Wilbers Joyce, Kappelle Arnoud C, Versteeg Laura, Tuladhar Anil M, Steens Stefan C A, Meijer Frederick J A, Boogerd Willem, Dorresteijn Lucille D, Kaanders Johannes H, Kessels Roy P C, van Dijk Ewoud J
Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Nijmegen PO Box 9101, 6500 HB Nijmegen, the Netherlands (J.W., A.C.K., A.M.T., E.J.v.D.); Department of Medical Psychology, Radboud University Medical Center and Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, 6500 HE, the Netherlands (L.V., R.P.C.K.); Department of Radiology and Nuclear Medicine, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, the Netherlands (S.C.A.S., F.J.A.M.); Department of Neurology, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, PO Box 90203, 1006 BE Amsterdam, the Netherlands (W.B.); Department of Neurology, Medisch Spectrum Twente, PO Box 50000, 7500 KA Enschede, the Netherlands (L.D.D.); Department of Radiation Oncology, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, the Netherlands (J.H.K.).
Neurooncol Pract. 2015 Sep;2(3):144-150. doi: 10.1093/nop/npv012. Epub 2015 May 7.
Long-term cancer treatment complications become more prevalent as survival improves. Little is known about the psychological complications in long-term survivors of head and neck cancer (HNC). We investigated cognitive functioning and its relation with depression, fatigue, cognitive complaints, and brain lesions on MRI.
This study is part of a multicentre, prospective cohort study of 65 patients treated for HNC. A comprehensive neuropsychological assessment was combined with validated questionnaires on subjective memory complaints, depression, and fatigue after a median of 7 years follow-up. Results were compared with age- and education-adjusted normative data. Further, we evaluated cerebral white matter hyperintensities (WMH), brain volume, and infarctions on MRI.
HNC patients had worse cognitive performance in two of the five assessed cognitive domains: episodic memory ( = -0.48, = .003) and speed of information processing ( = -0.47, < 0.001). Patients with fatigue performed worse than patients without fatigue on verbal fluency (mean difference in z-score 0.52, = .02) and speed of information processing (0.49, = .04). Patients with subjective memory complaints had a worse episodic memory performance (mean difference in z-score -0.96; = .02). Patients with cerebral infarction(s) on MRI performed worse on fluency (mean difference in z-score 0.74, = .005). A lower cognitive performance was not associated with depression, WMH or brain volume.
Long-term HNC survivors showed worse cognitive functioning 7 years after treatment. Cognitive function was associated with subjective complaints and fatigue, but not with depressive symptoms. Cerebral infarctions on MRI were correlated with cognitive function, whereas WMH, and brain volume were not.
随着癌症患者生存率的提高，长期癌症治疗并发症变得愈发普遍。对于头颈癌（HNC）长期幸存者的心理并发症，人们知之甚少。我们调查了认知功能及其与抑郁、疲劳、认知主诉和MRI脑病变的关系。
本研究是一项多中心前瞻性队列研究的一部分，该研究纳入了65例接受HNC治疗的患者。在中位随访7年后，综合神经心理学评估与关于主观记忆主诉、抑郁和疲劳的有效问卷相结合。将结果与年龄和教育程度调整后的常模数据进行比较。此外，我们在MRI上评估了脑白质高信号（WMH）、脑容量和梗死灶。
HNC患者在五个评估认知领域中的两个领域表现出较差的认知能力：情景记忆（=-0.48，=0.003）和信息处理速度（=-0.47，<0.001）。有疲劳症状的患者在语言流畅性（z评分平均差异0.52，=0.02）和信息处理速度（0.49，=0.04）方面比无疲劳症状的患者表现更差。有主观记忆主诉的患者情景记忆表现更差（z评分平均差异-0.96；=0.02）。MRI上有脑梗死的患者在流畅性方面表现更差（z评分平均差异0.74，=0.005）。较低的认知能力与抑郁、WMH或脑容量无关。
HNC长期幸存者在治疗7年后表现出较差的认知功能。认知功能与主观主诉和疲劳有关，但与抑郁症状无关。MRI上的脑梗死与认知功能相关，而WMH和脑容量则无关。
