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Long-term follow-up of neuropsychological functions in patients with high grade gliomas: can cognitive status predict patient’s outcome after surgery?

  • Original Article - Tumor - Glioma
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Abstract

Background

Patients affected by a high-grade glioma (HGG) have a poor prognosis with a median survival of 12–16 months. Such poor prognosis affects the perception of the remaining life by patients and the neuropsychological status can strongly affect every-day functioning of these patients. Monitoring changes of neuropsychological functioning (NPF) overtime may provide better clinical information and optimize the neuro-oncological management. The aims of our work were (1) to investigate the feasibility of a complex neuropsychological battery in HGG patients before and during follow-up after surgery; (2) to study the neuropsychological profile of patients affected by HGGs and their relation with the disease status (relapse/death) across time after surgery.

Methods

One hundred two patients who received surgery for HGG between 2011 and 2017 were studied. All clinical data were prospectively recorded. NPF was assessed during the neuro-oncological follow-up through the Milano-Bicocca Battery (MIBIB). Statistical analysis was performed on the neuropsychological results of the tests administered.

Results

First, MIBIB proved to be suitable for patients with HGG tumors before and after surgery, and during long-term follow-up; it also showed a cluster structure representative of the principal cognitive domains. Second, we found a steep decline in the neuropsychological profile before death and/or tumor relapse for the 52% of the neuropsychological tests administered.

Conclusion

Complex neuropsychological batteries can be administered to HGG patients before and during follow-up after surgery. There is a correlation between neuropsychological deterioration and tumor relapse and/or death, which may reflect a progressive damage to cognitive functions due to tumor infiltration and progression.

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Author information

Author notes

  1. Barbara Zarino and Andrea Di Cristofori contributed equally to the study and should therefore be considered as first co-authors

Authors and Affiliations

  1. Unit of Neurosurgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35 (Padiglione Monteggia), 20122, Milan, Italy

    Barbara Zarino, Giorgia Abete Fornara, Giulio Andrea Bertani, Marco Locatelli, Manuela Caroli, Paolo Rampini & Giorgio Carrabba

  2. Unit of Neurosurgery, Azienda Socio SanitariaTerritoriale – Monza, Ospedale San Gerardo, Via Pergolesi 33, 20900, Monza, MB, Italy

    Andrea Di Cristofori

  3. Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy

    Marco Locatelli

  4. Unit of Neurophysiopathology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy

    Filippo Cogiamanian

  5. Neuroscience Area, Scuola Internazionale Superiore di Studi Avanzati (SISSA), Trieste, Italy

    Davide Crepaldi

Authors
  1. Barbara Zarino
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  2. Andrea Di Cristofori
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  3. Giorgia Abete Fornara
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  4. Giulio Andrea Bertani
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  5. Marco Locatelli
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  6. Manuela Caroli
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Contributions

B.Z., A.D.C., and G.A.F.: concept of the study, writing of the manuscript, and data collection.

G.A.B., M.L., P.R., F.C., and G.C.: revision of the manuscript, analysis of clinical data.

M.C.: neuro-oncological follow-up of the patients, data collection, and manuscript revision.

D.C.: writing of the manuscript, analysis of neuropsychological data

Corresponding authors

Correspondence to Barbara Zarino or Andrea Di Cristofori.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Comments

In this study, the authors address the question of long-term follow-up of neuropsychological functions in patients with high grade gliomas (HGG). In particular, it is assessed how can cognitive status predict patient’s outcome after surgery. The conclusion is that there is a correlation between neuropsychological deterioration and HGG relapse and/or death, which may reflect a progressive damage to cognitive functions due to tumor infiltration and progression. This present study nice completes some other reports in the current literature. It has been previously acknowledged that cognitive impairment occurs in the majority of treatment-naive glioma patients, suggesting that neurocognitive dysfunction is related to the tumor (doi.org/10.1007/s11060-017-2503-z). Moreover, and more important, patient-tailored cognitive assessment may be a non-invasive addition to disease monitoring without overburdening patients and clinical care (doi.org/10.1007/s11060-019-03249-1). One could imagine that machine learning based prediction models would be developed in the near future. Yet, much heterogeneity is present among reports and should be of our concern to strive for standardised battery test in the frame of multicentric trials.

Constantin Tuleasca

Lausanne, Lille, France

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Zarino, B., Di Cristofori, A., Fornara, G.A. et al. Long-term follow-up of neuropsychological functions in patients with high grade gliomas: can cognitive status predict patient’s outcome after surgery?. Acta Neurochir 162, 803–812 (2020). https://doi.org/10.1007/s00701-020-04230-y

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  • DOI: https://doi.org/10.1007/s00701-020-04230-y

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