Loaiza Sergio, Carvajal Sonia, Giraldo Daniel, Galvis Astrid, Ortiz Leon
Scientific Division, Clinica Las Americas, Diagonal 75B N. 2A-80/140, Torre 3, Medellin, Colombia.
Department of Psychology, Universidad de San Buenaventura, Carrera 56C N. 51-110, Medellin, Colombia.
Clin Neurol Neurosurg. 2018 Aug;171:34-41. doi: 10.1016/j.clineuro.2018.05.006. Epub 2018 May 24.
Advances in therapeutic schemes for High Grade Gliomas, such as the introduction of Stupp protocol, have raised interest in elucidating its effects on quality of life and cognitive function. This study aims to examine executive functions, memory and attention in patients with High Grade Gliomas, before initiation and after completion of Stupp protocol.
A before-after study was executed. Patients were selected from a consecutive sample of subjects with High Grade Gliomas who had not initiated Stupp protocol. Neuropsi - Attention and Memory test (Second edition) was employed to evaluate subjects. Inferential analysis was conducted with Bayesian Mixed Effects Model for repeated measures, using a contrast coding scheme for estimating the change between mean neurocognitive scores obtained before and after Stupp protocol. Model was fitted employing random-effect predictors accounting for concomitant administration of bevacizumab and anticonvulsants, and by-subject performance variability. As excluding patients who did not complete Stupp protocol might bias results, complementary analyses were conducted for determining if those were consistent in alternative scenarios.
Twenty-nine patients were included; 17 (58.6%) completed Stupp protocol and both neuropsychological evaluations. Inside Fixed Effects Model, 95% credible intervals for all cognitive functions crossed the zero threshold (No change); however, in all Mixed Effects Models, credible intervals for memory and attention did not cross zero.
Results showed significant recovery in memory and attention functions after treatment and suggest a confounding role for co-administered treatments and other factors related to subject cognitive performance variability. Nevertheless, these findings need to be corroborated with additional studies including more representative samples.
高级别胶质瘤治疗方案的进展，如引入Stupp方案，引发了人们对阐明其对生活质量和认知功能影响的兴趣。本研究旨在检查高级别胶质瘤患者在开始和完成Stupp方案之前及之后的执行功能、记忆和注意力。
进行了一项前后对照研究。从尚未开始Stupp方案的高级别胶质瘤连续样本中选取患者。采用Neuropsi-注意力和记忆测试（第二版）对受试者进行评估。使用贝叶斯混合效应模型进行重复测量的推断分析，采用对比编码方案估计Stupp方案前后获得的平均神经认知分数之间的变化。模型拟合采用随机效应预测因子，考虑贝伐单抗和抗惊厥药物的联合使用以及个体表现的变异性。由于排除未完成Stupp方案的患者可能会使结果产生偏差，因此进行了补充分析，以确定在其他情况下这些结果是否一致。
纳入29例患者；17例（58.6%）完成了Stupp方案及两项神经心理学评估。在固定效应模型中，所有认知功能的95%可信区间均越过零阈值（无变化）；然而，在所有混合效应模型中，记忆和注意力的可信区间未越过零。
结果显示治疗后记忆和注意力功能有显著恢复，并提示联合治疗及与个体认知表现变异性相关的其他因素起混杂作用。尽管如此，这些发现需要通过包括更具代表性样本的额外研究来证实。
