Pretreatment cognitive performance predicts survival in patients with leptomeningeal disease.

Abstract

Leptomeningeal disease (LMD) involves the spread of malignant cells from solid tumors to the cerebrospinal fluid or to the leptomeninges. LMD has a very poor prognosis and it is difficult to diagnose and follow with traditional diagnostic tools. The purposes of this study were to characterize cognitive functioning of LMD patients before treatment and to determine if measurement of cognitive functioning could be used to predict survival time. Thirty-seven subjects with LMD were administered the Mattis Dementia Rating Scale (DRS) before they received treatment and statistical analyses were performed. The Conceptualization subtest of the DRS was the most sensitive to disease course. It was the only individual subtest to predict survival and it was the most impaired subtest across individual subjects. These results support earlier findings of a frontal-subcortical pattern of dysfunction in LMD patients. Cognitive performance at time of LMD diagnosis predicts survival time. Age and clinical status, two factors often correlated with survival in the cancer literature, did not predict survival time for our LMD population. In addition, there were no correlations between survival time and previous medical history or demographic factors. Neuropsychological assessment appears to be a valuable tool both for tracking disease course over time and for predicting survival of patients.