Cognitive functioning and predictors thereof in patients with 1–10 brain metastases selected for stereotactic radiosurgery
Purpose Information on predictive factors of cognitive functioning in patients with (multiple) brain metastases (BM) selected for radiosurgery may allow for more individual care and may play a role in predicting cognitive outcome after radiosurgery. The aim of this study was to evaluate cognitive pe...
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| Veröffentlicht in: | Journal of neuro-oncology 2019-11, Vol.145 (2), p.265-276 |
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| creator | Schimmel, Wietske C. M. Gehring, Karin Hanssens, Patrick E. J. Sitskoorn, Margriet M. |
| description | Purpose
Information on predictive factors of cognitive functioning in patients with (multiple) brain metastases (BM) selected for radiosurgery may allow for more individual care and may play a role in predicting cognitive outcome after radiosurgery. The aim of this study was to evaluate cognitive performance, and predictors thereof, in patients with 1–10 BM before radiosurgery.
Methods
Cognition was measured before radiosurgery using a standardized neuropsychological test battery in patients with 1–10 BM (expected survival > 3 months; KPS ≥ 70; no prior BM treatment). Regression formulae were constructed to calculate sociodemographically corrected z scores. Group and individual cognitive functioning was analyzed. Multivariable regression was used to explore potential predictors.
Results
Patients (N = 92) performed significantly worse than controls (N = 104) on all 11 test variables (medium-large effect sizes for 8 variables). Percentages of impairment were highest for information processing (55.3%), dexterity (43.2%) and cognitive flexibility (28.7%). 62% and 46% of patients had impairments in at least two, or three test variables, respectively. Models including combinations of clinical and psychological variables were predictive of verbal memory, psychomotor speed, information processing and dexterity. Neither number nor volume of metastases predicted patients’ test performance.
Conclusions
Already before radiosurgery, almost half of the patients suffered from severe cognitive deficits in at least three test variables. At group and individual level, information processing, cognitive flexibility, and dexterity were most affected. These cognitive impairments may impair daily functioning and patients’ ability to make (shared) treatment decisions. Both clinical (symptomatic BM; timing of BM diagnosis) and psychological (mental fatigue) characteristics influenced cognitive performance.
Clinical trial information
Cognition and Radiation Study A (CAR-Study A; ClinicalTrials.gov Identifier: NCT02953756; Medical Ethics Committee file number: NL53472.028.15/P1515). |
| doi_str_mv | 10.1007/s11060-019-03292-y |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_6856035</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2297125160</sourcerecordid><originalsourceid>FETCH-LOGICAL-c474t-87ee2f351e94a93d187940a2f5912a2568420f63456d7755ac29336cd9c0ef2e3</originalsourceid><addsrcrecordid>eNp9kc2KFDEUhYMoTtv6Ai4k4GY2pflPZSNIM47CgBsFdyGTutWdoTppk9RIgwvfwTf0SSZtj-PPQghkcb9zcm4OQk8peUEJ0S8LpUSRjlDTEc4M6_b30IJKzTvNNb-PFoQq3UkjPp2gR6VcEUKE5vQhOuFUSib7foG-rtI6hhquAY9z9DWkGOIauzjgXYYh-JpywXUDGdKIQ8Q7VwPEWvCXUDeY_vj2nRJ8mV0bbaG60g4UXGACX2HAY8q41IO6uubucXZDSGXOa8j7x-jB6KYCT27vJfr45uzD6m138f783er1ReeFFrXrNQAbuaRghDN8oL02gjg2SkOZY1L1gpFRcSHVoLWUzjPDufKD8QRGBnyJXh19d_PlFgbf8mc32V0OW5f3Nrlg_57EsLHrdG1VLxXhshmc3hrk9HmGUu02FA_T5CKkuVjGjKZM0gYv0fN_0Ks059jWO1BKaNLyNoodKZ9TKRnGuzCU2EO59liubeXan-XafRM9-3ONO8mvNhvAj0Bpo9h--Pfb_7G9ASy4s6s</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2296470568</pqid></control><display><type>article</type><title>Cognitive functioning and predictors thereof in patients with 1–10 brain metastases selected for stereotactic radiosurgery</title><source>MEDLINE</source><source>SpringerNature Journals</source><creator>Schimmel, Wietske C. M. ; Gehring, Karin ; Hanssens, Patrick E. J. ; Sitskoorn, Margriet M.</creator><creatorcontrib>Schimmel, Wietske C. M. ; Gehring, Karin ; Hanssens, Patrick E. J. ; Sitskoorn, Margriet M.</creatorcontrib><description>Purpose
Information on predictive factors of cognitive functioning in patients with (multiple) brain metastases (BM) selected for radiosurgery may allow for more individual care and may play a role in predicting cognitive outcome after radiosurgery. The aim of this study was to evaluate cognitive performance, and predictors thereof, in patients with 1–10 BM before radiosurgery.
