Skip to main content
SpringerLink
Log in

Cognitive rehabilitation for early post-surgery inpatients affected by primary brain tumor: a randomized, controlled trial

  • Clinical Study
  • Published:
Journal of Neuro-Oncology Aims and scope Submit manuscript

Abstract

Cognitive impairment is one of the most common neurological disorders in neuro-oncological patients and exerts a deep negative impact on quality of life interfering with familiar, social and career-related activities. To test the effectiveness of early cognitive rehabilitation treatment for inpatients affected by primary brain tumors. Out of 109 consecutive patients enrolled in the study, 58 patients were randomly assigned to a rehabilitation group or to a control group. The rehabilitation consisted of 16 one-hour individual sessions of therapist-guided cognitive training, spread over 4 weeks, combining computer exercises and metacognitive training. Patients in the control group received usual care without cognitive training. All patients were evaluated by means of a comprehensive neuropsychological battery at the admission (T0) and after 4 weeks (T1). Patients in the rehabilitation group showed a significant improvement of cognitive functions. In particular, the domains that benefited most from the training were visual attention and verbal memory. The control group exhibited only a slightly, not statistically relevant, enhancement of cognitive performances. Cognitive rehabilitation for neuro-oncological inpatients resulted in a significant enhancement of cognitive performances after the training, also providing a foundation for early administration. Future research should be aimed to clarify the patients’ characteristics that predict neuropsychological improvement, to identify the most effective elements in rehabilitative programs and to study the effects of treatment extension to everyday life.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. Jensen OM, Estève J, Moller H, Renard H (1990) Cancer in the European Community and its member states. Eur J Cancer 26(11–12):1167–1256

    PubMed  CAS  Google Scholar 

  2. Radhakrishnan K, Bohnen NI, Kurland L (1994) Epidemiology of brain tumors. In: Morantz RA, Walsh JW (eds) Brain tumors: a comprehensive text. Marcel Dekker, New York, pp 1–18

    Google Scholar 

  3. Meyers CA, Rock EP, Fine HA (2012) Refining endpoints in brain tumor clinical trials. J Neurooncol 108:227–230

    Article  PubMed  Google Scholar 

  4. Huang ME, Wartella JE, Kreutzer JS (2001) Functional outcomes and quality of life in patients with brain tumors: a preliminary report. Arch Phys Med Rehabil 82:1540–1546

    Article  PubMed  CAS  Google Scholar 

  5. Mukand JA, Blackinton DD, Crincoli MG, Lee JJ, Santos BB (2001) Incidence of neurologic deficits and rehabilitation of patients with brain tumors. Am J Phys Med Rehabil 80:346–350

    Article  PubMed  CAS  Google Scholar 

  6. Hottinger AF, Yoon H, Deangelis LM, Abrey LE (2009) Neurological outcome of long-term glioblastoma survivors. J Neurooncol 95:301–305

    Article  PubMed  Google Scholar 

  7. Zucchella C, Bartolo M, Di Lorenzo C, Villani V, Pace A (2013) Cognitive impairment in primary brain tumors outpatients: a prospective cross-sectional survey. J Neurooncol 112(3):455–460

    Article  PubMed  CAS  Google Scholar 

  8. Taphoorn MJ, Klein M (2004) Cognitive deficits in adult patients with brain tumours. Lancet Neurol 3(3):159–168

    Article  PubMed  Google Scholar 

  9. Hahn CA, Dunn RH, Logue PE, King JH, Edwards CL, Halperin EC (2003) Prospective study of neuropsychologic testing and quality-of-life assessment of adults with primary malignant brain tumors. Int J Radiat Oncol Biol Phys 55:992–999

    Article  PubMed  CAS  Google Scholar 

  10. Giovagnoli AR, Silvani A, Colombo E, Boiardi A (2005) Facets and determinants of quality of life in patients with recurrent high grade glioma. J Neurol Neurosurg Psychiatry 76(4):562–568

    Article  PubMed  CAS  Google Scholar 

  11. Gustaffson M, Edvardsson T, Ahlstrom G (2006) The relationship between function, quality of life and coping in patients with low-grade gliomas. Support Care Cancer 14:1205–1212

