Cognitive Deficits in Primary Brain Tumours: A Framework for Management and Rehabilitation

Abstract

Cognitive deficits related to tumour or treatment are estimated to be present in the majority of patients diagnosed with a primary brain tumour, with a large variation based on tumour site, extent, and grade, as well as nature of intervention. These deficits have a significant impact on patient’s quality of life and functional status. The improved patient survival duration in recent years has increased the need to detect, understand and intervene on these cognitive deficits, and optimise patient pathways for treatment. This article reviews the nature of deficits arising in patients with primary brain tumour, and the association of the deficits with neuroanatomical site of tumour. The approach to interventions through adaptation and remediation is outlined, with aim of improving function, promoting generalization of outcomes and optimizing any neuroplasticity that may arise. The evidence for pharmacological therapies and cognitive rehabilitation is presented, and a framework for implementation is provided.

Share and Cite:

M. Back, E. Back, M. Kastelan and H. Wheeler, "Cognitive Deficits in Primary Brain Tumours: A Framework for Management and Rehabilitation," Journal of Cancer Therapy, Vol. 5 No. 1, 2014, pp. 74-81. doi: 10.4236/jct.2014.51010.

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1] R. Stupp, M. E. Hegi, W. P. Mason, et al., “Effects of Radiotherapy with Concomitant and Adjuvant Temozolomide versus Radiotherapy Alone on Survival in Glioblastoma in a Randomised Phase III Study: 5-Year Analysis of the EORTC-NCIC Trial,” Lancet Oncology, Vol. 10, No. 5, 2009, pp. 459-466. http://dx.doi.org/10.1016/S1470-2045(09)70025-7
[2] G. Cairncross, M. Wang, E. Shaw, et al., “Phase III Trial of Chemoradiotherapy for Anaplasticoligodendroglioma: Long-Term Results of RTOG 9402,” Journal of Clinical Oncology, Vol. 31, No. 3, 2013, pp. 337-343. http://dx.doi.org/10.1200/JCO.2012.43.2674
[3] M. van den Bent, A. Brandes, M. Taphoorn, et al., “Adjuvant Procarbazine, Lomustine, and Vincristine Chemotherapy in Newly Diagnosed Anaplastic Oligodendroglioma: Long-Term Follow-Up of EORTC Brain Tumor Group Study 26951,” Journal of Clinical Oncology, Vol. 31, No. 3, 2013, pp. 344-350. http://dx.doi.org/10.1200/JCO.2012.43.2229
[4] K. Gehring, M. Sitskoorn, N. Aaronson and M. Taphoorn, “Interventions for Cognitive Deficits in Adults with Brain Tumours,” Lancet Neurology, Vol. 7, No. 6, 2008, pp. 548-560. http://dx.doi.org/10. 1016/S1474-4422(08)70111-X
[5] D. M. Langenbahn, T. Ashman, J. Cantor, et al., “An Evidence-Based Review of Cognitive Rehabilitation in Medical Conditions Affecting Cognitive Function,” Archives of Physical Medicine and Rehabilitation, Vol. 94, No. 2, 2013, pp. 271-286. http://dx.doi.org/10.1016/j.apmr.2012.09.011
[6] M. J. Taphoorn and M. Klein, “Cognitive Deficits in Adult Patients with Brain Tumours,” Lancet Neurology, Vol. 3, No. 3, 2004, pp. 159-168. http://dx.doi.org/10.1016/S1474-4422(04)00680-5
[7] D. R. Johnson, A. M. Sawyer and C. A. Meyers, “Early Measures of Cognitive Function Predict Survival in Patients with Newly Diagnosed Glioblastoma,” Neuro-Oncology, Vol. 14, No. 6, 2012, pp. 808-816. http://dx.doi.org/10.1093/neuonc/nos082
[8] O. Tucha, C. Smely, M. Preier and K. W. Lange, “Cognitive Deficits before Treatment among Patients with Brain Tumors,” Neurosurgery, Vol. 47, No. 2, 2000, pp. 324-333. http://dx.doi.org/10.1097/ 00006123-200008000-00011
[9] M. Klein, J. J. Heimans, N. K. Aaronson, et al., “Effect of Radiotherapy and Other Treatment-Related Factors on Mid-Term to Long-Term Cognitive Sequelae in Low-Grade Gliomas: A Comparative Study,” Lancet, Vol. 360, No. 9343, 2002, pp. 1361-1368. http://dx.doi.org/10.1016/S0140-6736(02)11398-5
[10] K. Piil, M. Jarden, J. Jakobsen, et al., “A Longitudinal, Qualitative and Quantitative Exploration of Daily Life and Need for Rehabilitation among Patients with High-Grade Gliomas and Their Caregivers,” BMJ Open, Vol. 3, No. 7, 2013.
[11] M. Klein, N. Engleberts, H. van der Ploeg, et al., “Epilepsy in Low-Grade Gliomas: The Impact on Cognitive Function and Quality of Life,” Annals of Neurology, Vol. 54, No. 4, 2003, pp. 514-520. http://dx.doi.org/10.1002/ana.10712
