Patient-reported outcome and cognitive measures to be used in vascular and brain tumor surgery: proposal for a minimum set.

BACKGROUND: The standardization of outcome measures is needed for comparing studies and using common measures in clinical practice. We aimed to identify cognitive and patient-reported outcomes and timing of assessment for glioma, meningioma, and vascular surgery. METHOD: A consensus study was conducted. Participants selected cognitive and patient-reported measures among a list of instruments identified through a literature search. RESULTS: Seventeen cognitive tests for the glioma and meningioma's evaluation, 8 for the vascular diseases, and one questionnaire on quality of life and one on emotional distress were identified. The timing of outcome assessment selected was before surgery, at discharge, and after 3 and 12 months for glioma; before surgery and after 3 months for meningioma; before surgery, at discharge, and after 6 months for vascular diseases. CONCLUSION: The identification of common outcome measures is the first step toward a shared data collection improving the quality and comparability of future studies.

Relationship between quality of life and dysarthria in patients with multiple sclerosis.

OBJECTIVE: To evaluate dysarthria and dysarthria-related quality of life (QOL) and analyze its relations with duration of disease, severity, and general QOL in patients with multiple sclerosis (MS). DESIGN: Cross-sectional observational study. SETTING: Rehabilitation center. PARTICIPANTS: Consecutive patients with MS (N=163) were recruited (mean age, 52 ± 10.4 y; mean MS duration, 19 ± 10.4 y). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Presence of dysarthria; dysarthria characteristics; MS severity and duration; and dysarthria-related and generic QOL were evaluated by means of the therapy outcome measure scale; Robertson profile; Expanded Disability Status Scale (EDSS), years of disease; QOL of the dysarthric speaker questionnaire; and Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), respectively. RESULTS: The mean EDSS score was 6.5 ± 1.3. Dysarthria affected 57 (35%) of the 163 patients. Dysarthria severity was mild in most of the 57 patients with dysarthria. Median Robertson profile scores were slightly but significantly higher in the nondysarthric group compared with the dysarthric group (P=.001). The QOL for the dysarthric speaker questionnaire was significantly more compromised in patients with dysarthria (P=.001). No difference on the SF-36 scores between patients with and without dysarthria was found, with the exception of the physical activity and physical pain subscales. The QOL for the dysarthric speaker questionnaire showed no correlation with MS duration and a weak correlation with EDSS score (r=.25). Correlations between the SF-36 and QOL for the dysarthric speaker scores were few and weak, with the exception of the role limitations because of emotions (r=-.428) and mental health subscales (r=-.383). CONCLUSIONS: Dysarthria-related QOL is compromised in patients with MS and dysarthria and might be used as a supplementary measure in clinical practice and research for patients who have MS.

Brain tumours in the time of COVID-19: An online survey on patients' disease experience in one Italian region.

Background: Since the outbreak, in 2019, of COVID-19, the world has experienced marked changes in daily habits, partly reflecting the exceptional social restrictions and health measures adopted to contain the disease. All these measures significantly affected not only peoples's daily lives and psychological well-being but also the possibility for the healthcare system to function properly. In this setting, brain tumour patients were at risk due to their higher physical and mental fragility and their need for regular care. The aim of the present study was to assess, using a self-reported online questionnaire, the patients's perceptions regarding their disease experience. Materials and methods: We developed an online anonymous self-report survey to assess patients's disease experience during the pandemic. We investigated the impact of the COVID-19 pandemic on patients's cancer care schedules, their psychological distress and emotions felt during the pandemic, their levels of worry about COVID-19, and their oncological conditions. Results: 107 patients answered our survey, most of them suffering from a glioma. Less than one-third of the sample had their appointments cancelled, delayed or converted into online visits due to the pandemic. Of the patients who answered the survey, 95% declared they were satisfied with their Institute's oncological management. The feelings reported most often were peacefulness or anxiety/worry; the majority of the sample reported high levels of loneliness, which tended to increase with age, whilst the psychological distress was correlated with age and with having a recurrence of the disease. Half of the sample declared severe worry about their oncological condition, in particular subjects with a recurrence or who were receiving adjuvant therapies. Patients with recurrence tended to worry more about the possibility of contracting COVID-19, and its effects. Conclusion: Our findings illustrate how fragile and in need of care patients with a brain tumour may be, especially those with more severe clinical conditions. These data may help boost healthcare professionals's knowledge about brain tumour patients's needs and fears, so as to be able to offer them a better hospital experience and improve their clinical management, while possibly also reducing the psychological burden on patients and their families.

