Journal
JOURNAL OF NEURO-ONCOLOGY
Volume 146, Issue 1, Pages 131-138Publisher
SPRINGER
DOI: 10.1007/s11060-019-03353-2
Keywords
Radiotherapy; Neurocognitive function; Primary brain tumors; Global deficit score
Categories
Funding
- National Institute of Health (NIH) [1KL2TR001444, UL1TR000100, R01CA238783-01, TL1TR001443, R01NS065838]
- American Cancer Society Pilot Award [ACS-IRG 70-002]
- American Cancer Society Research Scholar Grant [RSG-15-229-01-CCE]
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Introduction We investigated multi-domain baseline neurocognition of primary brain tumor patients prior to radiotherapy (RT), including clinical predictors of function and association between pre-RT and post-RT impairment on a prospective trial. Methods A multi-domain neuropsychological battery (memory, executive functioning, language, attention, processing) was performed on 37 patients, pre-RT and 3-(n = 21), 6-(n = 22) and 12-(n = 14) months post-RT. Impairment rate was the proportion of patients with standardized T-scores <= 1.5 standard deviations below normative means. Per-patient impairment across all domains was calculated using a global deficit score (GDS; higher value indicates more impairment). Associations between baseline GDS and clinical variables were tested. Global GDS impairment rate at each time point was the fraction of patients with GDS scores > 0.5. Results Statistically significant baseline neurocognitive impairments were identified on 4 memory (all p <= 0.03) and 2 out of 3 (p = 0.01, p = 0.027) executive functioning tests. Per-patient baseline GDS was significantly associated with tumor volume (p = 0.048), tumor type (p = 0.043), seizure history (p = 0.007), and use of anti-epileptics (p = 0.009). The percentage of patients with the same impairment status at 3-, 6-, and 12-months as at baseline were 88%, 85%, and 85% respectively. Conclusions Memory and executive functioning impairment were the most common cognitive deficits prior to RT. Patients with larger tumors, more aggressive histology, and use of anti-epileptics had higher baseline GDS values. GDS is a promising tool to encompass multi-domain neurocognitive function, and baseline GDS can identify those at risk of cognitive impairment.
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