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Neuropsychological Evaluation of Patients with Intrinsic Brain Tumors

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Epilepsy Surgery and Intrinsic Brain Tumor Surgery

Abstract

This chapter begins with a discussion of the primary purposes of neuropsychological assessment in patients with intrinsic brain tumors and is followed by an overview of the most important tumor characteristics as well as patient status factors that need to be considered when using neuropsychological tests to assess these patients. The cognitive domains that comprise a comprehensive battery of neuropsychological tests are reviewed, along with some representative tests from each domain. In addition, personality testing, assessment of mood, and measures of health-related quality of life designed specifically for patients with brain cancer are briefly covered. Next, a short, standardized battery of neuropsychological tests that have been used internationally in multisite brain cancer clinical trials is described. The chapter concludes with a summary of the salient results of neuropsychological assessments before and after treatment with resective surgery, cranial irradiation, and chemotherapy and the primary cognitive deficits associated with each of these treatment modalities. Finally, there is a brief discussion weighing the clinical decision making trade-offs using health utility measures when there are conflicts between the quantity (survival) and quality (cognition and quality of life).

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References

  1. Mitchell AJ, Kemp S, Benito-Leon J, Reuber M. The influence of cognitive impairment on health-related quality of life in neurological disease. Acta Neuropsychiatrica. 2010;22:2–13.

    Article  Google Scholar 

  2. Dirven L, Reijneveld JC, Taphoorn MJB. Health-related quality of life or quantity of life: a difficult trade-off in primary brain tumors? Sem Oncol. 2014;41:541–52.

    Article  Google Scholar 

  3. Dwan TM, Ownsworth T, Chambers S, Walker DG, Shum DHK. Neuropsychological assessment of individuals with brain tumor: comparison of approaches used in the classification of impairment. Frontiers Oncol. 2015;5.(Article 56:1–8.

    Article  Google Scholar 

  4. Janelsins MC, Kohli S, Mohile SG, Usuki K, Ahles TA, Morrow GR. An update on cancer- and chemotherapy-related cognitive dysfunction: current status. Sem Oncol. 2011;38:431–8.

    Article  Google Scholar 

  5. Klein M, Duffau H, De Witt Hammer PC. Cognition and resective surgery for diffuse infiltrative glioma: an overview. J Neuro-Oncol. 2012;108:309–18.

    Article  Google Scholar 

  6. Klein M, Postma TJ, Taphoorn MJB, Aaronson NK, Vandertop WP, Muller M, et al. The prognostic value of cognitive functioning in the survival of patients with high-grade glioma. Neurology. 2003;61:1796–9.

    Article  CAS  Google Scholar 

  7. Meyers CA, Hess KR, Yung WK, Levin VA. Cognitive function as a predictor of survival in patients with recurrent malignant glioma. J Oncol. 2000;18:646–50.

    Article  CAS  Google Scholar 

  8. Meyers CA, Geara F, Wong PF, Morrison WH. Neurocognitive effects of therapeutic irradiation for base of skull tumors. Int J Radiation Oncol. 2000;46:51–5.

    Article  CAS  Google Scholar 

  9. Anderson SW, Ryken TC. Intracranial tumors. In: Morgan JE, Ricker JH, editors. Textbook of clinical neuropsychology. New York: Taylor & Francis; 2008. p. 578–87.

    Google Scholar 

  10. Meyers CA, Hess KR. Multifaceted end points in brain tumor clinical trials: cognitive deterioration precedes MRI progression. Neurooncology. 2003;5:89–95.

    Google Scholar 

  11. Appelbaum PS, Grisso T. MacCAT-CR: MacArthur competence assessment tool for clinical research. Sarasota: Professional Assessment Resources; 2001.

    Google Scholar 

  12. Loeb P. Independent living scales manual. San Antonio: The Psychological Corporation; 1996.

    Google Scholar 

  13. Rodin MB, Mohile SG. Assessing decisional capacity in the elderly. Semin Oncol. 2008;35:625–32.

    Article  Google Scholar 

  14. Denlinger CS, Ligibel JA, Are M, Baker KS, Demark-Wahnefried W, Friedman DL, et al. Survivorship: cognitive function, version 1.2014. National Comprehensive Cancer Network. J Natl Compr Cancer Netw. 2014;12:976–86.

