The cognitive and behavioral effects of meningioma lesions involving the ventromedial prefrontal cortex

Abstract

Object Anterior skull base meningiomas are frequently associated with changes in personality and behavior. Although such meningiomas often damage ventromedial prefrontal cortex (vmPFC), which is important for higher cognition, the cognitive and behavioral effects of these meningiomas remain poorly understood. Using detailed neuropsychological assessments in a large series of patients, this study examines the cognitive and behavioral effects of meningioma lesions involving vmPFC. Methods We reviewed neuropsychology and lesion mapping records of 70 patients who underwent resection of meningiomas. The patients were drawn from the Neurological Patient Registry at the University of Iowa. Patients were sorted into two groups: those with lesions involving vmPFC and those with lesions that did not involve vmPFC. Neuropsychological data pertaining to a comprehensive array of cognitive and behavioral domains were available preoperatively in 20 patients and postoperatively in all 70 patients. Results There was no change in basic cognitive functions (e.g. attention, perception, memory, construction and motor performance, language, or executive functions) from the pre-operative to post-operative epochs for vmPFC and non-vmPFC groups. There was a significant decline in the behavioral domain, specifically adaptive function, for both the vmPFC and non-vmPFC groups, and this decline was more pronounced for the vmPFC group. Additionally, postoperative data indicated that the vmPFC group had a specific deficit in value-based decision making, as evidenced by poor performance on the Iowa Gambling Task, compared to the non-vmPFC group. The vmPFC and non-vmPFC groups did not differ postoperatively on other cognitive measures, including intellect, memory, language, and perception. Conclusions Lesions of vmPFC resulting from meningiomas are associated with specific deficits in adaptive function and value-based decision making. Meningioma patients showed decline in adaptive function postoperatively, and this decline was especially notable in patients with vmPFC region meningiomas. Early detection and resection of meningiomas of the anterior skull base (involving gyrus rectus) may prevent these deficits.

Meningiomas and Cognitive Impairment after Treatment: A Systematic and Narrative Review

“…Table 1 summarizes the characteristics of all included studies and their corresponding patients that underwent neuropsychological cognitive evaluation prior to and after treatment. Overall, 9 retrospective [ 5 , 23 , 24 , 30 , 33 , 34 , 35 , 36 , 37 ] and 13 prospective [ 20 , 21 , 22 , 25 , 26 , 27 , 28 , 29 , 31 , 32 , 38 , 39 , 40 ] studies were reviewed, corresponding to a total of 1572 patients (range 9–261) with a mean age of 58.4 years (range 23–87). Most patients were female (n = 1084, 68.9%), with a female-to-male ratio of 2.3:1.…”

Surgery on giant meningiomas in very old patients entails frequent postoperative intracranial hemorrhages and atypical histopathology

“…Some did not report cognitive symptoms [ 15 , 16 , 24 ], whereas others reported cognitive impairment in 51–59% of patients [ 7 , 18 , 19 ]. Previous studies on patients with giant meningiomas reported cognitive impairment as the surgical indication in 50–84% [ 32 – 34 ]. Based on our results, cognitive impairment is more common in giant meningiomas.…”

Comparing and Contrasting the Cognitive Effects of Hippocampal and Ventromedial Prefrontal Cortex Damage: A Review of Human Lesion Studies

“…This early neuropsychological report indicates that vmPFC damage causes disruptions across cognition including in decision making, emotion, social interactions and personality. We still lack, however, a widely agreed account of precisely what role the vmPFC plays ( Abel et al, 2016 , Delgado et al, 2016 , Szczepanski and Knight, 2014 ).…”

“…Economic decision making has been closely associated with the vmPFC ( Clark et al, 2004 , Fellows, 2011 , Levy and Glimcher, 2012 ), with much of the research conducted on gambling ( Abel et al, 2016 , Clark et al, 2008 , O'Doherty et al, 2001 , Zald and Andreotti, 2010 ), often using the Iowa Gambling Test ( Bechara et al, 1994 ). This is a card game where the player has to choose one card at a time from various decks of cards that end up proving either disadvantageous (high risk) or advantageous (low risk).…”