Department of Radiation Medicine and Applied Sciences, University of California San Diego, 3960 Health Sciences Dr, Mail Code 0865, La Jolla, CA, USA.
Center for Multimodal Imaging and Genetics, University of California San Diego, La Jolla, CA, 92093, USA.
J Neurooncol. 2020 Jan;146(1):131-138. doi: 10.1007/s11060-019-03353-2. Epub 2019 Nov 23.
We investigated multi-domain baseline neurocognition of primary brain tumor patients prior to radiotherapy (RT), including clinical predictors of function and association between pre-RT and post-RT impairment on a prospective trial.
A multi-domain neuropsychological battery (memory, executive functioning, language, attention, processing) was performed on 37 patients, pre-RT and 3-(n = 21), 6-(n = 22) and 12-(n = 14) months post-RT. Impairment rate was the proportion of patients with standardized T-scores ≤ 1.5 standard deviations below normative means. Per-patient impairment across all domains was calculated using a global deficit score (GDS; higher value indicates more impairment). Associations between baseline GDS and clinical variables were tested. Global GDS impairment rate at each time point was the fraction of patients with GDS scores > 0.5.
Statistically significant baseline neurocognitive impairments were identified on 4 memory (all p ≤ 0.03) and 2 out of 3 (p = 0.01, p = 0.027) executive functioning tests. Per-patient baseline GDS was significantly associated with tumor volume (p = 0.048), tumor type (p = 0.043), seizure history (p = 0.007), and use of anti-epileptics (p = 0.009). The percentage of patients with the same impairment status at 3-, 6-, and 12-months as at baseline were 88%, 85%, and 85% respectively.
Memory and executive functioning impairment were the most common cognitive deficits prior to RT. Patients with larger tumors, more aggressive histology, and use of anti-epileptics had higher baseline GDS values. GDS is a promising tool to encompass multi-domain neurocognitive function, and baseline GDS can identify those at risk of cognitive impairment.
我们研究了原发性脑肿瘤患者放疗（RT）前的多领域基线神经认知，包括功能的临床预测因子，以及前瞻性试验中 RT 前和 RT 后损伤之间的关联。
对 37 名患者进行了多领域神经心理学测试（记忆、执行功能、语言、注意力、处理），包括 3 个月（n=21）、6 个月（n=22）和 12 个月（n=14）后。损伤率为标准化 T 分数低于正常平均值 1.5 个标准差的患者比例。使用全球缺陷评分（GDS；更高的值表示更多的损伤）计算所有领域的每个患者的损伤程度。测试了基线 GDS 与临床变量之间的关联。每个时间点的全局 GDS 损伤率是 GDS 评分>0.5 的患者分数。
在 4 个记忆测试（所有 p 值均≤0.03）和 3 个执行功能测试中的 2 个（p 值分别为 0.01、0.027）中发现了显著的基线神经认知损伤。每个患者的基线 GDS 与肿瘤体积（p=0.048）、肿瘤类型（p=0.043）、癫痫发作史（p=0.007）和抗癫痫药物的使用（p=0.009）显著相关。在 3、6 和 12 个月时与基线相同的损伤状态的患者百分比分别为 88%、85%和 85%。
记忆和执行功能损伤是 RT 前最常见的认知缺陷。肿瘤较大、组织学侵袭性较强、使用抗癫痫药物的患者基线 GDS 值较高。GDS 是一种很有前途的工具，可以涵盖多领域的神经认知功能，基线 GDS 可以识别那些有认知损伤风险的患者。
