Habets Esther J J, Kloet Alfred, Walchenbach Rob, Vecht Charles J, Klein Martin, Taphoorn Martin J B
Department of Neurology, Medical Centre Haaglanden, PO Box 432, The Hague, 2501 CK, the Netherlands,
Acta Neurochir (Wien). 2014 Aug;156(8):1451-9. doi: 10.1007/s00701-014-2115-8. Epub 2014 May 31.
Many high-grade glioma (HGG) patients have cognitive impairments, which impact daily functioning. Cognitive impairments can be caused by tumour-, treatment-, and patient-related factors. The effect of the tumour and of surgical resection on cognition is, however, not well known. We investigated tumour and surgical effects on cognitive functioning in patients with HGG.
At baseline, preceding surgery, 62 patients with HGG underwent neuropsychological testing concerning seven cognitive domains: verbal and working memory, attention, executive functioning, psychomotor function, information processing speed, and visuoconstructive abilities. Thirty-nine patients were included in follow-up testing after surgery, but before subsequent treatment. Tumour size and site, use of anti-epileptic drugs and corticosteroids, and extent of resection were recorded.
Compared to healthy controls, cognitive functioning of patients was significantly impaired in all domains. Prior to surgery 79 % (49 of 62) of patients had cognitive impairment in at least one domain. At median follow-up of 5 weeks after surgery, 59 % (23 of 39) of patients were cognitively impaired in at least one domain. At follow-up, 49 % showed improvement, while 23 % declined. Left hemisphere tumour localization was associated with worse verbal memory (P=0.004), and larger tumours in this hemisphere with poorer executive functioning (P < 0.001). Changes in cognitive performance at follow-up relative to baseline were not related to tumour characteristics or extent of resection.
Tumour-related cognitive deficits are present in a majority of HGG patients preceding surgery. Surgery does not result in cognitive deterioration in the short term in most patients.
许多高级别胶质瘤（HGG）患者存在认知障碍，这会影响日常功能。认知障碍可能由肿瘤、治疗和患者相关因素引起。然而，肿瘤及手术切除对认知的影响尚不清楚。我们调查了HGG患者中肿瘤及手术对认知功能的影响。
在基线时，即手术前，62例HGG患者接受了关于七个认知领域的神经心理学测试：言语和工作记忆、注意力、执行功能、心理运动功能、信息处理速度和视觉构建能力。39例患者在手术后但在后续治疗前接受了随访测试。记录肿瘤大小和部位、抗癫痫药物和皮质类固醇的使用情况以及切除范围。
与健康对照组相比，患者在所有领域的认知功能均显著受损。手术前，79%（62例中的49例）的患者至少在一个领域存在认知障碍。术后5周的中位随访期时，59%（39例中的23例）的患者至少在一个领域存在认知障碍。随访时，49%的患者有所改善，而23%的患者有所下降。左半球肿瘤定位与较差的言语记忆相关（P = 0.004），该半球较大的肿瘤与较差的执行功能相关（P < 0.001）。随访时相对于基线的认知表现变化与肿瘤特征或切除范围无关。
大多数HGG患者在手术前存在与肿瘤相关的认知缺陷。大多数患者在短期内手术不会导致认知恶化。
