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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 p...

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Autores principales: Schimmel, Wietske C. M., Gehring, Karin, Hanssens, Patrick E. J., Sitskoorn, Margriet M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer US 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6856035/
https://www.ncbi.nlm.nih.gov/pubmed/31552588
http://dx.doi.org/10.1007/s11060-019-03292-y
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author Schimmel, Wietske C. M.
Gehring, Karin
Hanssens, Patrick E. J.
Sitskoorn, Margriet M.
author_facet Schimmel, Wietske C. M.
Gehring, Karin
Hanssens, Patrick E. J.
Sitskoorn, Margriet M.
author_sort Schimmel, Wietske C. M.
collection PubMed
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). ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s11060-019-03292-y) contains supplementary material, which is available to authorized users.
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spelling pubmed-68560352019-12-03 Cognitive functioning and predictors thereof in patients with 1–10 brain metastases selected for stereotactic radiosurgery Schimmel, Wietske C. M. Gehring, Karin Hanssens, Patrick E. J. Sitskoorn, Margriet M. J Neurooncol Clinical Study 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). ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s11060-019-03292-y) contains supplementary material, which is available to authorized users. Springer US 2019-09-24 2019 /pmc/articles/PMC6856035/ /pubmed/31552588 http://dx.doi.org/10.1007/s11060-019-03292-y Text en © The Author(s) 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
spellingShingle Clinical Study
Schimmel, Wietske C. M.
Gehring, Karin
Hanssens, Patrick E. J.
Sitskoorn, Margriet M.
Cognitive functioning and predictors thereof in patients with 1–10 brain metastases selected for stereotactic radiosurgery
title Cognitive functioning and predictors thereof in patients with 1–10 brain metastases selected for stereotactic radiosurgery
title_full Cognitive functioning and predictors thereof in patients with 1–10 brain metastases selected for stereotactic radiosurgery
title_fullStr Cognitive functioning and predictors thereof in patients with 1–10 brain metastases selected for stereotactic radiosurgery
title_full_unstemmed Cognitive functioning and predictors thereof in patients with 1–10 brain metastases selected for stereotactic radiosurgery
title_short Cognitive functioning and predictors thereof in patients with 1–10 brain metastases selected for stereotactic radiosurgery
title_sort cognitive functioning and predictors thereof in patients with 1–10 brain metastases selected for stereotactic radiosurgery
topic Clinical Study
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6856035/
https://www.ncbi.nlm.nih.gov/pubmed/31552588
http://dx.doi.org/10.1007/s11060-019-03292-y
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