[12] M. Vargo, “Brain Tumor Rehabilitation,” American Journal of Physical Medicine & Rehabilitation, Vol. 90, No. 5, 2011, pp. S50-S62. http://dx.doi.org/10.1097/PHM.0b013e31820be31f
[13] G. Gillen, “Cognitive and Perceptual Rehabilitation: Optimizing Function,” Mosby Elsevier, St Louis Missouri, 2009.
[14] B. Zoltan, “Vision, Perception and Cognition. A Manual for the Evaluation and Treatment of the Adult with Acquired Brain Injury,” 4th Edition, Slack Incorporated, New Jersey, 2007.
[15] The Society for Cognitive Rehabilitation, “What Is Cognitive Rehabilitation?” 2013. www.societyforcognitiverehab.org
[16] M. Sohlberg and C. Mateer, “Cognitive Rehabilitation: An Integrative Neuropsychological Approach,” The Guildford Press, New York, 2001.
[17] S. Galbiati, M. Recta, V. Pastore, et al., “Attention Remediation Following Traumatic Brain Injury in Childhood and Adolescence,” Neuropsychology, Vol. 23, No. 1, 2009, pp. 40-49. http://dx.doi.org/10. 1037/a0013409
[18] C. Meyers, M. Weitzner, A. Valentine and V. Levin, “Methylphenidate Therapy Improves Cognition, Mood, and Function of Brain Tumor Patients,” Journal of Clinical Oncology, Vol. 16, No. 7, 1998, pp. 2522-2527.
[19] K. Gehring, S. Y. Patwardhan and R. Collins, “A Randomized Trial on the Efficacy of Methylphenidate and Modafinil for Improving Cognitive Functioning and Symptoms in Patients with a Primary Brain Tumor,” Journal of Neuro-Oncology, Vol. 107, No. 1, 2012, pp. 165-174. http://dx.doi.org/10.1007/ s11060-011-0723-1
[20] F. Boele, L. Douw, M. de Groot, et al., “The Effect of Modafinil on Fatigue, Cognitive Functioning, and Mood in Primary Brain Tumor Patients: A Multicenter Randomized Controlled Trial,” Neuro-Oncology, Vol. 15, No. 10, 2013, pp. 1420-1428. http://dx.doi.org/10.1093/neuonc/not102
[21] S. Rapp, D. Capp, A. Peiffer, et al., “Phase III Randomised Double-Blind, Placebo Controlled Trial of Donepezil in Irradiated Brain Tumour Survivors,” Journal of Clinical Oncology, Vol. 31, 2013.
[22] K. Gehring, M. Sitskoorn, C. Gundy, et al., “Cognitive Rehabilitation in Patients with Gliomas: A Randomized, Controlled Trial,” Journal of Clinical Oncology, Vol. 27, No. 22, 2009, pp. 3712-3722. http://dx.doi.org/10.1200/JCO.2008.20.5765
[23] C. Zucchella, A. Capone, V. Codella, et al., “Cognitive Rehabilitation for Early Post-Surgery Inpatients Affected by Primary Brain Tumor: A Randomized, Controlled Trial,” Journal of Neuro-Oncology, Vol. 114, No. 1, 2013, pp. 93-100. http://dx.doi.org/10.1007/s11060-013-1153-z
[24] D. Whiting, G. Simpson, E. Koh, et al., “A Multi-Tiered Intervention to Address Behavioural and Cognitive Changes after Diagnosis of Primary Brain Tumour: A Feasibility Study,” Brain Injury, Vol. 26, No. 7-8, 2012, pp. 950-961. http://dx.doi.org/10.3109/02699052.2012.661912
[25] A. Diamond and K. Lee, “Interventions Shown to Aid Executive Function Development in Children 4 to 12 Years Old,” Science, Vol. 333, No. 6045, 2011, pp. 959-963. http://dx.doi.org/10.1126/science. 1204529
[26] A. Lundqvist, K. Gundstrom and J. Ronnberg, “Computerized Working Memory Training in a Group of Patients Suffering from Acquired Brain Injury,” Brain Injury, Vol. 24, No. 10, 2010, pp. 1173-1183. http://dx.doi.org/10.3109/02699052.2010.498007
[27] A. Asher, “Cognitive Dysfunction among Cancer Survivors,” Archives of Physical Medicine and Rehabilitation, Vol. 90, No. 5, 2011, pp. S16-S26.
[28] P. Eriksson, E. Perileva, T. Bjork-Eriksson, et al., “Neurogenesis in the Adult Hippocampus,” Nature Medicine, Vol. 4, 1998, pp. 1313-1317. http://dx.doi.org/10.1038/3305
[29] N. Gates, M. Fiatarone Singh, P. Sachdev and M. Valenzuela, “The Effect of Exercise Training on Cognitive Function in Older Adults with Mild Cognitive Impairment: A Meta-analysis of Randomized Controlled Trials,” American Journal of Geriatric Psychiatry, Vol. 21, No. 11, 2013, pp. 1086-1097. http://dx.doi.org/10.1016/j.jagp.2013.02.018
[30] M. Angevaren, G. Aufdemkampe, H. Verhaar, et al., “Physical Activity and Enhanced Fitness to Improve Cognitive Function in Older People without Known Cognitive Impairment,” Cochrane Database of Systematic Reviews, Vol. 2, 2008, Article ID: CD005381.

Copyright © 2024 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.