, the underlying pathological substrate in this patient group via the pathology-confirmed series.

Dissociation of exact and approximate calculation in severe global aphasia.

We report a 68-year-old patient with severe global aphasia secondary to a large left hemisphere infarction including the parietal lobe. In addition to language and neuroradiological evaluation, the patient was given specifically designed arithmetic and clock tasks requiring either exact calculation or approximate calculation. Despite severe language impairment, the patient showed relatively well-preserved abilities for numerical comprehension and arithmetic operations. Further analyses using specifically designed arithmetic and clock tasks demonstrated a clear dissociation of the patient's abilities between impaired exact calculation and well-preserved approximate calculation. The results support the notion that numerical and arithmetic abilities are heterogeneous in that rote verbal arithmetic facts and quantitative numerical knowledge can be separable. Implications of the present findings for neural correlates of numerical and arithmetic processing suggest that the right hemisphere plays a crucial role in approximate calculation.