Prediction of neurocognitive outcome in adult brain tumor patients

Purpose: To determine the relative contributions of patient, disease and therapy specific factors on neurocognitive outcome of brain tumor patients. Patients and methods: Seventy-nine patients (mean age = 41.1 years; range: 17-75 years; 54% male, 46% female) with glioblastoma multiforme (37%), anaplastic astrocytoma (17%), low grade astrocytoma (13%), and oligodendroglioma (10%) predominantly in the frontal regions (45%) were evaluated in an outpatient neuro-oncology clinic. A neuropsychological test battery emphasized elements of attention/concentration. Multiple regression analyses determined relationships between functional outcomes and demographic and clinical predictors. Results: Key predictors of neurocognitive functioning included age of the patient (36-59 years, p < 0.01; >= 60 years, p < 0.05) and frontal region tumor location (p < 0.01). As expected, older patients did not perform as well as younger patients in absolute terms on neuropsychological tests; decrements persisted when comparisons were based on age-standardized versions of neurocognitive outcomes. Major depressive disorder was marginally associated with outcomes, while surgical interventions and radiotherapy did not show strong associations with test performances. Conclusions: Primary malignant brain disease was found to be less negative on neurocognitive outcomes for younger than for either middle-aged or older patients. Treatments were not as predictive of neurocognitive outcomes as age. No single test outcome measure was as sensitive to neurocognitive status as the empirically derived index of attention and concentration.