Treatment of cognitive deficits in brain tumour patients: current status and future directions

Abstract

Purpose of reviewIncreased life expectancy in brain tumour patients had led to the need for strategies that preserve and improve cognitive functioning, as many patients suffer from cognitive deficits. The tumour itself, as well as antitumor treatment including surgery, radiotherapy and chemotherapy, supportive treatment and individual patient factors are associated with cognitive problems. Here, we review the recent literature on approaches that preserve and improve cognitive functioning, including pharmacological agents and rehabilitation programs.Recent findingsMinimizing cognitive dysfunction and improving cognitive functioning in brain tumour patients may be achieved both by preserving cognitive functioning during antitumor treatment, including techniques such as awake brain surgery, less invasive radiation therapies such as stereotactic radiotherapy and proton therapy, as well as with interventions including cognitive rehabilitation programmes. Novel rehabilitation programs including computer-based cognitive rehabilitation therapy (CRT) programmes that can be adjusted to the specific patient needs and can be administered at home are promising. Furthermore, personalized/precision medicine approaches to identify patients who are at risk for cognitive decline may facilitate effective treatment strategies in the future.SummaryCognitive functioning has gained greater awareness in the neuro-oncological community, and methods to preserve and improve cognitive functioning have been explored. Rehabilitation programmes for brain tumour patients should be further developed and referred to in clinical practice.

Whole brain proton irradiation in adult Sprague Dawley rats produces dose dependent and non-dependent cognitive, behavioral, and dopaminergic effects

“…While no differences were noted for NOR, there were deficits in egocentric and allocentric learning and memory in proton irradiated rats. These cognitive deficits are consistent with cognitive deficits observed in patients that underwent radiotherapy 1,3,4 . Deficits in the CWM were found for all groups of irradiated rats; here again, the effects were not dose-dependent.…”

“…The use of therapeutic ionizing radiation has prolonged the life of cancer patients, but it can also impair neurocognitive function [1][2][3][4] . Cranial irradiation, in particular, is an essential palliative and curative treatment for many brain tumors and can prevent against development of brain metastases for some carcinomas and leukemias.…”

Rehabilitation of Adult Patients with Primary Brain Tumors: A Narrative Review

“…Patients with PBTs may experience deficits in cognition due to not only the presence and location of the tumor, but also as a side effect of treatments such as radiation, chemotherapy, and surgery. Cognitive deficits present barriers to care and reintegration into society [20]. Both cognitive rehabilitation and pharmacological interventions have been utilized in treating deficits in patients with PBTs.…”

“…Medical complications of patients with PBTs have been well documented and include venous thromboembolic disease, syndrome of inappropriate antidiuretic hormone (SIADH), dysphagia, and seizures, among others [11][12][13][14]. Psychiatric symptoms such as depression, fatigue, mood changes, and personality changes have been noted in conjunction with other symptoms such as headaches, sleep changes, and cognitive disturbances [15][16][17][18][19][20][21]. Survivorship care models propose interdisciplinary healthcare teams to deliver tailored care to cancer patients [22][23][24][25].…”

A randomized trial of stereotactic versus conventional radiotherapy in young patients with low-grade brain tumors: occupational therapy-based neurocognitive data

“… 1 , 2 Post-RT damage has been shown to occur in the setting of pre-existing brain pathology in the majority (90%) of patients 3–5 and is accentuated by disruption of neural pathways and cognitive networks. 6 , 7 The rapid evolution of technology has allowed us to deliver RT with increasing precision to target (tumor) with incremental sparing of normal tissues as we have progressed from conventional to conformal radiotherapy techniques. Despite obvious dosimetric advantages of technological advances, the near-axiomatic assumption that technological advance equates with tangible benefit in terms of improved efficacy and long-term sequelae, has often been difficult to prove.…”