Abstract
Cognitive deficits related to tumour or treatment are estimated to be present in the majority of patients diagnosed with a primary brain tumour, with a large variation based on tumour site, extent, and grade, as well as nature of intervention. These deficits have a significant impact on patient’s quality of life and functional status. The improved patient survival duration in recent years has increased the need to detect, understand and intervene on these cognitive deficits, and optimise patient pathways for treatment. This article reviews the nature of deficits arising in patients with primary brain tumour, and the association of the deficits with neuroanatomical site of tumour. The approach to interventions through adaptation and remediation is outlined, with aim of improving function, promoting generalization of outcomes and optimizing any neuroplasticity that may arise. The evidence for pharmacological therapies and cognitive rehabilitation is presented, and a framework for implementation is provided.
Highlights
Recent advancements in the multidisciplinary management of brain tumours have resulted in significant improvements in survival duration [1]
This review aims to provide a structure to approach neurocognitive deficits in patients with primary brain tumours with a framework to interventions
Reports suggested a benefit in primary brain tumours; a recent phase III study in over 190 patients with mild cognitive deficit after brain irradiation showed no significant improvement in global cognitive function
Summary
Recent advancements in the multidisciplinary management of brain tumours have resulted in significant improvements in survival duration [1]. Even for the patient subgroup diagnosed with glioblastoma multiforme the median survival has increased from 9 - 12 months in the years before the introduction of temozolomide in 2006, to 18 - 24 months in patients currently being managed [1]. This has meant patients have longer survival to manage with the side effects of tumour at initial diagnosis and its subsequent treatment, and increased duration to develop late side effects of intensified treatment multidisciplinary modalities. This review aims to provide a structure to approach neurocognitive deficits in patients with primary brain tumours with a framework to interventions
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