GLIOMA-16 EARLY NEUROCOGNITIVE OUTCOME POST RESECTION OF ADULT SUPRATENTORIAL GLIOMAS AT THE KENYATTA NATIONAL HOSPITAL

Abstract

Abstract Gliomas are the commonest brain tumors in our setting. Traditionally; Overall Survival, progression free survival and Extent of resection are used to define oncologic outcome in gliomas. These measures don’t reflect the complete patient status and hence the need for functional outcome determination. Cognitive outcome, is a key functional measure in gliomas. This was a prospective Cohort Study whose objective was to determine the Early Neurocognitive outcome post-resection of adult supratentorial gliomas at the Kenyatta National Hospital. Our study population was adult patients with supratentorial gliomas. We examined twenty patients who met the inclusion criteria. Data collection was by an interviewer-based questionnaire incorporating the ACE III (Addenbrooke Cognitive Examination III) tool administered at three instances as follows: - Within two weeks Preoperatively (T0), at one week postoperatively (T1) and at four weeks postoperatively (T2). The pre and post operative cognitive scores were then analyzed to determine the cognitive outcome. Statistical significance was considered where the p-value was <0.05. Ninety five percent of patients had cognitive impairment at baseline. Mean age of presentation was 34.3 years for Low grade glioma (LGG) and 43.8 years for High Grade Glioma (HGG). 55% of patients had LGG while 45% had HGG. Overall, there was transient decline in cognition from T0-T1 and a gradual improvement beyond the baseline from T1-T2. This improvement was across all domains but was significant in the total ACE score, memory and fluency. LGG showed the greatest improvement in cognition especially in the fluency domain. Sixty percent of the tumors were subtotally resected and showed significant cognitive change in the domains of Attention, fluency and Visuospatial association. Glioma surgery in our setting results in a transient decline in cognition one week postoperatively after which improvement in cognition beyond baseline is noted one month post operatively.