Medicine & Health
Glioma Treatment Linked to Cognitive Declines in First Year
Original Authors: Rydén, Latini, Munkhammar, Hellström, Neimantaite, Lycett, Harba, Carstam, Blomstrand, Zetterling, Smits, Jakola
The management of isocitrate dehydrogenase (IDH) mutated gliomas typically involves a multidisciplinary approach with early multimodal treatment, following current clinical guidelines. However, the comprehensive effects of this intensive treatment strategy on patients' cognitive functioning have been less thoroughly investigated. A recent longitudinal multicenter study aimed to bridge this knowledge gap by examining cognitive changes in these patients during the crucial first year post-treatment and identifying potential predictors of cognitive deterioration.
The study involved 127 patients, most of whom underwent multi-modal treatment, who were diagnosed for the first time with an IDH mutated glioma. Neuropsychological assessments were conducted both before surgery and one year later. The findings revealed reliable cognitive declines across several domains. Specifically, the largest proportions of declines were observed in executive functioning (24%), learning/memory (23%), and language (21%), based on reliable change indices. More granular analysis showed significant declines in specific tests such as inhibition/flexibility (32%), naming speed (29%), verbal memory (28%), object naming (28%), and verbal fluency (22%).
Further investigation using logistic regression models shed light on factors contributing to these cognitive changes. The results indicated that both older age and the receipt of chemoradiotherapy were significant predictors of declines in specific cognitive domains and individual tests. This suggests that certain patient demographics and treatment modalities may increase vulnerability to cognitive impairment following glioma treatment.
While the study clearly demonstrates that significant cognitive changes occur within the first year after guideline-based treatment for IDH mutated gliomas, the long-term implications remain to be fully understood. As lead author Rydén notes in the paper, "Older age and chemoradiotherapy increased the risk of cognitive declines one year after surgery, but to which extent the deficits are persistent or progressing remains unknown." This highlights a critical area for future research to inform patient counseling and support strategies.