Methods
Cognition was measured before radiosurgery using a standardized neuropsychological test battery in patients with 1–10 BM (expected survival > 3 months; KPS ≥ 70; no prior BM treatment). Regression formulae were constructed to calculate sociodemographically corrected z scores. Group and individual cognitive functioning was analyzed. Multivariable regression was used to explore potential predictors.
Results
Patients (N = 92) performed significantly worse than controls (N = 104) on all 11 test variables (medium-large effect sizes for 8 variables). Percentages of impairment were highest for information processing (55.3%), dexterity (43.2%) and cognitive flexibility (28.7%). 62% and 46% of patients had impairments in at least two, or three test variables, respectively. Models including combinations of clinical and psychological variables were predictive of verbal memory, psychomotor speed, information processing and dexterity. Neither number nor volume of metastases predicted patients’ test performance.
Conclusions
Already before radiosurgery, almost half of the patients suffered from severe cognitive deficits in at least three test variables. At group and individual level, information processing, cognitive flexibility, and dexterity were most affected. These cognitive impairments may impair daily functioning and patients’ ability to make (shared) treatment decisions. Both clinical (symptomatic BM; timing of BM diagnosis) and psychological (mental fatigue) characteristics influenced cognitive performance.
Clinical trial information
Cognition and Radiation Study A (CAR-Study A; ClinicalTrials.gov Identifier: NCT02953756; Medical Ethics Committee file number: NL53472.028.15/P1515).</description><identifier>ISSN: 0167-594X</identifier><identifier>EISSN: 1573-7373</identifier><identifier>DOI: 10.1007/s11060-019-03292-y</identifier><identifier>PMID: 31552588</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Brain cancer ; Brain Neoplasms - psychology ; Brain Neoplasms - radiotherapy ; Brain Neoplasms - secondary ; Clinical Study ; Cognition & reasoning ; Cognitive ability ; Cognitive Dysfunction - diagnosis ; Cognitive Dysfunction - etiology ; Female ; Humans ; Information processing ; Longitudinal Studies ; Male ; Medicine ; Medicine & Public Health ; Metastases ; Metastasis ; Middle Aged ; Neurology ; Neuropsychological Tests ; Oncology ; Patients ; Prognosis ; Prospective Studies ; Radiosurgery ; Radiosurgery - adverse effects</subject><ispartof>Journal of neuro-oncology, 2019-11, Vol.145 (2), p.265-276</ispartof><rights>The Author(s) 2019</rights><rights>Journal of Neuro-Oncology is a copyright of Springer, (2019). All Rights Reserved. © 2019. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c474t-87ee2f351e94a93d187940a2f5912a2568420f63456d7755ac29336cd9c0ef2e3</citedby><cites>FETCH-LOGICAL-c474t-87ee2f351e94a93d187940a2f5912a2568420f63456d7755ac29336cd9c0ef2e3</cites><orcidid>0000-0003-4689-2166 ; 0000-0002-6989-1855</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s11060-019-03292-y$$EPDF$$P50$$Gspringer$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s11060-019-03292-y$$EHTML$$P50$$Gspringer$$Hfree_for_read</linktohtml><link.rule.ids>230,315,782,786,887,27931,27932,41495,42564,51326</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31552588$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Schimmel, Wietske C. M.</creatorcontrib><creatorcontrib>Gehring, Karin</creatorcontrib><creatorcontrib>Hanssens, Patrick E. J.</creatorcontrib><creatorcontrib>Sitskoorn, Margriet M.</creatorcontrib><title>Cognitive functioning and predictors thereof in patients with 1–10 brain metastases selected for stereotactic radiosurgery</title><title>Journal of neuro-oncology</title><addtitle>J Neurooncol</addtitle><addtitle>J Neurooncol</addtitle><description>Purpose
Information on predictive factors of cognitive functioning in patients with (multiple) brain metastases (BM) selected for radiosurgery may allow for more individual care and may play a role in predicting cognitive outcome after radiosurgery. The aim of this study was to evaluate cognitive performance, and predictors thereof, in patients with 1–10 BM before radiosurgery.
