Ghadimi Keyvan, Abbas Imane, Karandish Alireza, Crisman Celina, Eskandar Emad N, Kobets Andrew J
Department of Neurological Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10461, USA.
Curr Oncol. 2025 Mar 6;32(3):152. doi: 10.3390/curroncol32030152.
Cognitive decline is common in patients with Glioblastoma (GB), occurring in both treated and untreated cases. It frequently presents as impairments in memory, attention, language, or other cognitive functions. In addition, these cognitive deficits can affect quality of life, functional independence, and overall survival, and they are associated with psychiatric conditions such as anxiety and depression.
This narrative review evaluates cognitive deficits in GB patients, both with and without treatment. It also explores the impact of tumor features such as size, location, and histology, along with patient characteristics such as age and education, and discusses the effects of standard therapies, such as surgery, chemotherapy, and radiotherapy, on cognitive outcomes.
Cognitive impairment in GB is influenced by tumor- and patient-specific factors, as well as treatment modalities. Initially, combination therapies such as surgery, radiotherapy, and chemotherapy may improve cognitive domains by reducing tumor burden, relieving cerebral edema, and reducing mass effects, subsequently bringing indirect effects of improved mental health and mood. While certain treatments like radiotherapy and chemotherapy carry risks of delayed neurotoxicity, studies indicate that, on balance, treated patients generally show better preservation or improvement in cognitive function than those who go untreated. However, excessive treatment aggressiveness and cumulative neurotoxic effects may diminish cognitive benefits.
Cognitive function is an independent factor in GB, which could affect survival in GB patients, therefore making routine cognitive assessments essential for prognosis, treatment planning, and rehabilitation. Neuroprotective agents, cognitive rehabilitation, and personalized, multidisciplinary strategies can help optimize both survival and cognitive preservation.
认知功能衰退在胶质母细胞瘤（GB）患者中很常见，在接受治疗和未接受治疗的病例中均会出现。它经常表现为记忆、注意力、语言或其他认知功能的损害。此外，这些认知缺陷会影响生活质量、功能独立性和总生存期，并且与焦虑和抑郁等精神疾病有关。
本叙述性综述评估了GB患者无论是否接受治疗时的认知缺陷。它还探讨了肿瘤特征（如大小、位置和组织学）以及患者特征（如年龄和教育程度）的影响，并讨论了标准治疗方法（如手术、化疗和放疗）对认知结果的影响。
GB患者的认知障碍受肿瘤和患者特定因素以及治疗方式的影响。最初，手术、放疗和化疗等联合治疗可能通过减轻肿瘤负担、缓解脑水肿和减轻占位效应来改善认知领域，随后带来心理健康和情绪改善的间接效果。虽然放疗和化疗等某些治疗存在迟发性神经毒性风险，但研究表明，总体而言，接受治疗的患者通常比未接受治疗的患者在认知功能上表现出更好的保留或改善。然而，过度积极的治疗和累积的神经毒性作用可能会削弱认知益处。
认知功能是GB的一个独立因素，它可能影响GB患者的生存，因此常规认知评估对于预后、治疗规划和康复至关重要。神经保护剂、认知康复以及个性化的多学科策略有助于优化生存和认知保留。
