A Prospective Study of Longitudinal Risks of Cognitive Deficit for People Undergoing Glioblastoma Surgery Using a Tablet Computer Cognition Testing Battery: Towards Personalized Understanding of Risks to Cognitive Function

Abstract

Glioblastoma and the surgery to remove it pose high risks to the cognitive function of patients. Little reliable data exist about these risks, especially postoperatively before radiotherapy. We hypothesized that cognitive deficit risks detected before surgery will be exacerbated by surgery in patients with glioblastoma undergoing maximal treatment regimens. We used longitudinal electronic cognitive testing perioperatively to perform a prospective, longitudinal, observational study of 49 participants with glioblastoma undergoing surgery. Before surgery (A1), the participant risk of deficit in 5/6 cognitive domains was increased compared to normative data. Of these, the risks to Attention (OR = 31.19), Memory (OR = 97.38), and Perception (OR = 213.75) were markedly increased. These risks significantly increased in the early period after surgery (A2) when patients were discharged home or seen in the clinic to discuss histology results. For participants tested at 4–6 weeks after surgery (A3) before starting radiotherapy, there was evidence of risk reduction towards A1. The observed risks of cognitive deficit were independent of patient-specific, tumour-specific, and surgery-specific co-variates. These results reveal a timeframe of natural recovery in the first 4–6 weeks after surgery based on personalized deficit profiles for each participant. Future research in this period could investigate personalized rehabilitation tools to aid the recovery process found.

Rehabilitation in People Living with Glioblastoma: A Narrative Review of the Literature

“…Two weeks after the surgery, when patients were discharged home, these risks significantly increased. Notably, for those participants who had a good enough performance status postoperatively to be able to undergo chemotherapy and radiotherapy at 4-6 weeks after surgery, the authors reported that the risks of cognitive deficits reduced and resembled those seen at the presurgical baseline [60]. These findings suggest that there are individual differences in cognitive performance postoperatively and there is a need for personalized cognitive rehabilitation in this population.…”

“…People with glioblastoma are at high risk for developing cognitive deficits due to the presence and location of the tumor, but also due to side effects of surgery, radiotherapy, and chemotherapy [58,59]. In a longitudinal prospective study with 49 participants with glioblastoma undergoing surgery, Sinha et al [60] found that before surgery, the participant risk of deficit was increased in five out of six cognitive domains as compared to normative groups (especially increased risks were to attention, memory, and perception). Two weeks after the surgery, when patients were discharged home, these risks significantly increased.…”