Prevalence Of Cognitive Symptoms Research Articles

Abstract 7453: Psychometric analysis of Neuro-QoL Perceived Cognitive Function tool in primary brain tumor patients

Abstract Cognitive dysfunction is commonly reported but variable in course and severity in the primary brain tumor (PBT) population. Brief, reliable, and sensitive measures of patient-reported outcomes (PRO) of cognitive symptoms on function are needed for clinical care and research. This study aims to assess the reliability and validity of the Neuro-QoL Perceived Cognitive Function tool (NQC) and explore associations with symptoms and objective testing of cognitive dysfunction in a cohort of PBT patients enrolled in a natural history study (NCT02851706: PI T. Armstrong). Patient sample characteristics and PROs, including NQC (<40 = moderate/severe (MS) dysfunction), a symptom burden measure (MD Anderson Symptom Inventory-Brain Tumor (MDASI-BT), scores ≥5 = MS) and the Montreal Cognitive Assessment ((MoCA), scores ≤ 25 indicating cognitive impairment (range: 0-30)) were collected. Descriptive statistics and a psychometric analysis consisting of bivariate correlations, Cronbach’s alpha, and factor analyses using principal axis factoring with nonorthogonal rotation were performed. Cohen’s kappa and correlation were used to assess agreement between objective and subjective measures of cognitive function. The cohort included 327 patients who completed the NQC at study entry [median age: 47 years (range: 18-85), primarily white (78%) males (55%) with high-grade tumors (73%), 65% with a Karnofsky Performance Status (KPS) ≥ 90 (good), and 29% reporting MS cognitive dysfunction]. Factor analysis of the NQC identified two underlying factor groupings: concentration/focus and executive function with Cronbach’s alphas of 0.92 and 0.91 that are interpretable and provided adequate fit for the data. While the NQC was moderately correlated with several MDASI-BT symptom factors, it was highly associated with the cognitive factor (r = -.646). To assess agreement, a subset of patients also completed the MoCA (n=172). These were primarily male (58%), white (79%), had high-grade tumors (67%), and a good KPS score (67%). In this subset, 24% had MS cognitive dysfunction as measured by the NQC while 44% were cognitively impaired using the MoCA resulting in a kappa agreement of 0.07. The correlation between the MoCA score and NQC T-score was -0.292. Understanding the impact and prevalence of cognitive symptoms, objective cognitive testing, and perceived impact is essential for PBT patient care and identifying supportive care interventions. Select NQC psychometric properties demonstrate reliability and validity in this population, with strong agreement with self-report of cognitive symptoms but weaker correlation with objective testing, highlighting the variability in perceived impact. Future research in cognitive function will explore the use of objective testing and perceived impact, its predictors in select populations (i.e., IDH-mutant tumors), and examine its association with biomarkers. Citation Format: Morgan L. Johnson, Elizabeth Vera, Kimberly Reinhart, Hope Miller, Anna Choi, Tricia Kunst, Bennett McIver, Ewa Grajkowska, Michelle L. Wright, Terri S. Armstrong, Tito Mendoza. Psychometric analysis of Neuro-QoL Perceived Cognitive Function tool in primary brain tumor patients [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 7453.

A cross-sectional investigation of cognition and epileptiform discharges in juvenile absence epilepsy.

Despite the prevalence of cognitive symptoms in the idiopathic generalized epilepsies (IGEs), cognitive dysfunction in juvenile absence epilepsy (JAE), a common yet understudied IGE subtype, remains poorly understood. This descriptive study provides a novel, comprehensive characterization of cognitive functioning in a JAE sample and examines the relationship between cognition and 24-h epileptiform discharge load. Forty-four individuals diagnosed with JAE underwent cognitive assessment using Woodcock Johnson III Test of Cognitive Abilities with concurrent 24-h ambulatory EEG monitoring. Generalized epileptiform discharges of any length, and prolonged generalized discharges ≥3s were quantified across wakefulness and sleep. The relationship between standardized cognitive scores and epileptiform discharges was assessed through regression models. Cognitive performances in overall intellectual ability, acquired comprehension-knowledge, processing speed, long-term memory storage and retrieval, and executive processes were 0.63-1.07 standard deviation (SD) units lower in the JAE group compared to the population reference mean, adjusted for educational attainment. Prolonged discharges (≥3s) were recorded in 20 patients (47.6%) from 42 available electroencephalography (EEG) studies and were largely unreported. Duration and number of prolonged discharges were associated with reduced processing speed and long-term memory storage and retrieval. Cognitive dysfunction is seen in patients with JAE across various cognitive abilities, including those representing more stable processes like general intellect. During 24-h EEG, prolonged epileptiform discharges are common yet underreported in JAE despite treatment, and they show moderate effects on cognitive abilities. If epileptiform burden is a modifiable predictor of cognitive dysfunction, therapeutic interventions should consider quantitative 24-h EEG with routine neuropsychological screening. The growing recognition of the spectrum of neuropsychological comorbidities of IGE highlights the value of multidisciplinary approaches to explore the causes and consequences of cognitive deficits in epilepsy.

