Cognitive impact of lower-grade gliomas and strategies for rehabilitation

Weyer-Jamora, Christina; Brie, Melissa S; Luks, Tracy; Smith, Ellen M. Lavoie; Braunstein, Steve; Villanueva-Meyer, Javier; Bracci, Paige M.; Chang, Susan M.; Hervey-Jumper, Shawn L.; Taylor, Jennie

doi:10.1093/nop/npaa072

Cited by 26 publications

(21 citation statements)

References 111 publications

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“…Given the emerging research for the use of cognitive rehabilitation for addressing cognitive and QoL concerns in LrGG (50)(51)(52)(53), this study underscores the value of including cognitive and QoL assessments as part of LrGG care, as well as highlighting the groundwork needed to refine cognitive treatments. More specifically, while still in its infancy for use in LrGG, cognitive rehabilitation models may want to consider how clinical factors such as age, T2 FLAIR volumes, tumor molecular characteristics, and treatment effects may jointly influence treatment response.…”

Section: Discussionmentioning

confidence: 80%

T2 FLAIR Hyperintensity Volume Is Associated With Cognitive Function and Quality of Life in Clinically Stable Patients With Lower Grade Gliomas

et al. 2022

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Survival outcomes for patients with lower grade gliomas (LrGG) continue to improve. However, damage caused both by tumor growth and by the consequences of treatment often leads to significantly impaired cognitive function and quality of life (QoL). While neuropsychological testing is not routine, serial clinical MRIs are standard of care for patients with LrGG. Thus, having a greater understanding of MRI indicators of cognitive and QoL impairment risk could be beneficial to patients and clinicians. In this work we sought to test the hypothesis that in clinically stable LrGG patients, T2 FLAIR hyperintensity volumes at the time of cognitive assessment are associated with impairments of cognitive function and QoL and could be used to help identify patients for cognitive and QoL assessments and interventions. We performed anatomical MR imaging, cognitive testing and QoL assessments cross-sectionally in 30 clinically stable grade 2 and 3 glioma patients with subjective cognitive concerns who were 6 or more months post-treatment. Larger post-surgical T2 FLAIR volume at testing was significantly associated with lower cognitive performance, while pre-surgical tumor volume was not. Older patients had lower cognitive performance than younger patients, even after accounting for normal age-related declines in performance. Patients with Astrocytoma, IDH mutant LrGGs were more likely to show lower cognitive performance than patients with Oligodendroglioma, IDH mutant 1p19q co-deleted LrGGs. Previous treatment with combined radiation and chemotherapy was associated with poorer self-reported QoL, including self-reported cognitive function. This study demonstrates the importance of appreciating that LrGG patients may experience impairments in cognitive function and QoL over their disease course, including during periods of otherwise sustained clinical stability. Imaging factors can be helpful in identifying vulnerable patients who would benefit from cognitive assessment and rehabilitation.

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Section: Discussionmentioning

confidence: 80%

T2 FLAIR Hyperintensity Volume Is Associated With Cognitive Function and Quality of Life in Clinically Stable Patients With Lower Grade Gliomas

et al. 2022

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“…Above all, not only postsurgical scores but also reaction times have a predictive value regarding the return to a normal life: indeed,lexical access speed was significantly linked to the capacity to resume professional activities ( 31 ). Thus, to improve postoperative outcomes, beyond new programs of neurocognitive rehabilitation aiming at facilitating the recovery of higher-order functions such as attention, memory or mental fatigue ( 32 – 34 ), a paradigmatic shift in the intraoperative functional mapping “à la carte” has recently been proposed ( 9 ).…”

Section: The Need To Improve Long-term Functional Outcomes In Lgg Pat...mentioning

confidence: 99%

Constant Multi-Tasking With Time Constraint to Preserve Across-Network Dynamics Throughout Awake Surgery for Low-Grade Glioma: A Necessary Step to Enable Patients Resuming an Active Life

Duffau

Lemaître

et al. 2022

Front. Oncol.

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Awake surgery for brain gliomas improves resection while minimizing morbidity. Although intraoperative mapping was originally used to preserve motor and language functions, the considerable increase of life expectancy, especially in low-grade glioma, resulted in the need to enhance patients’ long-term quality of life. If the main goal of awake surgery is to resume normal familial and socio-professional activities, preventing hemiparesis and aphasia is not sufficient: cognitive and emotional functions must be considered. To monitor higher-order functions, e.g., executive control, semantics or mentalizing, further tasks were implemented into the operating theater. Beyond this more accurate investigation of function-specific neural networks, a better exploration of the inter-system communication is required. Advances in brain connectomics led to a meta-network perspective of neural processing, which emphasizes the pivotal role of the dynamic interplay between functional circuits to allow complex and flexible, goal-directed behaviors. Constant multi-tasking with time constraint in awake patients may be proposed during intraoperative mapping, since it provides a mirror of the (dys)synchronization within and across neural networks and it improves the sensitivity of behavioral monitoring by increasing cognitive demand throughout the resection. Electrical mapping may hamper the patient to perform several tasks simultaneously whereas he/she is still capable to achieve each task in isolation. Unveiling the meta-network organization during awake mapping by using a more ecological multi-demand testing, more representative of the real-life conditions, constitutes a reliable way to tailor the surgical onco-functional balance based upon the expectations of each patient, enabling him/her to resume an active life with long-lasting projects.

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“…With modern treatment regimes, patients with LGGs may survive for many years. If they are exposed to morbidity from surgery, this can lead to long-term disability and reduced quality of life [ 63 , 64 , 65 ]; the need for safe resection with minimisation of resulting neurological deficit is therefore of paramount importance.…”

Section: Limitations Of 5-alamentioning

confidence: 99%

Fluorescence-Guided Surgery in the Surgical Treatment of Gliomas: Past, Present and Future

Sun

Cuthbert

Watts

2021

Cancers

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Gliomas are central nervous systems tumours which are diffusely infiltrative and difficult to treat. The extent of surgical resection is correlated with improved outcomes, including survival and disease-free progression. Cancerous tissue can be directly visualised intra-operatively under fluorescence by administration of 5-aminolevulinic acid to the patient. The adoption of this technique has allowed surgeons worldwide to achieve greater extents of resection, with implications for improved prognosis. However, there are practical limitations to use of 5-aminolevulinic acid. New adjuncts in the field of fluorescence-guided surgery aim to improve recognition of the interface between tumour and brain with the objective of improving resection and patient outcomes.

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Cognitive impact of lower-grade gliomas and strategies for rehabilitation

Cited by 26 publications

References 111 publications

T2 FLAIR Hyperintensity Volume Is Associated With Cognitive Function and Quality of Life in Clinically Stable Patients With Lower Grade Gliomas

T2 FLAIR Hyperintensity Volume Is Associated With Cognitive Function and Quality of Life in Clinically Stable Patients With Lower Grade Gliomas

Constant Multi-Tasking With Time Constraint to Preserve Across-Network Dynamics Throughout Awake Surgery for Low-Grade Glioma: A Necessary Step to Enable Patients Resuming an Active Life

Fluorescence-Guided Surgery in the Surgical Treatment of Gliomas: Past, Present and Future

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