Sekely Angela, Bernstein Lori J, Campbell Kristin L, Mason Warren P, Laperriere Normand, Kalidindi Navya, Or Rosemarylin, Ramos Ronald, Climans Seth A, Pond Gregory R, Ann Millar Barbara, Shultz David, Tsang Derek S, Zadeh Gelareh, Edelstein Kim
Graduate Department of Psychological Clinical Science, University of Toronto, Toronto, Ontario, Canada.
Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
Neurooncol Pract. 2022 Sep 13;10(1):89-96. doi: 10.1093/nop/npac068. eCollection 2023 Feb.
In addition to poor survival rates, individuals with glioblastoma (GBM) are at risk of neurocognitive impairment due to multiple factors. This study aimed to characterize neurocognitive impairment, neurobehavioral symptoms, fatigue, sleep disturbance, and depressive symptoms in newly diagnosed GBM patients; and to examine whether neurobehavioral symptoms, fatigue, sleep, and depressive symptoms influence neurocognitive performance.
This study was part of a prospective, inception cohort, single-arm exercise intervention in which GBM patients underwent a neuropsychological assessment shortly after diagnosis (median 4 weeks; ie, baseline) and 3, 6, 12, and 18 months later, or until tumor progression. Here, we present baseline data. Forty-five GBM patients (mean age = 55 years) completed objective neurocognitive tests, and self-report measures of neurobehavioral symptoms, fatigue, sleep disturbance, and depressive symptoms.
Compared to normative samples, GBM patients scored significantly lower on all neurocognitive tests, with 34 (76%) patients exhibiting neurocognitive impairment. Specifically, 53% exhibited impairment in memory retention, 51% in executive function, 42% in immediate recall, 41% in verbal fluency, and 24% in attention. There were high rates of clinically elevated sleep disturbance (70%), fatigue (57%), depressive symptoms (16%), and neurobehavioral symptoms (27%). A multivariate regression analysis revealed that depressive symptoms are significantly associated with neurocognitive impairment.
GBM patients are vulnerable to adverse outcomes including neurocognitive impairment, neurobehavioral symptoms, fatigue, sleep disturbance, and depressive symptoms shortly after diagnosis, prior to completing chemoradiation. Those with increased depressive symptoms are more likely to demonstrate neurocognitive impairment, highlighting the need for early identification and treatment of depression in this population.
胶质母细胞瘤（GBM）患者除了生存率低之外，还因多种因素面临神经认知障碍的风险。本研究旨在描述新诊断的GBM患者的神经认知障碍、神经行为症状、疲劳、睡眠障碍和抑郁症状；并研究神经行为症状、疲劳、睡眠和抑郁症状是否会影响神经认知表现。
本研究是一项前瞻性、起始队列、单臂运动干预的一部分，GBM患者在诊断后不久（中位时间4周；即基线）以及3、6、12和18个月后，或直至肿瘤进展时接受神经心理学评估。在此，我们展示基线数据。45名GBM患者（平均年龄 = 55岁）完成了客观神经认知测试，以及神经行为症状、疲劳、睡眠障碍和抑郁症状的自我报告测量。
与正常样本相比，GBM患者在所有神经认知测试中的得分均显著较低，34名（76%）患者表现出神经认知障碍。具体而言，53%的患者存在记忆保持障碍，51%的患者存在执行功能障碍，42%的患者存在即时回忆障碍，41%的患者存在语言流畅性障碍，24%的患者存在注意力障碍。临床睡眠障碍（70%）、疲劳（57%）、抑郁症状（16%）和神经行为症状（27%）的发生率较高。多变量回归分析显示，抑郁症状与神经认知障碍显著相关。
GBM患者在完成放化疗之前，诊断后不久就容易出现包括神经认知障碍、神经行为症状、疲劳、睡眠障碍和抑郁症状在内的不良后果。抑郁症状增加的患者更有可能表现出神经认知障碍，这凸显了在该人群中早期识别和治疗抑郁症的必要性。