    Article  Google Scholar 

  15. Ahles TA, Saykin AJ. Candidate mechanisms for chemotherapy induced cognitive changes. Natl Rev Cancer. 2007;7:192–201.

    Article  CAS  Google Scholar 

  16. Salkade PR, Lim TA. Methotrexate-induced acute toxic leukoencephalopathy. J Cancer Res Ther. 2012;8:292–6.

    Article  CAS  Google Scholar 

  17. Schagen SB, Das E, Vermeulen I. Information about chemotherapy-associated cognitive problems contributes to cognitive problems in cancer patients. Psychooncology. 2012;21:1132–5.

    Article  Google Scholar 

  18. Lazareff JA, Castro-Sierra E. Preoperative and postoperative analysis of visual and auditory memory in children with cerebellar tumors. Childs Nerv Syst. 1996;12:81–6.

    Article  CAS  Google Scholar 

  19. Margelisch K, Studer M, Ritter BC, Steinlin M, Leibundgut K, Heinks T. Cognitive dysfunction in children with brain tumors at diagnosis. Pediatr Blood Cancer. 2015;62:1805–12.

    Article  Google Scholar 

  20. Miller AH, Ancoli-Israel S, Bower JE, Capuron L, Irwin MR. Neuroendocrine-immune mechanisms of behavioral comorbidities in patients with cancer. J Clin Oncol. 2008;26:971–82.

    Article  CAS  Google Scholar 

  21. Iuvone L, Mariotti P, Colosimo C, Guzzetta F, Ruggiero A, Riccardi R. Long term cognitive outcome, brain CT scan and MRI abnormalities in children cured for ALL. Cancer. 2002;95:2562–70.

    Article  Google Scholar 

  22. Moberget T, Andersson S, Lundar T, Due-Tønnessen BJ, Heldal A, Endestad T, et al. Long-term supratentorial brain structure and cognitive function following cerebellar tumour resections in childhood. Neuropsychologia. 2015;69:218–31.

    Article  CAS  Google Scholar 

  23. Papazoglou A, King T, Morris R, Krawiecki N. Cognitive predictors of adaptive functioning vary according to pediatric brain tumor location. Dev Neuropsychol. 2008;33:505–20.

    Article  Google Scholar 

  24. Klein M, Taphoorn MJ, Heimans JJ, Van der Ploeg HM, Vandertop WP, Smit EF, et al. Neurobehavioral status and health-related quality of life in newly diagnosed high-grade glioma patients. J Clin Oncol. 2001;19:4037–47.

    Article  CAS  Google Scholar 

  25. Habets EJ, Kloet A, Walchenbach R, Vecht CJ, Klein M, Taphoorn MJ. Tumour and surgery effects on cognitive functioning in high-grade glioma patients. Acta Neurochir. 2014;156:1451–9.

    Article  Google Scholar 

  26. Crossen JR, Garwood D, Glatstein E, Neuwelt EA. Neurobehavioral sequelae of cranial irradiation in adults: a review of radiation-induced encephalopathy. J Clin Oncol. 1994;12:627–42.

    Article  CAS  Google Scholar 

  27. Chang EL, Wefel JS, Hess KR, Allen PK, Lang FF, Kornguth DG, et al. Neurocognition in patients with brain metastases treated with radiosurgery or radiosurgery plus whole brain irradiation: a randomized controlled trial. Lancet Oncol. 2009;10:1037–44.

    Article  Google Scholar 

  28. Meyers CA, Brown PD. Role and relevance of neurocognitive assessment in clinical trials of patients with CNS tumors. J Clin Oncol. 2006;24:1305–9.

    Article  Google Scholar 

  29. Onodera S, Aoyama H, Tha KK, Hashimoto N, Toyomaki A, Terae S, et al. The value of 4-month neurocognitive function as an endpoint in brain metastases trials. J Neuro-Oncol. 2014;120:311–9.

    Article  Google Scholar 

  30. Iuvone L, Peruzzi L, Colosimo C, Tamburrini G, Caldarelli M, Di Rocco C, et al. Pretreatment neuropsychological deficits in children with brain tumors. NeuroOncol. 2011;13:517–24.