    Article  Google Scholar 

  12. Biegler KA, Chaoul MA, Cohen L (2009) Cancer, cognitive impairment, and meditation. Acta Oncol 48(1):18–26

    Article  PubMed  Google Scholar 

  13. Giovagnoli AR (2012) Investigation of cognitive impairments in people with brain tumors. J Neuroncol 108(2):277–283

    Article  Google Scholar 

  14. Kim JH, Brown SL, Jenrow KA (2008) Mechanisms of radiation induced brain toxicity and implications for future trials. J Neurooncol 87:279–286

    Article  PubMed  CAS  Google Scholar 

  15. Gehring K, Sitskoorn MM, Aaronson NK, Taphoorn MJ (2008) Interventions for cognitive deficits in adults with brain tumours. Lancet Neurol 7:548–560

    Article  PubMed  Google Scholar 

  16. Levine B, Robertson IH, Clare L, Carter G, Hong J, Wilson BA, Duncan J, Stuss DT (2000) Rehabilitation of executive functioning: an experimental-clinical validation of goal management training. J Int Neuropsychol Soc 6:299–312

    Article  PubMed  CAS  Google Scholar 

  17. Kaschel R, Della Sala S, Cantagallo A, Fahlböck A, Laaksonen R, Kazen M (2002) Imagery mnemonics for the rehabilitation of memory: a randomised group controlled trial. Neuropsychol Rehabil 12:127–153

    Article  Google Scholar 

  18. Sinforiani E, Banchieri L, Zucchella C, Pacchetti C, Sandrini G (2004) Cognitive rehabilitation in Parkinson’s disease. Arch Gerontol Geriatr Suppl 9:387–391

    Article  PubMed  Google Scholar 

  19. Brissart H, Daniel F, Morele E, Leroy M, Debouverie M, Defer GL (2011) Cognitive rehabilitation in multiple sclerosis: a review of the literature. Rev Neurol (Paris) 167(4):280–290

    Article  CAS  Google Scholar 

  20. Cicerone KD, Langenbahn DM, Braden C et al (2011) Evidence-based cognitive rehabilitation: updated review of the literature from 2003 through 2008. Arch Phys Med Rehabil 92(4):519–530

    Article  PubMed  Google Scholar 

  21. Rao SM, Bieliauskas LA (1983) Cognitive rehabilitation two and one-half years post right temporal lobectomy. J Clin Neuropsychol 5(4):313–320

    Article  PubMed  CAS  Google Scholar 

  22. Sherer M, Meyers CA, Bergloff P (1997) Efficacy of postacute brain injury rehabilitation for patients with primary malignant brain tumors. Cancer 80(2):250–257

    Article  PubMed  CAS  Google Scholar 

  23. Locke DE, Cerhan JH, Wu W, Malec JF, Clark MM, Rummans TA, Brown PD (2008) Cognitive rehabilitation and problem-solving to improve quality of life of patients with primary brain tumors: a pilot study. J Support Oncol 6(8):383–391

    PubMed  Google Scholar 

  24. Duval J, Coyette F, Seron X (2008) Rehabilitation of the central executive component of working memory: a re-organisation approach applied to a single case. Neuropsychol Rehabil 18(4):430–460

    Article  PubMed  CAS  Google Scholar 

  25. Gehring K, Sitskoorn MM, Gundy CM, Sikkes SA, Klein M, Postuma TJ, van den Bent MJ, Beute GN, Enting RH, Kappelle AC, Boogerd W, Veninga T, Twijnstra A, Boerman DH, Taphroon MJ, Aaronson NK (2009) Cognitive rehabilitation in patients with gliomas: a randomized, controlled trial. J Clin Oncol 27(22):3712–3722

    Article  PubMed  Google Scholar 

  26. Hassler MR, Elandt K, Preusser M, Lehrner J, Binder P, Dieckmann K, Rottenfusser A, Marosi C (2010) Neurocognitive training in patients with high-grade glioma: a pilot study. J Neurooncol 97(1):109–115

    Article  PubMed  Google Scholar 

  27. Folstein MF, Folstein SE, McHugh PR (1975) “Mini mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12:189–198

    Article  PubMed  CAS  Google Scholar 

  28. Orsini A, Grossi D, Capitani E, Laiacona M, Papagno C, Vallar G (1987) Verbal and spatial immediate memory span: normative data from 1355 adults and 1112 children. J Neurol Sci 8(6):539–548

    CAS  Google Scholar 

  29. Carlesimo GA, Caltagirone C, Gainotti G (1996) The mental deterioration battery: normative data, diagnostic reliability and qualitative analyses of cognitive impairment. The Group for the standardization of the mental deterioration battery. Eur Neurol 36(6):378–384

    Article  PubMed  CAS  Google Scholar 

  30. Carlesimo GA, Buccione I, Fadda L, Graceffa A, Mauri M, Lo Russo S, Bevilacqua G, Caltagirone C (2002) Standardizzazione di due test di memoria per uso clinico: Breve Racconto e Figura di Rey. Nuova Rivista Neurol 12:1–13

    Google Scholar 

  31. Basso A, Capitani E, Laiacona M (1987) Raven’s coloured progressive matrices and brain damage: normative values in 305 adult normal controls. Funct Neurol 2(2):189–194

    PubMed  CAS  Google Scholar 

  32. Apollonio I, Leone M, Isella V, Piamarta F, Consoli T, Villa ML, Forapani E, Russo A, Nichelli P (2005) The frontal assessment battery (FAB): normative values in an Italian population sample. Neurol Sci 26:108–116

    Article  Google Scholar 

  33. Giovagnoli AR, Del Pesce M, Mascheroni S, Simoncelli M, Laiacona M, Capitani E (1996) Trail making test: normative values from 287 normal adults controls. Ital J Neurol Sci 17:305–309

    Article  PubMed  CAS  Google Scholar 

  34. Spinnler H, Tognoni G (1987) Standardizzazione e taratura italiana di test neuropsicologici. Ital J Neurol Sci 6(Suppl.8):1–120

    Google Scholar 

  35. Caffarra P, Vezzadini G, Dieci F, Zonato F, Venneri A (2002) Rey-Osterrieth complex figure: normative values in an Italian population sample. Neurol Sci 22:443–447

    Article  PubMed  CAS  Google Scholar 

  36. Novelli G, Papagno C, Capitani E, Laiacona M, Vallar G, Cappa S (1986) Tre test clinici di ricerca e produzione lessicale: taratura su soggetti normali. Archivio di Psicologia, Neurologia e Psichiatria 47:477–486

    Google Scholar 

  37. Capasso R, Miceli G (2001) Esame Neuropsicologico per l’Afasia (E.N.P.A.). Springer, Milano

    Google Scholar 

  38. Lageman SK, Cerhan JH, Locke DEC, Anderson SK, Wu W, Brown PD (2010) Comparing neuropsychological tasks to optimize brief cognitive batteries for brain tumors clinical trials. J Neurooncol 96(2):271–276

    Article  PubMed  Google Scholar 

  39. Papagno C, Casarotti A, Comi A, Gallucci M, Riva M, Bello L (2012) Measuring clinical outcomes in neuro-oncology. A battery to evaluate low-grade gliomas (LGG). J Neurooncol 108(2):269–275

    Article  PubMed  Google Scholar 

  40. Powell T, Malia K (2009) Training di riabilitazione cognitiva, Erickson edn. Trento, Italia

    Google Scholar 

  41. Gollin D, Ferrari A, Peruzzi A (2011) Una palestra per la mente. Erickson, Trento

    Google Scholar 

  42. Kim YH, Yoo WK, Ko MH, Park CH, Kim ST, Na DL (2009) Plasticity of the attentional network after brain injury and cognitive rehabilitation. Neurorehabil Neural Repair 23:468–477

    Article  PubMed  Google Scholar 

  43. Petersen SE, van Mier H, Fiez JA, Raichle ME (1998) The effects of practice on the functional anatomy of task performance. Proc Natl Acad Sci USA 95:853–860

    Article  PubMed  CAS  Google Scholar 

  44. Solberg MM, Mater CA (2001) Improving attention and managing attentional problems. Adapting rehabilitation techniques to adults with ADD. Ann N. Y. Acad Sci 931:359–375

    Article  Google Scholar 

  45. Robertson IH (2005) The rehabilitation of attention. In: Stuss DT, Winocur G, Robertson IH (eds) Cognitive neurorehabilitation. Cambridge University Press, New York, pp 302–313

