Abstract
Deficits in neurocognitive functioning (NCF) frequently occur in glioma patients. Both treatment and the tumor itself contribute to these deficits. Data about the role of the tumor are scarce, because NCF has mostly been studied postoperatively. We aimed to summarize data on pre-treatment NCF in glioma patients and to determine the overall and domain-specific prevalence of neurocognitive dysfunction. We searched PubMed and Embase according to PRISMA-P protocol for studies that evaluated pre-treatment NCF in glioma patients (1995-November 2016) and extracted information about NCF. We performed analysis of data for two main outcome measures; mean cognitive functioning of the study sample (at group level) and the percentage of impaired patients (at individual level). We included 23 studies. Most studies were small observational prospective cohort studies. In 11 (47.5%) studies, patient selection was based on tumor location. NCF was analyzed at the group level in 14 studies, of which 13 (92.9%) found decreased NCF at group level, compared to normative data or matched controls. The proportion of individuals with decreased NCF was reported in 15 studies. NCF was impaired (in any domain) in 62.6% of the individuals (median; interquartile range 31.0–79.0). Cognitive impairments were more common in patients with high-grade glioma than with low-grade glioma (OR 2.50; 95% CI 1.71–3.66). Cognitive impairment occurs in the majority of treatment-naive glioma patients, suggesting that neurocognitive dysfunction is related to the tumor. However, the literature about pre-treatment NCF in glioma patients is characterized by small-scale studies and strong heterogeneity in patient selection, resulting in high risk of bias.
Highlights
Diffuse gliomas are progressive brain tumors that are almost invariably fatal, despite recent advances in treatment
Our findings argue for the direct influence of the tumor on neurocognitive functioning (NCF), and support the view that adequate monitoring and treatment of cognitive symptoms is of great importance in diffuse glioma patients already at an early stage
Standard screening tests aimed at cognitive decay, such as the Folstein Mini Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA), cannot always provide relevant information, because they lack sensitivity and domain-specific information
Summary
Diffuse gliomas are progressive brain tumors that are almost invariably fatal, despite recent advances in treatment. Patients with diffuse glioma (WHO grade II–IV) often have deficits in neurocognitive functioning (NCF). J Neurooncol (2017) 134:9–18 quality of life (HRQOL) of patients and their partners [5,6,7]. For this reason, NCF is an important outcome measure of treatment, especially in patients with low-grade glioma (LGG, WHO grade II), who show relatively long periods of disease-free survival compared to patients with high-grade glioma (HGG, WHO grade III-IV). The neurocognitive deficits in glioma patients may be found in one or more cognitive domains, such as executive functioning, language and memory. To detect neurocognitive deficits in glioma patients, neuropsychological evaluation with sensitive and wide-ranging tests is required. Standard screening tests aimed at cognitive decay, such as the Folstein Mini Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA), cannot always provide relevant information, because they lack sensitivity and domain-specific information
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