Tumour and surgery effects on cognitive functioning in high-grade glioma patients
Tumour and surgery effects on cognitive functioning in high-grade glioma patients
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DOI：
10.1007/s00701-014-2115-8
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发表时间：
2014-08-01
影响因子：
2.4
通讯作者：
Taphoorn, Martin J. B.
中科院分区：
文献类型：
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作者：
Habets, Esther J. J.;Kloet, Alfred;Taphoorn, Martin J. B.
许多高级别胶质瘤（HGG）患者有认知障碍，影响日常功能。认知障碍可由肿瘤、治疗和患者相关因素引起。然而，肿瘤和手术切除对认知的影响并不为人所知。我们调查了肿瘤和手术对HGG患者认知功能的影响。在基线，手术前，62例HGG患者进行了神经心理学测试，涉及7个认知领域：言语和工作记忆，注意力，执行功能，心理功能，信息处理速度和视觉建设能力。39名患者在手术后但在后续治疗前被纳入随访测试。肿瘤的大小和位置，抗癫痫药物和皮质类固醇的使用，以及切除的程度被记录下来。与健康对照组相比，患者的认知功能在所有领域都明显受损。术前79%（49/62）的患者至少在一个领域存在认知障碍。在术后5周的中位随访中，59%（39例中的23例）的患者在至少一个领域存在认知障碍。在随访中，49%的人表现出改善，而23%的人下降。左半球肿瘤定位与语言记忆差相关（P=0.004），该半球肿瘤较大与执行功能差相关（P < 0.001）。与基线相比，随访时认知功能的变化与肿瘤特征或切除范围无关。大多数HGG患者术前存在肿瘤相关的认知功能障碍。在大多数患者中，手术不会在短期内导致认知功能恶化。
Many high-grade glioma (HGG) patients have cognitive impairments, which impact daily functioning. Cognitive impairments can be caused by tumour-, treatment-, and patient-related factors. The effect of the tumour and of surgical resection on cognition is, however, not well known. We investigated tumour and surgical effects on cognitive functioning in patients with HGG.At baseline, preceding surgery, 62 patients with HGG underwent neuropsychological testing concerning seven cognitive domains: verbal and working memory, attention, executive functioning, psychomotor function, information processing speed, and visuoconstructive abilities. Thirty-nine patients were included in follow-up testing after surgery, but before subsequent treatment. Tumour size and site, use of anti-epileptic drugs and corticosteroids, and extent of resection were recorded.Compared to healthy controls, cognitive functioning of patients was significantly impaired in all domains. Prior to surgery 79 % (49 of 62) of patients had cognitive impairment in at least one domain. At median follow-up of 5 weeks after surgery, 59 % (23 of 39) of patients were cognitively impaired in at least one domain. At follow-up, 49 % showed improvement, while 23 % declined. Left hemisphere tumour localization was associated with worse verbal memory (P=0.004), and larger tumours in this hemisphere with poorer executive functioning (P < 0.001). Changes in cognitive performance at follow-up relative to baseline were not related to tumour characteristics or extent of resection.Tumour-related cognitive deficits are present in a majority of HGG patients preceding surgery. Surgery does not result in cognitive deterioration in the short term in most patients.