Noll Kyle R, Walbert Tobias, Wefel Jeffrey S
Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Department of Neurology and Neurosurgery, Henry Ford Health System, Detroit, Michigan.
Curr Opin Neurol. 2020 Dec;33(6):716-722. doi: 10.1097/WCO.0000000000000865.
PURPOSE OF REVIEW: This review succinctly summarizes the recent literature regarding etiological contributors to impaired neurocognitive function (NCF) in adult patients with glioma. A brief overview of intervention and prevention strategies is also provided. RECENT FINDINGS: A majority of patients with glioma exhibit NCF deficits, most frequently in memory and executive functioning. Impairments are often disabling and associated with reduced quality of life and survival. Cause is multifactorial and includes the tumour itself, treatments received and associated comorbidities. Although modern techniques such as brain mapping, dosing modifications and prophylactic medication aim to improve the NCF outcomes following neurosurgical resection and radiation therapy, a sizeable proportion of patients continue to evidence treatment-related NCF declines related to adverse effects to both local and distributed cerebral networks. Numerous patient and tumour characteristics, including genetic markers and sociodemographic factors, influence the pattern and severity of NCF impairment. Some rehabilitative and pharmacologic approaches show promise in mitigating NCF impairment in this population, though benefits are somewhat modest and larger scale intervention studies are needed. SUMMARY: Research regarding NCF in patients with glioma has dramatically proliferated, providing insights into the mechanisms underlying impaired NCF and pointing to potential interventions, though further work is needed.
综述目的:本综述简要总结了近期关于成年胶质瘤患者神经认知功能(NCF)受损病因的文献。还提供了干预和预防策略的简要概述。 最新发现:大多数胶质瘤患者存在NCF缺陷,最常见于记忆和执行功能方面。这些损害往往会导致功能丧失,并与生活质量下降和生存率降低相关。病因是多因素的,包括肿瘤本身、接受的治疗以及相关合并症。尽管诸如脑图谱、剂量调整和预防性用药等现代技术旨在改善神经外科切除和放射治疗后的NCF结果,但仍有相当一部分患者因对局部和分布式脑网络的不良反应而持续出现与治疗相关的NCF下降。许多患者和肿瘤特征,包括基因标记和社会人口统计学因素,都会影响NCF损害的模式和严重程度。一些康复和药物治疗方法在减轻该人群的NCF损害方面显示出前景,不过效果较为有限,需要开展更大规模的干预研究。 总结:关于胶质瘤患者NCF的研究急剧增加,为NCF受损的潜在机制提供了见解,并指出了潜在的干预措施,不过仍需进一步研究。
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