Cognitive functioning in long-term survivors of high-grade glioma

Abstract

In a pilot study, two groups of patients with malignant glioma underwent sequential neuropsychological evaluations after successful tumor treatment. Group 1 included nine patients treated from 1981 to 1985; all patients received irradiation and eight underwent chemotherapy. The baseline neuropsychological assessment was performed 1 to 63 months after tumor diagnosis, with follow-up evaluations at irregular intervals over the next 3 to 7 years. Six patients in Group 1 exhibited impairment on most measures at baseline; subsequently, two patients developed profound cognitive impairment. Initially, three patients functioned in the average range on most tasks; thereafter, two deteriorated on one measure each. Group 2 was ascertained prospectively and included 16 patients treated from 1985 to 1987, all of whom received irradiation and chemotherapy. The first evaluation was performed 18 months after diagnosis, then every 6 months for 2 years, and then yearly. Compared to a control group, those in Group 2 had significant cognitive impairment at baseline. Cognitive performance did not change over the next 12 months in 10 patients who remained free of tumor, but within 2 years of baseline testing, deterioration on specific tasks was evident in two of seven disease-free survivors. When last tested, five of six disease-free survivors had deteriorated on one or more measures. Unlike Group 1, severe global cognitive impairment was not seen, perhaps because Group 2 was followed for a shorter time. Verbal and nonverbal composite scores derived from intelligence quotient (IQ) tests showed less impairment at baseline than did other measures and were more likely to remain stable subsequently. Verbal memory and sustained attention were the most impaired at baseline, and verbal learning and flexibility in thinking showed the greatest tendency to decline over time. Cognitive functioning in survivors of high-grade glioma is best measured and monitored by tests that probe a broader spectrum of abilities than IQ. Neuropsychological measures used in this analysis lacked sensitivity at the lower end of the impaired range. Future studies should use tests better able to discern cognitive differences at low performance levels. Based on this experience, the authors conclude that most long-term survivors of high-grade glioma will have significant cognitive difficulties, usually evident by the first assessment; some patients will develop profound impairment years later, and few are capable of fully independent living.

Long-term Glioblastoma Multiforme Survivors: a Population-based Study

“…All five had received whole-brain irradiation which caused their dementia. It is distressing that dementia and a loss of independence may be the usual outcomes for LTGBMS and malignant glioma survivors 22 when aggressive therapy successfully controls the tumor. This may be less common now that local radiation therapy has replaced whole-brain treatment.…”

Pathogenesis of Cognitive Decline Following Therapeutic Irradiation for Head and Neck Tumors

“…N umerous reports have been published on cognitive decline in patients following cranial irradiation for primary brain tumors or metastases and following prophylaxis for leukemia and small cell carcinoma of the lung (16)(17)(18). H owever, there are only a few reports on brain injury following irradiation for extracranial neoplasms of the head and neck (10,19,20).…”

Quality of life in patients with brain tumor: what's relevant in our quest for therapeutic efficacy

“…[12,13,18,28,35] The toxicity of therapy has also been assessed, for the most part, in categorical terms such as "major" or "minor" morbidity and mortality. [8,9,11] Although a number of investigators have attempted to evaluate cognitive and psychosocial function, [1,23,24,60,66,69,70] relatively few reports of these evaluations appear in current literature. In the second major use of QOL measures--selection of patients to be included in a clinical trial [61]--physical outcome measures have been used predominantly [6,28,54,59,65] (Table 1).…”