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Review
. 2017 Aug;134(1):9-18.
doi: 10.1007/s11060-017-2503-z. Epub 2017 May 31.

Tumor-related neurocognitive dysfunction in patients with diffuse glioma: a systematic review of neurocognitive functioning prior to anti-tumor treatment

Emma van Kessel  1 , Anniek E Baumfalk  2 , Martine J E van Zandvoort  2   3 , Pierre A Robe  2 , Tom J Snijders  2
Affiliations
Review

Tumor-related neurocognitive dysfunction in patients with diffuse glioma: a systematic review of neurocognitive functioning prior to anti-tumor treatment

Emma van Kessel et al. J Neurooncol. 2017 Aug.

Abstract

Deficits in neurocognitive functioning (NCF) frequently occur in glioma patients. Both treatment and the tumor itself contribute to these deficits. Data about the role of the tumor are scarce, because NCF has mostly been studied postoperatively. We aimed to summarize data on pre-treatment NCF in glioma patients and to determine the overall and domain-specific prevalence of neurocognitive dysfunction. We searched PubMed and Embase according to PRISMA-P protocol for studies that evaluated pre-treatment NCF in glioma patients (1995-November 2016) and extracted information about NCF. We performed analysis of data for two main outcome measures; mean cognitive functioning of the study sample (at group level) and the percentage of impaired patients (at individual level). We included 23 studies. Most studies were small observational prospective cohort studies. In 11 (47.5%) studies, patient selection was based on tumor location. NCF was analyzed at the group level in 14 studies, of which 13 (92.9%) found decreased NCF at group level, compared to normative data or matched controls. The proportion of individuals with decreased NCF was reported in 15 studies. NCF was impaired (in any domain) in 62.6% of the individuals (median; interquartile range 31.0-79.0). Cognitive impairments were more common in patients with high-grade glioma than with low-grade glioma (OR 2.50; 95% CI 1.71-3.66). Cognitive impairment occurs in the majority of treatment-naive glioma patients, suggesting that neurocognitive dysfunction is related to the tumor. However, the literature about pre-treatment NCF in glioma patients is characterized by small-scale studies and strong heterogeneity in patient selection, resulting in high risk of bias.

Keywords: Brain tumor; Cognition; Glioma; Neurocognitive functioning; Neuropsychology.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Different methods to calculate the percentage of impaired patients within in a certain cognitive domain (here: executive functioning), based on results from different cognitive tests. Method 1 (true percentage) can only be calculated if individual-level data per test are available. Method 2–4 are based on group results per test: method 2, which is used in this review, will usually give an underestimation of the true proportion, but offers the closest estimation
Fig. 2
Fig. 2
Flowchart of the systematic literature search
Fig. 3
Fig. 3
Number of studies reporting—overall and domain-specific—neurocognitive impairment at the group level
Fig. 4
Fig. 4
Proportion of glioma patients with cognitive impairment, including overall and domain-specific proportions. The bars represent boxplots with median, IQR (interquartile range), minimum and maximum values
See this image and copyright information in PMC

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