    CAS  Google Scholar 

  31. Iuvone L, Marlotti P, Colosimo C, Guzzetta F, Ruggiero A, Riccardl R. Long-term cognitive outcome, brain computed tomography scan, and magnetic resonance imaging in children cure for acute lymphoblastic leukemia. Cancer. 2002;95(12):2562–70.

    Article  Google Scholar 

  32. DeAnglis LM. Brain tumors. N Engl J Med. 2001;344:114–23.

    Article  Google Scholar 

  33. Mukand JA, Blackinton DD, Crincoli MG, Lee JJ, Santos BB. Incidence of neurologic deficits and rehabilitation of patients with brain tumors. Am J Phys Med. 2001;80:346–50.

    Article  CAS  Google Scholar 

  34. Meyers CA. Neurocognitive dysfunction in cancer patients. Oncology. 2000;14:75–8.

    CAS  PubMed  Google Scholar 

  35. Mendez MF, Cummings JL. Miscellaneous dementia syndromes-neoplasia-related dementia. In: Mendez M, Cummings J, editors. Dementia: a clinical approach. Philadelphia: Butterworth-Heinemann; 2003. p. 521–6.

    Google Scholar 

  36. Lezak MD, Howieson DB, Bigler ED, Tranel D. Neuropsychological assessment. 5th ed. New York: Oxford University Press; 2012.

    Google Scholar 

  37. Folstein MF, Folstein SE, Mchugh PR. “Mini-mental state.” a practical method for grading the cognitive state of patients for the clinician. J Psych Res. 1975;12:189–98.

    Article  CAS  Google Scholar 

  38. Nasreddine ZS, Phillips N, Chertkow H. Normative data for the Montreal cognitive assessment (MoCA) in a population-based sample. Neurology. 2012;78:765–6.; author reply 766. https://doi.org/10.1212/01.wnl.0000413072.54070.a3.

    Article  PubMed  Google Scholar 

  39. Strauss E, Sherman EMS, Spreen O. A compendium of neuropsychological tests: administration, norms, and commentary. 3rd ed. New York: Oxford University; 2006.

    Google Scholar 

  40. Heilman KM, Watson RT, Valenstein E. Neglect and related disorders. In: Heilamn KM, Valenstein E, editors. Clinical neuropsychology. 4th ed. New York: Oxford University Press; 2003. p. 296–346.

    Google Scholar 

  41. Blumenfeld H. Neuroanatomy through clinical cases. Sunderland: Sinauer Associates; 2010.

    Google Scholar 

  42. Meyers CA, Weitzner MA, Valentine AD, Levin VA. Methylphenidate therapy improves cognition, mood, and function of brain tumor patients. J Clin Oncol. 1998;16:2522–7.

    Article  CAS  Google Scholar 

  43. Benedict RHB, Schretlen D, Groninger L, Brandt J. Hopkins verbal learning test-revised: normative data and analysis of inter-form and test-retest reliability. Clin Neuropsychol. 1998;12:43–55.

    Article  Google Scholar 

  44. Benton AL, Hamsher K. Multilingual aphasia examination. 2nd ed. Iowa City: AJA Associates; 1989.

    Google Scholar 

  45. Lezak MD, Howieson DB, Loring DW. Neuropsychological assessment. 4th ed. New York: Oxford University Press; 2004. p. 68–84.

    Google Scholar 

  46. Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, et al. The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst. 1993;85:365–76.

    Article  CAS  Google Scholar 

  47. Osoba D, Aaronson NK, Muller M, Sneeuw K, Hsu MA, Yung WK, et al. The development and psychometric validation of a brain cancer quality-of-life questionnaire for use in combination with general cancer- specific questionnaires. Qual Life Res. 1996;5:139–50.

    Article  CAS  Google Scholar 

  48. Fayers PM, Aaronson NK, Bjordal K, Groenvold M, Curran D, Bottomley A. The EORTC QLQ-C30 scoring manual. 3rd ed. Brussels: European Organization for Research and Treatment of Cancer; 2001.