Twelve Months and Counting: Following Clinical Outcomes in Critical COVID-19 Survivors.

Rationale: Recent reports suggest that patients with severe coronavirus disease (COVID-19) often experience long-term consequences of the infection. However, studies on intensive care unit (ICU) survivors are underrepresented. Objectives: We aimed to explore 12-month clinical outcomes after critical COVID-19, describing the longitudinal progress of disabilities, frailty status, frequency of cognitive impairment, and clinical events (rehospitalization, institutionalization, and falls). Methods: We performed a prospective cohort study of survivors of COVID-19 ICU admissions in Sao Paulo, Brazil. We assessed patients every 3 months for 1 year after hospital discharge and obtained information on 15 activities of daily living (basic, instrumental, and mobility activities), frailty, cognition, and clinical events. Results: We included 428 patients (mean age of 64 yr, 61% required invasive mechanical ventilation during ICU stay). The number of disabilities peaked at 3 months compared with the pre-COVID-19 period (mean difference, 2.46; 99% confidence interval, 1.94-2.99) and then decreased at 12 months (mean difference, 0.67; 99% confidence interval, 0.28-1.07). At 12-month follow-up, 12% of patients were frail, but half of them presented frailty only after COVID-19. The prevalence of cognitive symptoms was 17% at 3 months and progressively decreased to 12.1% (P = 0.012 for trend) at the end of 1 year. Clinical events occurred in all assessments. Conclusions: Although a higher burden of disabilities and cognitive symptoms occurred 3 months after hospital discharge of critical COVID-19 survivors, a significant improvement occurred during the 1-year follow-up. However, one-third of the patients remained in worse conditions than their pre-COVID-19 status.

Dementia and associated factors among the elderly in Vietnam: a cross-sectional study

BackgroundDementia poses a serious threat to the wellbeing of the elderly. In the context of the rapidly ageing population of Vietnam however, little is known about the prevalence of symptoms and other related factors. This study aims to detect the prevalence of cognitive symptoms of dementia in the elderly in Vietnam as well as other associated factors.MethodsA cross-sectional study was conducted over a period of six communes at the Northern, Central and Southern region of Vietnam. Prevalence of cognitive symptoms of dementia was the outcome of interest and assessed by Mini Mental State Evaluation (MMSE) questionnaire and was standardized according to the age structure of Vietnam. A total of 3308 adults aged 60 and above were included. Association between having cognitive symptoms of dementia and other factors was assessed with logistic regression.FindingsCognitive symptoms of dementia were perceived in 46.4% of the sample group. The symptoms were more common among participants who were older, female, had a lower educational level, were not physically active or have previously had stroke.ConclusionsPrevalence of cognitive symptoms of dementia in adults aged 60 and above was relatively high in Vietnam. Other modifiable associated factors including physical inactivity and social connectedness should also be considered in designing intervention program to prevent dementia in the future.

Simultaneous Stimulation of the Globus Pallidus Interna and the Nucleus Basalis of Meynert in the Parkinson-Dementia Syndrome

Background/Aim: The prevalence of cognitive symptoms in recently diagnosed Parkinson’s disease (PD) patients may be as high as 60%. We report a novel deep brain stimulation (DBS) strategy targeting both motor and cognitive symptoms. Methods: A PD patient diagnosed with mild cognitive impairment underwent DBS surgery targeting the globus pallidus interna (GPi; to treat motor symptoms) and the nucleus basalis of Meynert (NBM; to treat cognitive symptoms) using a single electrode per hemisphere. Results: Compared to baseline, 2-month follow-up after GPi stimulation was associated with motor improvements, whereas partial improvements in cognitive functions were observed 3 months after the addition of NBM stimulation to GPi stimulation. Conclusion: This case explores an available alternative for complete DBS treatment in PD, stimulating 2 targets at different frequencies with a single electrode lead.

