Lang Stefan, Cadeaux Magalie, Opoku-Darko Micheal, Gaxiola-Valdez Ismael, Partlo Lisa A, Goodyear Bradley G, Federico Paolo, Kelly John
Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada; Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.
Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.
World Neurosurg. 2017 Mar;99:448-456. doi: 10.1016/j.wneu.2016.12.061. Epub 2016 Dec 28.
Patients with brain tumors are known to have deficits in cognitive, motor, and emotional domains. Comprehensive evaluation of the patient with brain tumor includes taking into account all these domains at baseline and throughout treatment. Standard neuropsychological assessment methods, however, are lengthy, expensive, and often are variable. The authors appraised the feasibility of using a brief, inexpensive, comprehensive, and standardized neuropsychological battery, the National Institutes of Health (NIH) Toolbox, to assess these domains in patients with diffuse glioma.
Eighteen patients were recruited and completed the NIH Toolbox Cognitive Battery, 2 motor tests (Grip Strength and Grooved Pegboard), and the NIH Toolbox Emotional Battery. Fully corrected T scores are reported, as well as composite scores of fluid and crystallized cognition. Follow-up cognitive (n = 13) and motor assessment (n = 12) were performed at 1 month after surgery.
The total time to complete the battery was approximately 60 minutes. A total of 78% of patients demonstrated significant impairment on one or more cognitive test, whereas 37% had impaired fluid cognition. Crystallized and overall composite cognitive scores were relatively intact, with 16% of patients showing significant impairment. A total of 22% of patients had impaired strength in the left hand, and 22% had impaired dexterity in both hands. In addition, 50% of patients showed impairment in one or more emotional domain. At 1 month after surgery, a significant decrease in crystallized cognition was observed.
The NIH Toolbox represents a feasible alternative to current neuropsychological batteries in the assessment of neurosurgical patients. It can be administered quickly, inexpensively, and will give the neurosurgical community a common currency when reporting neuropsychological results.
已知脑肿瘤患者在认知、运动和情感领域存在缺陷。对脑肿瘤患者的全面评估包括在基线时以及整个治疗过程中考虑所有这些领域。然而，标准的神经心理学评估方法耗时、昂贵，且结果往往存在差异。作者评估了使用一种简短、廉价、全面且标准化的神经心理测试组合——美国国立卫生研究院（NIH）工具箱，来评估弥漫性胶质瘤患者这些领域的可行性。
招募了18名患者，他们完成了NIH工具箱认知测试组合、两项运动测试（握力和有槽钉板测试）以及NIH工具箱情感测试组合。报告了完全校正的T分数以及流体智力和晶体智力的综合分数。术后1个月进行了随访认知评估（n = 13）和运动评估（n = 12）。
完成整个测试组合的总时间约为60分钟。共有78%的患者在一项或多项认知测试中表现出显著受损，而37%的患者流体智力受损。晶体智力和总体综合认知分数相对完整，16%的患者表现出显著受损。共有22%的患者左手力量受损，22%的患者双手灵活性受损。此外，50%的患者在一个或多个情感领域表现出受损。术后1个月，观察到晶体智力显著下降。
NIH工具箱是评估神经外科患者时现有神经心理测试组合的一种可行替代方法。它可以快速、廉价地进行测试，并且在报告神经心理结果时将为神经外科界提供一种通用标准。
