Abstract
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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Funding
This work was funded, in part, by: National Institute of Health (NIH) grants #1KL2TR001444 (JAH-G), #UL1TR000100 (JAH-G), R01CA238783-01 (JAH-G), TL1TR001443 (KRT, DM), R01NS065838 (C.R.M.); American Cancer Society Pilot Award ACS-IRG 70-002 (JAH-G); American Cancer Society Research Scholar Grant RSG-15-229-01-CCE (C.R.M.).
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Drs. Seibert, Dr. Hattangadi-Gluth, and Dr. Karunamuni report grant funding from Varian Medical Systems, unrelated to the present study.
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Karunamuni, R., Tringale, K.R., Burkeen, J. et al. Multi-domain neurocognitive classification of primary brain tumor patients prior to radiotherapy on a prospective clinical trial. J Neurooncol 146, 131–138 (2020). https://doi.org/10.1007/s11060-019-03353-2
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DOI: https://doi.org/10.1007/s11060-019-03353-2