P122 – 2666: Neuropsychological evaluation of children with middle cranial fossa arachnoid cysts, before and after decompression of the cyst through neurosurgical fenestration

Objective To evaluate cognitive outcome in children after surgical decompression of arachnoid cysts of the middle cranial fossa. An additional objective was to assess the children as one part of the decision whether to perform a surgical intervention or not. Arachnoid cysts are often considered asymptomatic incidental findings of MRI or CT. In this project the aim was to assess prevalence of cognitive symptoms correlated to the cyst and possible postsurgical improvement. Methods Neuropsychological assessment at the department of child neurology at Karolinska University Hospital, Stockholm. The assessment of intellectual ability was done using WISC-IV. Assessment of specific cognitive functions was done using NEPSY-II, Rey Oesterrieth Complex Figure test, BNT-II and FAS (test of verbal fluency). A follow-up with the same psychometric tests 4–5 months after surgery. Results To this date 6 children has gone through presurgical assessment. Four of six children showed cognitive symptoms in the assessment. Symptoms that was correlated to the location of the cyst and the neurosurgeon decided on fenestration of the cyst. Two of six children had no cognitive symptoms and the neurosurgeon decided on no surgical intervention. Two of the four children with symptoms have been evaluated 5 months after decompression of the cyst. Both clinical and psychometric results points towards reduction of cognitive symptoms in these two patients. Conclusion Neuropsychological assessment might be used as a help in decisions regarding surgery. Pre- and post-op assessment might be a way of evaluating the possible benefits of decompression of arachnoid cysts of the middle cranial fossa in children.

Cognitive symptoms in non-Hodgkin lymphoma survivors: Prevalence and discussion with doctors.

9130 Background: Several studies have documented the negative impact of chemotherapy on patients’ cognitive functioning. However, this concern has been understudied among non-Hodgkin Lymphoma (NHL) survivors. Methods: We analyzed survey data from a population-based study of survivors diagnosed with aggressive NHL in Los Angeles County 2-5 years prior to the study; data were collected between 2003-2005. We assessed prevalence of cognitive symptoms (CS) by a single item screener that asked if in the past 6 months survivors experienced problems with memory, attention, or concentration; if yes, we asked if they discussed the problem with a doctor. Frequency of CS was assessed by a 4 item scale that measured how often survivors experienced different CS in the past 4 weeks (none, a little, some, most, all the time). Logistic regression analyses identified correlates of reporting CS (yes/no) as well as discussion with a doctor (yes/no). Analyses were based on data from 358 survivors who had received chemotherapy and saw a doctor for follow-up care in the past year. Results: 134/358 survivors (37%) reported CS, many reporting difficulty some, most, or all the time with memory (64%), attention (58%), concentration (57%), and problem solving (46%). Survivors with higher education, who were not married/partnered, and who had more comorbidities were more likely to report CS (p<0.05 for all). Report of CS was not associated with age, NHL grade, time since completion of chemotherapy, or having been treated with radiation or bone marrow/stem cell transplant. Of the 134 survivors who reported CS, only 43% discussed them with a doctor. Survivors who reported being given information about late effects of treatment were more likely to discuss CS than those who were not (OR: 3.4, 95% CI 1.4-8.5, p<0.01). Conclusions: One in three NHL survivors reported CS following chemotherapy; however, a majority did not discuss these with a doctor. Periodic screening for CS in NHL survivors may be needed and would provide an opportunity to improve patient-clinician communication about this issue. Additionally, research that identifies mechanisms that cause CS in this population is warranted in order to develop targeted behavioral and medical interventions.

Family-Perceived Distress From Delirium-Related Symptoms of Terminally Ill Cancer Patients

Delirium is a frequent symptom of terminally ill cancer patients and can cause serious distress to family members. To clarify the degree of emotional distress of family members concerning terminal delirium, a survey of bereaved families was performed. A questionnaire was mailed to 300 bereaved families with a request to rate the frequency and level of their distress for 12 delirium-related symptoms. A total of 195 responses were analyzed (effective response rate=65%). Seventy-four percent and 62% of the family members reported that the patients had symptoms of physical restlessness and mood lability, respectively. Psychotic symptoms, such as hallucinations and delusions, were reported by 35%-37%, and somnolence was reported in 92%. The prevalence of cognitive symptoms (e.g., communication difficulty, memory disturbance) ranged between 50% and 72%. More than two-thirds of the bereaved family members perceived all delirium-related symptoms other than somnolence as distressing or very distressing when they occurred "often" or "very often." For physical restlessness, mood lability, and psychotic symptoms that occurred "sometimes," 27%-36% of the family members had moderate to high levels of distress. The bereaved family members of terminally ill cancer patients experienced high levels of distress from both the agitation and cognitive symptoms of terminal delirium. Multidisciplinary interventions, including the prevention of agitation and the minimization of cognitive impairment, pharmacological or medical treatments, and supportive and psychoeducational approaches for family members, are needed to alleviate family distress.