A systematic review of cognitive interventions for adult patients with brain tumours

Abstract

Background: Neurocognitive impairments are common in patients with current or previously treated brain tumours, and such impairments can negatively affect patient outcomes including quality of life and survival. This systematic review aimed to identify and describe interventions used to ameliorate (improve) or prevent cognitive impairments in adults with brain tumours. Methods: We performed a literature search of the Ovid MEDLINE, PsychINFO and PsycTESTS databases from commencement until September 2021. Results: In total, 9998 articles were identified by the search strategy; an additional 14 articles were identified through other sources. Of these, 35 randomised and nonrandomised studies were deemed to meet the inclusion/exclusion criteria of our review and were subsequently included for evaluation. A range of interventions were associated with positive effects on cognition, including pharmacological agents such as memantine, donepezil, methylphenidate, modafinil, ginkgo biloba and shenqi fuzheng, and nonpharmacological interventions such as general and cognitive rehabilitation, working memory training, Goal Management Training, aerobic exercise, virtual reality training combined with computerassisted cognitive rehabilitation, hyperbaric oxygen therapy and semantic strategy training. However, most identified studies had a number of methodological limitations and were judged to be at moderate-to-high risk of bias. In addition, it remains unclear whether and to what extent the identified interventions lead to durable cognitive benefits after cessation of the intervention. Conclusion: The 35 studies identified in this systematic review have indicated potential cognitive benefits for a number of pharmacological and nonpharmacological interventions in patients with brain tumours. Study limitations were identified and further studies should focus on improved study reporting, methods to reduce bias and minimise participant drop-out and withdrawal where possible, and consider standardisation of methods and interventions across studies. Greater collaboration between centres could result in larger studies with standardised methods and outcome measures, and should be a focus of future research in the field.

Understanding experiences of cognitive decline and cognitive assessment from the perspectives of people with glioma and their caregivers: A qualitative interview study

“…The inclusion of more people with glioma may have provided a greater diversity of views. However, recruiting people with glioma was challenging, partly due to the effects of the COVID-19 pandemic, and also reflects the small sample sizes seen in other studies with this patient group ( Kirkman et al, 2023 ). Most participants were interviewed within six-months of diagnosis, therefore follow-up interviews or interviews with participants further from diagnosis may have yielded additional experiences.…”

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

“…Management of cognitive deficits in people with primary brain tumors may include cognitive rehabilitation and/or pharmacotherapy. For a comprehensive review, we direct the reader to a recently published systematic review of cognitive interventions for adults with brain tumors by Kirkman and colleagues [62]. Out of 35 studies included in their review, 9 included at least a proportion of participants with glioblastoma (ranging from 4.8% to 100% of the study sample).…”

“…Out of 35 studies included in their review, 9 included at least a proportion of participants with glioblastoma (ranging from 4.8% to 100% of the study sample). Kirkman et al [62] included both randomized and nonrandomized studies; 14 studies reported on a pharmacological intervention and 21 on a nonpharmacological intervention. Examples of pharmacological agents that were associated with positive effects on cognition included memantine (NMDA receptor antagonist), donepezil (cholinesterase inhibitor), methylphenidate (CNS stimulant), modafinil (wakefulness-promoting agent), ginkgo biloba, and shenqi fuzheng.…”

“…Examples of pharmacological agents that were associated with positive effects on cognition included memantine (NMDA receptor antagonist), donepezil (cholinesterase inhibitor), methylphenidate (CNS stimulant), modafinil (wakefulness-promoting agent), ginkgo biloba, and shenqi fuzheng. Among the nonpharmacological interventions, working memory training, goal management training, aerobic exercise, virtual reality training combined with computer-assisted cognitive rehabilitation, hyperbaric oxygen therapy, and semantic strategy training were found to be linked to better outcomes in cognitive domains [62]. Regarding the potential mechanisms of action, because of the high diversity of the nonpharmacological interventions, the pathogenic basis of action is also likely to be varied [62].…”

Neurorehabilitation in brain tumours: evidences and suggestions for spreading of knowledge and research implementation

“…Recently 35 randomised and nonrandomised studies were included in a systematic review aimed to describe interventions used to ameliorate or prevent cognitive impairments in adults with BT: a range of interventions were associated with positive effects on cognition, including pharmacological agents such as memantine, donepezil, methylphenidate, modafinil, ginkgo biloba and shenqi fuzheng, and nonpharmacological interventions such as general and cognitive rehabilitation, working memory training, Goal Management Training, aerobic exercise, virtual reality training combined with computer assisted cognitive rehabilitation, hyperbaric oxygen therapy and semantic strategy training. Study limitations were identified and suggestions to standardise methods and outcome measures and to reduce bias were provided for future research in the field [60 ▪▪ ].…”