The autocracy of meaning: Intact visuo-imitative processes may not compensate for meaningful gestures.

The dual-route models of action distinguish between a semantic and a non-semantic visuo-motor route to execute different types of gestures. Despite the large amount of evidence in support to the model, some aspects are debated. One issue concerns the recruitment of the visuo-motor route to correctly execute meaningful gestures when the semantic route is damaged. Debated predictions of the dual-route model were investigated in a sample of 32 patients with left hemisphere stroke lesions compared to 27 healthy controls. Group analysis showed that patients were equally impaired on meaningful and meaningless gestures. Single-case analysis demonstrated that most cases were more impaired on meaningful than on meaningless gestures both when they are given in separate lists and when they are intermingled. Impaired performance on the imitation of meaningful gestures in both the separate and mixed list but spared performance on meaningless gestures in the separate list is against the hypothesis that the intact visuo-motor route compensates for damage to the semantic route. These results suggest that the damaged semantic route interferes with the visuo-motor route and prevents the processing of meaningful gestures along the visuo-motor route. Furthermore, an explorative analysis was conducted to investigate the relationship between gestures imitation and pantomime of object use on verbal command and between gestures imitation and performance on linguistic tasks. Although no significant correlation emerged, patients with moderate/severe impairment on the AAT performed significantly worse on meaningful, but not on meaningless gestures than patients with mild/minimal language impairment, suggesting that praxis and language systems are independent but dynamically interact.

Perspectives on (A)symmetry of Arcuate Fasciculus. A Short Review About Anatomy, Tractography and TMS for Arcuate Fasciculus Reconstruction in Planning Surgery for Gliomas in Language Areas.

Gliomas are brain tumors that are treated with surgical resection. Prognosis is influenced by the extent of resection and postoperative neurological status. As consequence, given the extreme interindividual and interhemispheric variability of subcortical white matter (WM) surgical planning requires to be patient's tailored. According to the "connectionist model," there is a huge variability among both cortical areas and subcortical WM in all human beings, and it is known that brain is able to reorganize itself and to adapt to WM lesions. Brain magnetic resonance imaging diffusion tensor imaging (DTI) tractography allows visualization of WM bundles. Nowadays DTI tractography is widely available in the clinical setting for presurgical planning. Arcuate fasciculus (AF) is a long WM bundle that connects the Broca's and Wernicke's regions with a complex anatomical architecture and important role in language functions. Thus, its preservation is important for the postoperative outcome, and DTI tractography is usually performed for planning surgery within the language-dominant hemisphere. High variability among individuals and an asymmetrical pattern has been reported for this WM bundle. However, the functional relevance of AF in the contralateral non-dominant hemisphere in case of tumoral or surgical lesion of the language-dominant AF is unclear. This review focuses on AF anatomy with special attention to its asymmetry in both normal and pathological conditions and how it may be explored with preoperative tools for planning surgery on gliomas in language areas. Based on the findings available in literature, we finally speculate about the potential role of preoperative evaluation of the WM contralateral to the surgical site.

Evaluating Semantic Knowledge Through a Semantic Association Task in Individuals With Dementia.

Conceptual knowledge is supported by multiple semantic systems that are specialized for the analysis of different properties associated with object concepts. Various types of semantic association between concrete concepts-categorical (CA), encyclopedic (EA), functional (FA), and visual-encyclopedic (VEA) associations-were tested through a new picture-to-picture matching task (semantic association task, SAT). Forty individuals with Alzheimer's disease (AD), 13 with behavioral variant of frontotemporal dementia (bv-FTD), 6 with primary progressive aphasia (PPA), and 37 healthy participants were tested with the SAT. Within-group comparisons highlighted a global impairment of all types of semantic association in bv-FTD individuals but a disproportionate impairment of EA and FA, with relative sparing of CA and VEA, in AD individuals. Single-case analyses detected dissociations in all dementia groups. Conceptual knowledge can be selectively impaired in various types of neurodegenerative disease on the basis of the specific cognitive process that is disrupted.