Department of Cognitive Neuropsychology, Tilburg University, Tilburg, Noord-Brabant, The Netherlands.
Department of Neurosurgery, Elisabeth-TweeSteden hospital, Tilburg, Noord-Brabant, The Netherlands.
Neurosurgery. 2020 Nov 16;87(6):1119-1129. doi: 10.1093/neuros/nyaa190.
Pre- and postoperative cognitive deficits have repeatedly been demonstrated in patients with glioblastoma (GBM).
To identify presurgical risk factors that facilitate the identification of GBM patients at risk for postoperative cognitive impairment.
Patients underwent neuropsychological assessment using Central Nervous System Vital Signs 1 d before (T0) and 3 mo after surgery (T3). Patients' standardized scores on 7 cognitive domains were compared to a normative sample using one-sample z tests. Reliable change indices with correction for practice effects were calculated to assess cognitive changes in individual patients over time. Logistic regression models were performed to assess presurgical sociodemographic, clinical, psychological, and cognitive risk factors for postoperative cognitive impairments.
At T0, 208 patients were assessed, and 136 patients were retested at T3. Patients showed significantly lower performance both prior to and 3 mo after surgery on all cognitive domains compared to healthy controls. Improvements and declines over time occurred respectively in 11% to 32% and 6% to 26% of the GBM patients over the domains. The regression models showed that low preoperative cognitive performance posits a significant risk factor for postoperative cognitive impairment on all domains, and female sex was a risk factor for postoperative impairments in Visual Memory.
We demonstrated preoperative cognitive risk factors that enable the identification of GBM patients who are at risk for cognitive impairment 3 mo after surgery. This information can help to inform patients and clinicians at an early stage, and emphasizes the importance of recognizing, assessing, and actively dealing with cognitive functioning in the clinical management of GBM patients.
术前和术后认知缺陷在胶质母细胞瘤（GBM）患者中反复出现。
确定术前风险因素，以便识别术后认知障碍风险较高的 GBM 患者。
患者在手术前 1 天（T0）和术后 3 个月（T3）使用中枢神经系统生命体征进行神经心理学评估。使用单样本 z 检验将患者在 7 个认知领域的标准化分数与正常样本进行比较。计算可靠变化指数，以校正练习效应，评估个体患者随时间的认知变化。进行逻辑回归模型，以评估术前社会人口统计学、临床、心理和认知风险因素与术后认知障碍的关系。
在 T0 时评估了 208 例患者，其中 136 例患者在 T3 时进行了复测。与健康对照组相比，患者在所有认知领域的术前和术后 3 个月的表现均明显降低。在所有领域中，分别有 11%至 32%的患者出现了改善，而 6%至 26%的患者出现了下降。回归模型表明，术前认知表现低是所有领域术后认知障碍的显著风险因素，女性是术后视觉记忆障碍的风险因素。
我们证明了术前认知风险因素可以识别术后 3 个月认知障碍风险较高的 GBM 患者。这些信息可以帮助患者和临床医生尽早了解情况，并强调在 GBM 患者的临床管理中识别、评估和积极处理认知功能的重要性。