    Google Scholar 

  49. Cella DF, Tulsky DS, Gray G, Sarafian B, Linn E, Bonomi A, et al. The functional assessment of Cancer therapy scale: development and validation of the general measure. J Clin Oncol. 1993;11:570–9.

    Article  CAS  Google Scholar 

  50. Weitzner MA, Meyers CA, Gelke CK, Byrne KS, Cella DF, Levin VA. The functional assessment of Cancer therapy (FACT) scale. Development of a brain sub-scale and revalidation of the general version (FACT-G) in patients with primary brain tumors. Cancer. 1995;75:1151–61.

    Article  CAS  Google Scholar 

  51. Cleeland CS, Mendoza TR, Wang XS, Chou C, Harle MT, Morrissey M, et al. Assessing symptom distress in cancer patients: the M.D. Anderson symptom inventory. Cancer. 2000;89:1634–46.

    Article  CAS  Google Scholar 

  52. Armstrong TS, Mendoza T, Gning I, Coco C, Cohen MZ, Eriksen L, et al. Validation of the M.D. Anderson symptom inventory brain tumor module (MDASI- brain tumor). J Neuro-Oncol. 2006;80:27–35.

    Article  CAS  Google Scholar 

  53. Sloan JA, Dueck A. Issues for statisticians in conducting analyses and translating results for quality of life end points in clinical trials. J Biopharm Stat. 2004;14:73–96.

    Article  CAS  Google Scholar 

  54. Klein M, Duffau H, De Witt Hamer PC. Cognitive and resective surgery for diffuse infiltrative glioma: an overview. J Neuro-Oncol. 2012;108:309–18.

    Article  Google Scholar 

  55. Jones-Gotman M, Zatorre RJ, Olivier A, Andermann F, Cendes F, Staunton H, et al. Learning and retention of words and designs following excision from medial or lateral temporal lobe structures. Neuropsychologia. 1997;35:963–73.

    Article  CAS  Google Scholar 

  56. Dulay MF, Levin HS, York MK, Mizrahi EM, Verma A, Goldsmith I, et al. Predictors of individual visual memory decline after unilateral anterior temporal lobe resections. Neurology. 2009;72:1837–42.

    Article  CAS  Google Scholar 

  57. Stuss DT, Benson DF. Neuropsychological studies of the frontal lobes. Psychol Bull. 1984;95:3–28.

    Article  CAS  Google Scholar 

  58. Tucha O, Smely C, Preier M, Becker G, Paul GM, Lange KW. Preoperative and postoperative cognitive functioning in patients with frontal meningiomas. J Neurosurg. 2003;98:21–31.

    Article  Google Scholar 

  59. Teixidor P, Gatignol P, Leroy M, Masuet-Aumatell C, Capelle L, Duffau H. Assessment of verbal working memory before and after surgery for low-grade glioma. J Neuro-Oncol. 2007;81:305–13.

    Article  Google Scholar 

  60. Talacchi A, Santini B, Savazzi S, Gerosa M. Cognitive effects of tumour and surgical treatment in glioma patients. J Neuro-Oncol. 2011;103:541–9.

    Article  Google Scholar 

  61. Friedman MA, Meyers CA, Sawaya R. Neuropsychological effects of third ventricle tumor surgery. Neurosurgery. 2003;52:791–8.

    Article  Google Scholar 

  62. Honegger J, Barocka A, Sadri B, Fahlbusch R. Neuropsychological results of craniopharyngioma surgery in adults: a prospective study. Surg Neurol. 1998;50:19–29.

    Article  CAS  Google Scholar 

  63. Laperrie N, Zuraw L, Cairncross G. Radiotherapy for newly diagnosed malignant glioma in adults: a systematic review. Radiother Oncol. 2002;64:259–73.

    Article  Google Scholar 

  64. Armstrong CL, Corn BW, Ruffer JE, Pruitt AA, Mollman JE, Phillips PC. Radiotherapeutic effects on brain function: double dissociation of memory systems. Neuropsychiatry Neuropsychol Behav Neurol. 2000;13:101–11.

    CAS  PubMed  Google Scholar 

  65. Douw L, Klein M, Fagel SS, van den Heuvel J, Taphoorn MJ, Aaronson NK, et al. Cognitive and radiological effects of radiotherapy in patients with low-grade glioma: long-term follow-up. Lancet Neurol. 2009;8:810–8.

    Article  Google Scholar 

  66. Torres IJ, Mundt AJ, Sweeney PJ, Llanes-Macy S, Dunaway L, Catillo M, et al. A longitudinal neuropsychological study of partial brain radiation in adults with brain tumors. Neurology. 2003;60:1113–8.

    Article  CAS  Google Scholar 

  67. Ernst-Stecken A, Ganslandt O, Lambrecht U, Sauer R, Grabenbauer G. Survival and quality of life after hypofractionated stereotactic radiotherapy for recurrent malignant glioma. J Neuro-Oncol. 2007;81:287–94.

    Article  Google Scholar 

  68. Kocher M, Soffietti R, Abacioglu U, Villà S, Fauchon F, Baumert BG, et al. Adjuvant whole-brain radiotherapy vs observation after radiosurgery or surgical resection of 1 to 3 cerebral metastases: results of the EORTC 22952-26001 study. J Clin Oncol. 2011;29:134–41.

    Article  Google Scholar 

  69. Aoyama H, Shirato H, Tago M, Nakagawa K, Toyoda T, Hatano K, et al. Stereotactic radiosurgery plus whole-brain radiation therapy vs stereotactic radiosurgery alone for treatment of brain metastases: a randomized clinical trial. JAMA. 2006;295:2483–91.

    Article  CAS  Google Scholar 

  70. Brown PD, Jaeckle K, Ballman KV, Farace E, Cerhan JH, Anderson K, et al. Effect of radiosurgery alone vs radiosurgery with whole brain radiation therapy on cognitive function in patients with 1 to 3 brain metastases. JAMA. 2016;316:401–9.

    Article  Google Scholar 

  71. Wefel JS, Saleeba AK, Buzdar AU, Meyers CA. Acute and late onset cognitive dysfunction associated with chemotherapy in women with breast cancer. Cancer. 2010;116:3348–56.

    Article  Google Scholar 

  72. Anderson-Hanley C, Sherman ML, Riggs R, Agocha VB, Compas BE. Neuropsychological effects of treatment for adults with cancer: a meta-analysis and review of the literature. J Int Neuropsych Soc. 2003;9:967–82.

    Article  Google Scholar 

  73. Phillips C, Thompson G. What is a QALY? 2nd ed. London: Hayward Medical Communications; 2009.

    Google Scholar 

  74. Duckworth J, Nayiager T, Pullenayegum E, Whitton A, Hollenberg R, Horsman J, et al. Health-related quality of life in long-term survivors of brain tumors in childhood and adolescence: a serial study spanning a decade. J Ped Hematol Oncol. 2015;37:362–7.

    Article  Google Scholar 

  75. Torrance GW, Feeny D, Furlong W, Barr RD, Zhang Y, Wang Q. Multi-attribute preference functions for a comprehensive health status classification system: Health Utilities Index Mark 2. Med Care. 1996;34:1–21.

    Article  Google Scholar 

  76. Fisk JD, Brown MG, Sketris IS, Metz LM, Murray TJ, Stadnyk KJ. A comparison of health utility measures for the evaluation of multiple sclerosis treatments. J Neurol Neurosurg Psychiatry. 2005;76:58–63.

    Article  CAS  Google Scholar 

  77. Whitehead SJ, Ali S. Health outcomes in economic evaluation: the QALY and utilities. Br Med Bull. 2010;96:5–21.

    Article  Google Scholar 

  78. Lacey L, Bobula J, Rudell K, Alvir J, Leibman C. Quality of life and utility measurement in a large clinical trial sample of patients with mild to moderate Alzheimer’s disease: determinants and level of changes observed. Value Health. 2015;18:638–45.

    Article  Google Scholar 

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Ramirez-Aubone, C., Lee, G.P. (2019). Neuropsychological Evaluation of Patients with Intrinsic Brain Tumors . In: Fountas, K., Kapsalaki, E. (eds) Epilepsy Surgery and Intrinsic Brain Tumor Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-95918-4_7

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