Lövgren Izabelle, Voets Natalie Laura, Isaac Claire, Honeyman Susan Isabel, Mier Juan Felipe, Stacey Richard, Apostolopoulos Vasileios, Plaha Puneet
Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
Neurooncol Pract. 2024 Oct 20;12(2):301-312. doi: 10.1093/nop/npae106. eCollection 2025 Apr.
Cognitive impairment following anti-tumor treatment is a common concern for brain tumor patients. However, growing evidence indicates that significant impairments can be present even before treatment. The purpose of this study was to identify factors that explain variability in pretreatment test performance, beyond that of tumor burden.
Using multi-step linear regression, we retrospectively probed the contribution of clinical-, tumor-, patient-, and self-reported factors to variance in performance among 96 treatment-naïve brain tumor patients across 13 objective neurocognitive tests. Agreement between subjective and objective reports of cognitive impairment was also examined.
Clinically significant preoperative impairments were observed in both objective and subjective domains. Estimated premorbid intelligence quotient (IQ), tumor volume, diagnosis of an astrocytoma, self-reported depression, and perceived cognitive functioning scores were the most common predictors of objective neurocognitive performance prior to treatment, explaining 12.3%-58.3% of the variance. No association was identified between objective and subjective reports of cognitive impairment.
Glioma patients frequently exhibit objective and subjective impairments prior to treatment. Both tumor- and self-reported factors were identified as predictors of performance, after correcting for estimated premorbid IQ. Nevertheless, more than 41.7% of the variance in cognitive performance remained unexplained, indicating a substantial role for additional, as yet unaccounted for, clinical factors. Notable disparity between objective and subjective cognitive impairment status re-emphasizes the importance of assessing both domains to ascertain a patient's overall functioning in the context of treatment outcomes.
抗肿瘤治疗后的认知障碍是脑肿瘤患者普遍关注的问题。然而，越来越多的证据表明，甚至在治疗前就可能存在显著的认知障碍。本研究的目的是确定除肿瘤负荷外，能够解释治疗前测试表现差异的因素。
我们采用多步线性回归，回顾性探究了临床、肿瘤、患者及自我报告因素对96例未经治疗的脑肿瘤患者在13项客观神经认知测试中表现差异的影响。同时还检查了认知障碍主观报告与客观报告之间的一致性。
在客观和主观领域均观察到具有临床意义的术前认知障碍。估计的病前智商（IQ）、肿瘤体积、星形细胞瘤诊断、自我报告的抑郁以及感知认知功能评分是治疗前客观神经认知表现最常见的预测因素，可解释12.3%-58.3%的差异。未发现认知障碍客观报告与主观报告之间存在关联。
胶质瘤患者在治疗前常表现出客观和主观认知障碍。在校正估计的病前智商后，肿瘤因素和自我报告因素均被确定为表现的预测因素。然而，仍有超过41.7%的认知表现差异无法解释，这表明其他尚未考虑的临床因素起着重要作用。客观与主观认知障碍状态之间的显著差异再次强调了评估两个领域以确定患者在治疗结果背景下整体功能的重要性。
