References for this review were identified by searches of MEDLINE with the terms “cognition”, “cognitive functioning”, “glioma”, “brain tumour”, “radiation encephalopathy”. References were also selected from relevant articles and chapters of recent books on neuro-oncology. Articles published up to September 2003 were included. Only papers published in English or with an English abstract were reviewed.
ReviewCognitive deficits in adult patients with brain tumours
Section snippets
Measurement of cognitive function
Cognitive ability depends on multiple discrete functions and on the intactness of more basic functions, such as motor, sensory, and praxis abilities and a normal level of consciousness. Moreover, because emotional distress can cause impairments in attention, vigilance, and motivation, subsequently affecting performance in several cognitive domains, this issue should be taken into account, especially in patients with brain tumours.11, 12
The choice of cognitive test (panel 1)13, 14, 15, 16, 17, 18
Causes of cognitive deficits
Cognitive deficits in patients with brain tumours can be caused by the tumour, by tumour-related epilepsy and its treatment (surgery, radiotherapy, antiepileptics, chemotherapy, or corticosteroids), and by psychological distress. More likely, a combination of these factors will contribute to cognitive dysfunction. Also, tumour regrowth (either locally or diffusely [gliomatosis cerebri]), leptomeningeal metastasis, or metabolic disturbances might negatively affect cognitive function.
Treatment of cognitive disturbances
Although many studies have documented the nature and extent of cognitive deficits in patients with brain tumours, surprisingly little work has been directed towards treatment (table). Apart from treatment of the tumour (surgery, radiotherapy, and chemotherapy) and surrounding oedema, which may improve cognitive functions, in most patients cognitive deterioration caused by the tumour and its treatment is not easy to treat. Patients with communicating hydrocephalus as a consequence of treatment
Conclusion
Cognitive function is increasingly regarded as an important endpoint in brain tumour patients. An important rationale for the selection of a given brain tumour treatment may be related to cognitive side-effects and effect on quality of life. Assessment of cognitive function in long-term surviving patients with brain tumour has also become crucial.
The role of radiotherapy—for a long time thought to be the main cause of cognitive deficits in patients with brain tumour—has been studied. An
Search strategy and selection criteria
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