Treatment of Radiation-Induced Cognitive Decline in Adult Brain Tumor Patients

Abstract

Opinion statement Patients with either primary or metastatic brain tumors quite often have cognitive impairment. Maintaining cognitive function is important to brain tumor patients and a decline in cognitive function is generally accompanied by a decline in functional independence and performance status. Cognitive decline can be a result of tumor progression, depression/anxiety, fatigue/sleep dysfunction, or the treatments they have received. It is our opinion that providers treating brain tumor patients should obtain pre-treatment and serial cognitive testing in their patients and offer mitigating and therapeutic interventions when appropriate. They should also support cognition-focused clinical trials.

Rehabilitation of Adult Patients with Primary Brain Tumors: A Narrative Review

“…Therapeutic radiotherapy has been linked to several complications. Traditionally, these are categorized temporally in relation to the treatment [5,28]. Earlier complications are generally viewed…”

“…Therapeutic radiotherapy has been linked to several complications. Traditionally, these are categorized temporally in relation to the treatment [5,28]. Earlier complications are generally viewed as reversible while later complications are generally viewed as progressive and irreversible [28].…”

“…Traditionally, these are categorized temporally in relation to the treatment [5,28]. Earlier complications are generally viewed as reversible while later complications are generally viewed as progressive and irreversible [28]. Acute encephalopathy occurs within several days and is characterized by symptoms such as nausea, somnolence, fever, headache, and exacerbation of focal symptoms.…”

“…In a study examining a mixed population of patients with various primary brain tumors, including both benign and malignant types, one study found that the MoCA had poor sensitivity and negative predictive value in screening for specific cognitive deficits as compared to a 1-1.5-h neuropsychological assessment. These findings suggest that even if a patient scores a normal score of 26 or greater on the MoCA, a cognitive assessment should still be considered to evaluate for specific cognitive deficits [76] [28]. In order to screen for mood changes, healthcare providers can screen with The Hospital Anxiety and Depression Scale and the Patient Health Questionnaire-9 [17].…”

“…These findings suggest that even if a patient scores a normal score of 26 or greater on the MoCA, a cognitive assessment should still be considered to evaluate for specific cognitive deficits [ 76 ]. Testing for specific cognitive domains can be done with Trail Making Test Part A, Trail Making Test Part B, Digit Span, Letter-Number Sequencing, Hopkins Verbal Learning Test-Revised, Boston Naming Test, Wechsler Adult Intelligence Scale 4th edition, and Controlled Oral Word Association Test [ 28 ]. In order to screen for mood changes, healthcare providers can screen with The Hospital Anxiety and Depression Scale and the Patient Health Questionnaire-9 [ 17 ].…”