- Neuronursing Division, National Institute of Nursing Education, Post Graduate Institute of Medical Education and Research, Chandigarh, India
- Psychiatric Nursing Division, College of Nursing, All India Institute of Medical Sciences, New Delhi, India
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
Department of Neurosurgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
DOI:10.4103/2152-7806.179229Copyright: © 2016 Surgical Neurology International This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
How to cite this article: Dhandapani M, Gupta S, Mohanty M, Gupta SK, Dhandapani S. Trends in cognitive dysfunction following surgery for intracranial tumors. Surg Neurol Int 22-Mar-2016;7:
How to cite this URL: Dhandapani M, Gupta S, Mohanty M, Gupta SK, Dhandapani S. Trends in cognitive dysfunction following surgery for intracranial tumors. Surg Neurol Int 22-Mar-2016;7:. Available from: http://surgicalneurologyint.com/surgicalint_articles/trends-in-cognitive-dysfunction-following-surgery-for-intracranial-tumors/
Background:This study was conducted to prospectively assess the cognitive function of patients with intracranial tumors.
Methods:The cognitive status of patients with intracranial tumors were prospectively studied before surgery, and later at 1 and 6 months following surgery, on purposive sampling, using validated post graduate institute (PGI) battery for brain dysfunction (score 0–30) with a higher dysfunction rating score indicating poor cognitive status.
Results:Out of 23 patients enrolled, 20 could complete the study. They had substantial cognitive dysfunction before surgery (score 17.1 ± 9.4). Though there was no significant improvement (16.9 ± 9.0) at 1 month, the score improved significantly (10.3 ± 9.2) at 6 months following surgery (P = 0.008). The improvement was relatively subdued in intra-axial, malignant, and radiated tumors. Overall, there was a significant improvement in mental balance (P = 0.048), verbal retention of dissimilar pairs (P = 0.01), and recognition (P = 0.01), while dysfunction persisted in the domains of memory, verbal retention to similar pairs, and visual retention.
Conclusion:Patients with intracranial tumors have substantial cognitive dysfunction, which tend to show significant improvement beyond 6 months following surgery, especially among tumors, which were extra-axial, benign, and nonirradiated.
Keywords: Cognitive dysfunction, intracranial tumor, memory scales, surgery
Intracranial tumors are one of the common causes of mortality and morbidity worldwide.[
Cognitive dysfunction in these patients can impair the intellectual functions, activities of daily living (ADL), interpersonal relationships, and education and profession of the patients. It may prevent them from fulfilling their familial, professional, and social obligations thus can lead to poor quality of life (QoL) not only in patients,[
The factors leading to cognitive deficits include paraneoplastic effects such as duration and location of the tumor,[
There is lack of evidence on the domains, magnitude, and duration of cognitive dysfunction present in patients with intracranial tumors. Cognitive deficits of these patients are neither monitored nor managed during the follow-up visits. Knowing the trend in cognitive dysfunction is necessary to develop protocols and tools for assessing cognitive function. Identifying the magnitude and type of cognitive dysfunction, may aid in various cognitive behavioral therapies to improve the QoL of patients and caregivers. Appropriate interventions can be developed based on the specific cognitive impairment of the patients. However, there is a paucity of studies on trends in cognitive dysfunction with respect to the treatment provided. With this in mind, this study was undertaken to assess the cognitive function of the patients with intracranial tumors before surgery, later at 1 month and 6 months following surgery.
A longitudinal study was done to assess the cognitive changes in patients with intracranial tumors. Using purposive sampling, 23 newly diagnosed conscious intracranial tumor patients who were availing treatment from a Tertiary Care Center at Chandigarh and consented to the study were enrolled. Ethical clearance was obtained from the Institute Ethics Committee, and written consent was taken from all study subjects and guardians. All patients who underwent surgical management with or without radiotherapy or chemotherapy were followed up for cognitive assessment. Cognitive status was assessed before surgery, later at 1 month and 6 months following surgery.
