Influences on cognitive outcomes in adult patients with gliomas: A systematic review

Abstract

People with brain tumors, including those previously treated, are commonly affected by a range of neurocognitive impairments involving executive function, memory, attention, and social/emotional functioning. Several factors are postulated to underlie this relationship, but evidence relating to many of these factors is conflicting and does not fully explain the variation in cognitive outcomes seen in the literature and in clinical practice. To address this, we performed a systematic literature review to identify and describe the range of factors that can influence cognitive outcomes in adult patients with gliomas. A literature search was performed of Ovid MEDLINE, PsychINFO, and PsycTESTS from commencement until September 2021. Of 9,998 articles identified through the search strategy, and an additional 39 articles identified through other sources, 142 were included in our review. The results confirmed that multiple factors influence cognitive outcomes in patients with gliomas. The effects of tumor characteristics (including location) and treatments administered are some of the most studied variables but the evidence for these is conflicting, which may be the result of methodological and study population differences. Tumor location and laterality overall appear to influence cognitive outcomes, and detection of such an effect is contingent upon administration of appropriate cognitive tests. Surgery appears to have an overall initial deleterious effect on cognition with a recovery in most cases over several months. A large body of evidence supports the adverse effects of radiotherapy on cognition, but the role of chemotherapy is less clear. To contrast, baseline cognitive status appears to be a consistent factor that influences cognitive outcomes, with worse baseline cognition at diagnosis/pre-treatment correlated with worse long-term outcomes. Similarly, much evidence indicates that anti-epileptic drugs have a negative effect on cognition and genetics also appear to have a role. Evidence regarding the effect of age on cognitive outcomes in glioma patients is conflicting, and there is insufficient evidence for gender and fatigue. Cognitive reserve, brain reserve, socioeconomic status, and several other variables discussed in this review, and their influence on cognition and recovery, have not been well-studied in the context of gliomas and are areas for focus in future research.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/, identifier CRD42017072976

Neurocognition in adults with intracranial tumors: does location really matter?

“…Although tumor-related factors can play an important role in neurocognitive outcomes of a patient, the final outcome of the patient is more complicated than tumor-related only. Neurodegenerative, connectome and metabolic changes are not only affected by the tumor or surgery, but also by patient-related factors such as age, cognitive reserve or education level, gender, and genetic factors [ 46 ], as well as additional treatments (including anti-epileptic drugs [ 47 ] and corticosteroid treatment and possible medical complications (including epileptic seizures [ 48 ]). Each of these components is intrinsically related to the tumor type, which can complicate the correct risk stratification for neurocognitive decline.…”

Predicting attention deficits and functional recovery after glioma resection through functional executive networks: insights from dynamic properties

“…Postoperative attentional and executive dysfunctions are common following brain tumor resection, affecting both patients’ quality of life and functional recovery 1,2 . Indeed, after surgery immediate outcome in attentive domain in glioma patients can sometimes reveal cognitive deficits, even in absence of clear presurgical insufficient performance 3 .…”

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

“…Impairments in cognition are common in patients with current and previously treated brain tumours, 1,2 and likely arise from a range of complex, interacting risk factors including patient‐, tumour‐ and treatment‐specific variables. Some of the most well‐studied putative influences on cognitive dysfunction include cranial irradiation, surgery, tumour characteristics including volume and location, and anti‐epileptic drug use 1 . There is evidence indicating that cognitive impairments negatively influence patient outcomes including quality of life (QOL) and survival 3 .…”

“…Some of the most well‐studied putative influences on cognitive dysfunction include cranial irradiation, surgery, tumour characteristics including volume and location, and anti‐epileptic drug use. 1 There is evidence indicating that cognitive impairments negatively influence patient outcomes including quality of life (QOL) and survival. 3 As such, there is great interest in methods to ameliorate (improve) or prevent cognitive impairments in this population.…”