Methods
Cognition was measured before radiosurgery using a standardized neuropsychological test battery in patients with 1–10 BM (expected survival > 3 months; KPS ≥ 70; no prior BM treatment). Regression formulae were constructed to calculate sociodemographically corrected z scores. Group and individual cognitive functioning was analyzed. Multivariable regression was used to explore potential predictors.
Results
Patients (N = 92) performed significantly worse than controls (N = 104) on all 11 test variables (medium-large effect sizes for 8 variables). Percentages of impairment were highest for information processing (55.3%), dexterity (43.2%) and cognitive flexibility (28.7%). 62% and 46% of patients had impairments in at least two, or three test variables, respectively. Models including combinations of clinical and psychological variables were predictive of verbal memory, psychomotor speed, information processing and dexterity. Neither number nor volume of metastases predicted patients’ test performance.
Conclusions
Already before radiosurgery, almost half of the patients suffered from severe cognitive deficits in at least three test variables. At group and individual level, information processing, cognitive flexibility, and dexterity were most affected. These cognitive impairments may impair daily functioning and patients’ ability to make (shared) treatment decisions. Both clinical (symptomatic BM; timing of BM diagnosis) and psychological (mental fatigue) characteristics influenced cognitive performance.
Clinical trial information
Cognition and Radiation Study A (CAR-Study A; ClinicalTrials.gov Identifier: NCT02953756; Medical Ethics Committee file number: NL53472.028.15/P1515).</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Brain cancer</subject><subject>Brain Neoplasms - psychology</subject><subject>Brain Neoplasms - radiotherapy</subject><subject>Brain Neoplasms - secondary</subject><subject>Clinical Study</subject><subject>Cognition & reasoning</subject><subject>Cognitive ability</subject><subject>Cognitive Dysfunction - diagnosis</subject><subject>Cognitive Dysfunction - etiology</subject><subject>Female</subject><subject>Humans</subject><subject>Information processing</subject><subject>Longitudinal Studies</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Metastases</subject><subject>Metastasis</subject><subject>Middle Aged</subject><subject>Neurology</subject><subject>Neuropsychological Tests</subject><subject>Oncology</subject><subject>Patients</subject><subject>Prognosis</subject><subject>Prospective Studies</subject><subject>Radiosurgery</subject><subject>Radiosurgery - adverse effects</subject><issn>0167-594X</issn><issn>1573-7373</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>C6C</sourceid><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp9kc2KFDEUhYMoTtv6Ai4k4GY2pflPZSNIM47CgBsFdyGTutWdoTppk9RIgwvfwTf0SSZtj-PPQghkcb9zcm4OQk8peUEJ0S8LpUSRjlDTEc4M6_b30IJKzTvNNb-PFoQq3UkjPp2gR6VcEUKE5vQhOuFUSib7foG-rtI6hhquAY9z9DWkGOIauzjgXYYh-JpywXUDGdKIQ8Q7VwPEWvCXUDeY_vj2nRJ8mV0bbaG60g4UXGACX2HAY8q41IO6uubucXZDSGXOa8j7x-jB6KYCT27vJfr45uzD6m138f783er1ReeFFrXrNQAbuaRghDN8oL02gjg2SkOZY1L1gpFRcSHVoLWUzjPDufKD8QRGBnyJXh19d_PlFgbf8mc32V0OW5f3Nrlg_57EsLHrdG1VLxXhshmc3hrk9HmGUu02FA_T5CKkuVjGjKZM0gYv0fN_0Ks059jWO1BKaNLyNoodKZ9TKRnGuzCU2EO59liubeXan-XafRM9-3ONO8mvNhvAj0Bpo9h--Pfb_7G9ASy4s6s</recordid><startdate>20191101</startdate><enddate>20191101</enddate><creator>Schimmel, Wietske C. M.</creator><creator>Gehring, Karin</creator><creator>Hanssens, Patrick E. 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M. ; Gehring, Karin ; Hanssens, Patrick E. J. ; Sitskoorn, Margriet M.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c474t-87ee2f351e94a93d187940a2f5912a2568420f63456d7755ac29336cd9c0ef2e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Brain cancer</topic><topic>Brain Neoplasms - psychology</topic><topic>Brain Neoplasms - radiotherapy</topic><topic>Brain Neoplasms - secondary</topic><topic>Clinical Study</topic><topic>Cognition & reasoning</topic><topic>Cognitive ability</topic><topic>Cognitive Dysfunction - diagnosis</topic><topic>Cognitive Dysfunction - etiology</topic><topic>Female</topic><topic>Humans</topic><topic>Information processing</topic><topic>Longitudinal Studies</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Metastases</topic><topic>Metastasis</topic><topic>Middle Aged</topic><topic>Neurology</topic><topic>Neuropsychological Tests</topic><topic>Oncology</topic><topic>Patients</topic><topic>Prognosis</topic><topic>Prospective Studies</topic><topic>Radiosurgery</topic><topic>Radiosurgery - adverse effects</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Schimmel, Wietske C. M.