18 However, when comparing the MoCA to a more comprehensive neuropsychological battery in a PBT population, the MoCA has poorer sensitivity to detecting cognitive deficits. In a study by Olson et al, over half of the patients that were classified as normal by the MMSE were found to be cognitively impaired by the MoCA. 20 While it was originally developed for patients with MCI and Alzheimer’s disease, the MoCA detected cognitive impairment better than the MMSE in patients with brain metastases. The Montreal Cognitive Assessment (MoCA) is a brief screening tool created to identify mild cognitive impairment (MCI) and has better sensitivity than the MMSE. In addition, not having a standardized approach to cognitive testing and screening in routine clinical assessments limits the ability to quantify these important cognitive symptoms. The time needed to complete test administration training and the extensive time needed for the patients to complete the tests make them difficult to administer and limit their frequent use during routine clinical assessments. 16 Assessing cognition among PBT patients can be challenging when considering the length and sensitivity of these various tests while also trying to administer an assessment battery that addresses all relevant cognitive domains. 17 Neurocognitive batteries include a combination of these objective tests and provide a comprehensive picture of a patient’s cognitive function across several domains, which can aid in diagnosis. 18, 19 Other validated performance-based measures commonly used in brain tumor research include the Mattis Dementia Rating Scale, Neuropsychiatric Inventory, Hopkins Verbal Learning Test-Revised, Trail Making Test, Controlled Oral Word Association Test, Digit Span, Digit Symbol, Hand Dynamometer, and the Grooved Pegboard Test. ![]() ![]() 17 However, the MMSE has limited value in detecting CD in visuospatial and executive function and has minimal sensitivity in the brain tumor population. 16 The Mini-Mental State Examination (MMSE) is the most used screening tool in PBT clinical trials and assesses orientation, attention, memory, language, and visuospatial skills. While narrow in scope, cognitive screening tests are brief and used by clinicians as a tool to monitor progression of CD or identify impairment in at-risk individuals. 15 Objective cognitive functioning measures include neurocognitive assessments, which allow health care providers to identify deficits within specific cognitive domains and avoid issues inherent with patient self-report data. 14 Previous studies have identified limitations to solely relying on patient-reported measures of cognition as patients may under or overreport perceived cognitive impairments. Several patient-reported measures are commonly used to assess PBT patients including the HealthMeasures Quality of Life in Neurological Disorders (Neuro-QOL) Cognitive Function tool 13 and the MD Anderson Symptom Inventory-Brain Tumor module (MDASI-BT). 11 When considering the similarities between the mechanisms of spinal cord injuries and spinal cord tumors, 12 these findings highlight the need to explore cognitive deficits in the primary CNS tumor population.īoth patient-reported and objective measures of CD have been developed to assess and improve the evaluation of patients reporting or clinically suspected to have cognitive deficits. 9, 10 Craig et al reported that about 30% of the adult spinal cord injury population have severe cognitive impairments. However, there is evidence of cognitive impairment in those with spinal cord injury, specifically in the cognitive domains of memory, attention, and processing speed. ![]() 7, 8 Spinal cord tumors are rare, and there are limited reports describing cognitive function in these patients. 3, 6 Previous research suggests that assessing CD in this population is important as it may provide insight into overall survival, progression-free survival, and direct tumor management. ![]() 5 Furthermore, deficits in the cognitive domains of executive functioning, attention, memory, and processing speed have shown to be detrimental to a patient’s quality of life, even after treatment is ceased. 4 Similarly, Tucha et al reported that 71% of patients had impairments in 3 or more cognitive areas. 1–3 In a recent systematic review of literature on neurocognitive function in patients with diffuse glioma, 63% of patients had an impairment in at least one cognitive domain. CNS tumors, cognitive dysfunction, neurocognitive testing, telehealthĬognitive dysfunction (CD) is one of the most common symptoms experienced by primary brain tumor (PBT) patients and is associated with the disease and as a consequence of treatment, often including surgical resection, radiation therapy, and chemotherapy.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |