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

Abstract

Objective As preservation of cognitive functioning increasingly becomes important in the light of ameliorated survival after intracranial tumor treatments, identification of eloquent brain areas would enable optimization of these treatments. Methods This cohort study enrolled adult intracranial tumor patients who received neuropsychological assessments pre-irradiation, estimating processing speed, verbal fluency and memory. Anatomical magnetic resonance imaging scans were used for multivariate voxel-wise lesion-symptom predictions of the test scores (corrected for age, gender, educational level, histological subtype, surgery, and tumor volume). Potential effects of histological and molecular subtype and corresponding WHO grades on the risk of cognitive impairment were investigated using Chi square tests. P-values were adjusted for multiple comparisons (p < .001 and p < .05 for voxel- and cluster-level, resp.). Results A cohort of 179 intracranial tumor patients was included [aged 19–85 years, median age (SD) = 58.46 (14.62), 50% females]. In this cohort, test-specific impairment was detected in 20–30% of patients. Higher WHO grade was associated with lower processing speed, cognitive flexibility and delayed memory in gliomas, while no acute surgery-effects were found. No grading, nor surgery effects were found in meningiomas. The voxel-wise analyses showed that tumor locations in left temporal areas and right temporo-parietal areas were related to verbal memory and processing speed, respectively. Interpretation Patients with intracranial tumors affecting the left temporal areas and right temporo-parietal areas might specifically be vulnerable for lower verbal memory and processing speed. These specific patients at-risk might benefit from early-stage interventions. Furthermore, based on future validation studies, imaging-informed surgical and radiotherapy planning could further be improved.

The impact of brain lesions on health-related quality of life in patients with WHO CNS grade 3 or 4 glioma: a lesion-function and resting-state fMRI analysis

“…While several studies have been performed to elucidate the underlying causes of neurocognitive deterioration in glioma patients by modern neuroimaging methods, including voxelwise lesion-symptom mapping, fMRI, and tractography [38][39][40][41][42][43], these approaches have rarely been applied to selfreported HRQoL data [44]. It is reasonable to assume that apart from the presence of distracting symptoms, quality of life depends on various functional abilities, such as perception of sensory and emotional stimuli, attention, planning and execution of complex actions, language, speech, and memory.…”

The impact of brain lesions on quality of life in patients with WHO CNS grade 3 or 4 glioma: A lesion-function and resting-state fMRI analysis

“…While several have been to elucidate the underlying causes of neurocognitive deterioration in glioma patients by modern neuroimaging methods, including voxel-wise lesion-symptom mapping, fMRI, and tractography [35][36][37][38][39][40], these approaches have rarely been applied to self-reported QoL data [41]. It is reasonable to assume that quality of life depends on many different abilities, such as perception of physical and emotional stimuli, attention, planning of complex actions, language, speech, and memory.…”