Changes in language white matter tract microarchitecture associated with cognitive deficits in patients with presumed low-grade glioma

Abstract

OBJECTIVE The authors conducted a study to determine whether cognitive functioning of patients with presumed low-grade glioma is associated with white matter (WM) tract changes. METHODS The authors included 77 patients with presumed low-grade glioma who underwent awake surgery between 2005 and 2013. Diffusion tensor imaging with deterministic tractography was performed preoperatively to identify the arcuate, inferior frontooccipital, and uncinate fasciculi and to obtain the mean fractional anisotropy (FA) and mean diffusivity per tract. All patients were evaluated preoperatively using an extensive neuropsychological protocol that included assessments of the language, memory, and attention/executive function domains. Linear regression models were used to analyze each cognitive domain and each diffusion tensor imaging metric of the 3 WM tracts. RESULTS Significant correlations (corrected for multiple testing) were found between FA of the arcuate fasciculus and results of the repetition test for the language domain (β = 0.59, p < 0.0001) and between FA of the inferior frontooccipital fasciculus and results of the imprinting test for the memory domain (β = -0.55, p = 0.002) and the attention test for the attention and executive function domain (β = -0.62, p = 0.006). CONCLUSIONS In patients with glioma, language deficits in repetition of speech, imprinting, and attention deficits are associated with changes in the microarchitecture of the arcuate and inferior frontooccipital fasciculi.

Neurocognitive changes after awake surgery in glioma patients: a retrospective cohort study

“…This is somewhat in contrast with the findings of Incekara et al, who observed a deterioration in language functions after awake surgery of eloquently located presumed LGGs. Their smaller-scale study was mostly focused at left hemisphere brain regions, whereas our results represent a wider range of glioma patients [14]. Satoer et al, also found postoperative decline in language and executive functions.…”

The Impacts of Tumor and Tumor Associated Epilepsy on Subcortical Brain Structures and Long Distance Connectivity in Patients With Low Grade Glioma

“…In this retrospective cohort we did not have neurocognitive testing data available for these specific tracts to correlate our findings to neuro-cognitive performance. Recently however, using patients from the same cohort, a study was published on white matter tracts involved in language and attention showing a significant relationship between WM tract alterations and language and attention performance ( 69 ). In the future, an important question will be if the degree of subcortical volume loss correlates to the severity of neurocognitive deficits, our current database however lacks the outcome data to address this question.…”

Alterations of white matter integrity associated with cognitive deficits in patients with glioma

“…Besides the most common clinical manifestations, including nausea, headache, epilepsy, and neurological deficits, an increasing number of studies have shown that patients with gliomas may suffer impairments in multiple cognitive domains (Maesawa et al., 2015; Mariano, Mazza, & Galzio, 2013; Miotto et al., 2011). Gliomas have been reported to cause various degrees of white matter fiber damage (Incekara, Satoer, Visch‐Brink, Vincent, & Smits, 2018; Soni, Mehrotra, Behari, Kumar, & Gupta, 2017). In addition, gliomas are well recognized for their infiltrative growth along the white matter tracts (Louis, 2006).…”

“…FA is commonly referred to as a summary measure of microstructural integrity of WM tracts and is a normalized standard deviation of the eigenvalue between 0 and 1. A reduced FA in a WM tract usually indicates a change in the integrity of the fiber bundle (Alexander et al., 2011; Incekara et al., 2018). Diffusion tensor tomography (DTT) evaluates water diffusion in the WM of the brain and shows subcortical tract integrity based on indices such as FA, mean diffusivity, and radial diffusivity.…”