Elsevier

The Lancet Neurology

Volume 3, Issue 3, March 2004, Pages 159-168
The Lancet Neurology

Review
Cognitive deficits in adult patients with brain tumours

https://doi.org/10.1016/S1474-4422(04)00680-5Get rights and content

Summary

Cognitive function, with survival and response on brain imaging, is increasingly regarded as an important outcome measure in patients with brain tumours. This measure provides us with information on a patient's clinical situation and adverse treatment effects. Radiotherapy has been regarded as the main cause of cognitive decline in these patients, because children with brain tumours can develop intellectual deterioration caused by radiotherapy. In long-term surviving patients, radiotherapy may indeed lead to cognitive deficits, or even dementia. Recent studies, however, have made clear that focal radiotherapy in patients with glioma is not the main reason for cognitive deficits. The tumour itself and other medical treatments contribute largely to the cognitive deficits. Cognitive function is now also recognised as an independent prognostic factor in the survival of glioma patients. Additionally, cognitive deterioration can be the first indicator of progressive disease after treatment.

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

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.

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