    Google Scholar 

  46. Kolb B (1999) Synaptic plasticity and the organization of behaviour after early and late brain injury. Can J Exp Psychol 53:62–76

    Article  PubMed  CAS  Google Scholar 

  47. Giordana MT, Clara E (2006) Functional rehabilitation and brain tumor patients. A review of outcome. Neurol Sci 27:240–244

    Article  PubMed  CAS  Google Scholar 

  48. Geler-Kulcu D, Gulsen G, Buyukbaba E, Ozkan D (2009) Functional recovery of patients with brain tumor or acute stroke after rehabilitation: a comparative study. J Clin Neurosci 16:74–78

    Article  PubMed  CAS  Google Scholar 

  49. Bartolo M, Zucchella C, Pace A, Lanzetta G, Vecchione C, Bartolo M, Grillea G, Serrao M, Tassorelli C, Sandrini G, Pierelli F (2012) Early rehabilitation after surgery improves functional outcome in inpatients with brain tumours. J Neurooncol 107(3):537–544

    Article  PubMed  Google Scholar 

  50. Verhagen AP, de Vet HC, de Bie RA, Kessels AG, Boers M, Bouter LM, Knipschild PG (1998) The Delphi list: a criteria list for quality assessment of randomized clinical trials for conducting systematic reviews developed by Delphi consensus. J Clin Epidemiol 51:1235–1241

    Article  PubMed  CAS  Google Scholar 

  51. Meyers CA, Hess KR, Yung WK, Levin VA (2000) Cognitive function as a predictor of survival in patients with recurrent malignant glioma. J Clin Oncol 18(3):646–650

    PubMed  CAS  Google Scholar 

  52. Gehring K, Aaronson NK, Gundy CM, Taphoorn MJB, Sitskoorn MM (2011) Predictors of neuropsychological improvement following cognitive rehabilitation in patients with gliomas. J Int Neuropsychol Soc 17:256–266

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Neurorehabilitation Unit, IRCCS Neurological Mediterranean Institute NEUROMED, Via Atinense 18, 86077, Pozzilli, Isernia, Italy

    Chiara Zucchella, Annarita Capone, Valentina Codella, Francesco Pierelli & Michelangelo Bartolo

  2. Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy

    Chiara Zucchella

  3. Neurorehabilitation Unit, Laboratory of Multifactorial Biomechanics, IRCCS Neurological Mediterranean Institute NEUROMED, Via Atinense 18, 86077, Pozzilli, Isernia, Italy

    Alessandro Marco De Nunzio & Michelangelo Bartolo

  4. Laboratory of Vascular Pathophysiology, IRCCS Neurological Mediterranean Institute NEUROMED, Via Atinense 18, 86077, Pozzilli, Isernia, Italy

    Carmine Vecchione

  5. Department of Medicine, University of Salerno, via S. Allende, 84081, Baronissi, Salerno, Italy

    Carmine Vecchione

  6. Neurorehabilitation Unit, IRCCS National Neurological Institute C. Mondino Foundation, via Mondino 2, 27100, Pavia, Italy

    Giorgio Sandrini

  7. Department of Neurological Sciences, University of Pavia, via Mondino 2, 27100, Pavia, Italy

    Giorgio Sandrini

  8. Neurology Unit, Regina Elena National Cancer Institute, via E. Chianesi 53, 00144, Rome, Italy

    Andrea Pace

  9. Department of Medical-Surgical Sciences and Biotechnology, University of Rome “La Sapienza”, Corso della Repubblica 79, 04100, Latina, Italy

    Francesco Pierelli

Authors
  1. Chiara Zucchella
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Annarita Capone
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Valentina Codella
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Alessandro Marco De Nunzio
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Carmine Vecchione
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Giorgio Sandrini
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Andrea Pace
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Francesco Pierelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Michelangelo Bartolo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Michelangelo Bartolo.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Zucchella, C., Capone, A., Codella, V. et al. Cognitive rehabilitation for early post-surgery inpatients affected by primary brain tumor: a randomized, controlled trial. J Neurooncol 114, 93–100 (2013). https://doi.org/10.1007/s11060-013-1153-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11060-013-1153-z

Keywords

Search

Navigation