</creatorcontrib><creatorcontrib>Gehring, Karin</creatorcontrib><creatorcontrib>Hanssens, Patrick E. J.</creatorcontrib><creatorcontrib>Sitskoorn, Margriet M.</creatorcontrib><collection>Springer Nature OA Free Journals</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Neurosciences Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of neuro-oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Schimmel, Wietske C. M.</au><au>Gehring, Karin</au><au>Hanssens, Patrick E. J.</au><au>Sitskoorn, Margriet M.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Cognitive functioning and predictors thereof in patients with 1–10 brain metastases selected for stereotactic radiosurgery</atitle><jtitle>Journal of neuro-oncology</jtitle><stitle>J Neurooncol</stitle><addtitle>J Neurooncol</addtitle><date>2019-11-01</date><risdate>2019</risdate><volume>145</volume><issue>2</issue><spage>265</spage><epage>276</epage><pages>265-276</pages><issn>0167-594X</issn><eissn>1573-7373</eissn><abstract>Purpose
Information on predictive factors of cognitive functioning in patients with (multiple) brain metastases (BM) selected for radiosurgery may allow for more individual care and may play a role in predicting cognitive outcome after radiosurgery. The aim of this study was to evaluate cognitive performance, and predictors thereof, in patients with 1–10 BM before radiosurgery.
Methods
Cognition was measured before radiosurgery using a standardized neuropsychological test battery in patients with 1–10 BM (expected survival > 3 months; KPS ≥ 70; no prior BM treatment). Regression formulae were constructed to calculate sociodemographically corrected z scores. Group and individual cognitive functioning was analyzed. Multivariable regression was used to explore potential predictors.
Results
Patients (N = 92) performed significantly worse than controls (N = 104) on all 11 test variables (medium-large effect sizes for 8 variables). Percentages of impairment were highest for information processing (55.3%), dexterity (43.2%) and cognitive flexibility (28.7%). 62% and 46% of patients had impairments in at least two, or three test variables, respectively. Models including combinations of clinical and psychological variables were predictive of verbal memory, psychomotor speed, information processing and dexterity. Neither number nor volume of metastases predicted patients’ test performance.
Conclusions
Already before radiosurgery, almost half of the patients suffered from severe cognitive deficits in at least three test variables. At group and individual level, information processing, cognitive flexibility, and dexterity were most affected. These cognitive impairments may impair daily functioning and patients’ ability to make (shared) treatment decisions. Both clinical (symptomatic BM; timing of BM diagnosis) and psychological (mental fatigue) characteristics influenced cognitive performance.
Clinical trial information
Cognition and Radiation Study A (CAR-Study A; ClinicalTrials.gov Identifier: NCT02953756; Medical Ethics Committee file number: NL53472.028.15/P1515).</abstract><cop>New York</cop><pub>Springer US</pub><pmid>31552588</pmid><doi>10.1007/s11060-019-03292-y</doi><tpages>12</tpages><orcidid>https://orcid.org/0000-0003-4689-2166</orcidid><orcidid>https://orcid.org/0000-0002-6989-1855</orcidid><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; SpringerNature Journals |
| subjects | Adult Aged Aged, 80 and over Brain cancer Brain Neoplasms - psychology Brain Neoplasms - radiotherapy Brain Neoplasms - secondary Clinical Study Cognition & reasoning Cognitive ability Cognitive Dysfunction - diagnosis Cognitive Dysfunction - etiology Female Humans Information processing Longitudinal Studies Male Medicine Medicine & Public Health Metastases Metastasis Middle Aged Neurology Neuropsychological Tests Oncology Patients Prognosis Prospective Studies Radiosurgery Radiosurgery - adverse effects |
| title | Cognitive functioning and predictors thereof in patients with 1–10 brain metastases selected for stereotactic radiosurgery |
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