Cognitive changes of patients were assessed using PGI battery for brain dysfunction (BBD) which assesses various domains of cognitive functions.[
The raw score of each domain was made into a converted score according to the educational level of the patients. The total dysfunction score was calculated by adding the dysfunction scores of all domains and higher the dysfunction rating score poorer the cognitive status. The total maximum possible score is 30 (3 in each domain).
SPSS 21 (IBM, New York, USA) was utilized for descriptive and inferential statistics. Repeated measures ANOVA was used to compare the dysfunction score at different assessment.
Out of 23 patients with intracranial tumors enrolled, 20 patients were followed up as 2 patients died, and 1 patient was lost to follow-up. As per the sociodemographic data of patients shown in
Cognitive changes in patients
The cognitive function of the patients was significantly affected as the cognitive dysfunction score was 17.1 ± 9.4 out of 30 before any definite treatment (higher the score higher the dysfunction). There was an only mild nonsignificant improvement in the dysfunction rating score (16.91 ± 9.0) at 1 month of follow-up. There was a significant improvement only in recognition (P = 0.04).
There was a significant improvement in cognitive function at 6 months with the dysfunction rating score decreasing from 17.1 ± 9.4 to 10.3 ± 9.2 (P = 0.01) [
As shown in Figures
Cognitive dysfunction in patients with intracranial tumors is well evident in literature.[
There are many domains of cognitive function. There is no conclusive evidence on the particular domain being affected due to the difference in the cognitive tools used in various studies. In this study, most affected by all domains on first assessment was verbal retention to dissimilar pairs, an indicator of new learning. Other domains highly affected were a mental balance, attention, concentration, and delayed recall. The domains least affected were a recent memory and immediate recall. Cognitive deficits reported in literature include deficits in working memory, cognitive control, cognitive processing speed, visual searching, planning foresight, general attention,[
Cognitive deficits are reported in these patients before any definitive treatment, at 3 months postradiotherapy,[
The overall cognitive function at 6 months following surgery was significantly improved (P = 0.008). Though there was an improvement of cognitive function in all domains at 6 months, mental balance, verbal retention of dissimilar pairs and recognition have shown significant improvement [
The cognitive deficits identified in this study before initiation of radiotherapy, chemotherapy, or surgery explains the influence of tumor and its pathological process on cognitive deficits. It is reported that patients with frontal glioma exhibit more cognitive deficits due to the damage in the frontal lobe.[
Cognitive function was found to be better in patients with benign tumor and poor in patients who underwent radiotherapy at all points of assessment. The majority of the patients who received radiotherapy had a malignant tumor. The aggressive nature of the tumor along with radiotherapy can result in higher cognitive dysfunction. A mild deterioration in cognitive function at 1 month observed in patients of the malignant tumor could be due to the transient neurotoxic effect of radiation.[
Cognitive dysfunction leads to difficulties in performing cognitive tasks, contribute to functional disability, and behavioral changes and thus, makes the individual handicapped.[
This study is limited because of small sample size. Multicenter studies of larger sample size are needed to identify the significant relationship of various factors described in this study. A long-term follow-up of cognitive function will aid in cognitive rehabilitation which can be individualized for the patients with and without improvement in the cognitive function. As the cognitive dysfunction was found persisting even at 6 months, monitoring cognitive task, and developing appropriate management strategies are important to equip these patients in their personal, as well as social life. The neuro-oncology team must facilitate this to improve QoL for patients and their caregivers. Socioeconomic barriers are reported to result in irregular follow-up visits and poor outcome among neurosurgical patients.[
Patients with intracranial tumors have substantial cognitive dysfunction before any definite treatment. However, there was a significant improvement in cognitive function at 6 months following surgery with deficits persisting in some domains. One of the long-term goals for the neuro-oncology team must be to reduce the cognitive sequelae of these tumors with improvement in treatment modalities.
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