Artikel
Preoperative neurocognitive evaluation of brain tumor patients with minor neurological dysfunctions
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Autoren
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Philipp Hendrix
- Department of Neurosurgery, Saarland University Hospital, Homburg, Germany
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Elisa Hans
- Department of Neurosurgery, Saarland University Hospital, Homburg, Germany
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Joachim Oertel
- Department of Neurosurgery, Saarland University Hospital, Homburg, Germany
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Julia Karbach
- Department of Psychology, Goethe-University, Frankfurt, Germany
| Veröffentlicht: | 8. Juni 2016 |
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Gliederung
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Objective: Patients suffering from benign or malignant brain tumors may experience neurological or neuropsychological impairments. The lack of self-awareness for neurocognitive decrease in patients suffering from no or minor neurological dysfunctions may impact their social and professional lives. Here, we seek to determine which patient subgroups exhibit preoperative neurocognitive dysfunctions and moreover, assess which neuropsychological test is adequate for uncovering these deficits.
Method: Forty-nine brain tumor patients underwent neurocognitive testing via an extensive neuropsychological test battery assessing perceptual speed, short-term and working memory, verbal learning and memory, and executive functions (inhibition, cognitive flexibility, verbal fluency), fluid intelligence, anxiety, and depression. Patients with neurological dysfunctions that interfere with adequate neuropsychological assessment, psychiatric disorders and sedative medication were excluded.
Results: The patient cohort suffered either from pituitary adenoma (14), meningioma (14), cerebral metastasis (11) or glioblastoma multiforme (10). The average KPS was 91 (± 9). Tumor entity and tumor size were not associated with differences in neurocognitive performance. Patients with tumors compromising the frontal lobe (67%) performed significantly poorer in subtasks of the verbal fluency test compared to non-frontal lobe tumors. Additionally, frontal lobe tumor patients scored significantly higher on the anxiety and depression scales. Patients that presented with mild disturbance of speech or subjectively have recognized mild impairment of speech in the past (18%) exhibited significant deficits in the verbal learning and memory test. All but one patient were right-handed (98%). Patients with tumors within the left hemisphere (20%) displayed significant deficits in cognitive flexibility and in subtasks of the verbal fluency test. Distinct neurological status parameters (e.g. paresis, sensory deficits, cranial nerve deficits, ataxia) were not associated with particular deficits in neuropsychological performance.
Conclusions: The tumor localization within the left/dominant hemisphere or a tumor affecting the frontal lobe is associated with a poorer preoperative neurocognitive performance. Tumor entity, tumor size and neurological status do not correlate with preoperative neurocognitive impairments.
