Cognitive Impairment in Patients with Glioma: Mechanisms, Assessment, and Emerging Therapeutic Strategies

Aim: This review summarizes the current evidence on cognitive impairment in patients with glioma, with particular emphasis on the underlying mechanisms, methods for objective assessment of cognitive deficits, and currently available therapeutic strategies. Methods: Relevant literature was identified through searches of the PubMed, Cochrane Library, and Google Scholar databases. Studies addressing the mechanisms, assessment, and management of cognitive impairment in patients with glioma published between January 2000 and February 2026 were reviewed to summarize current evidence and emerging therapeutic strategies. A structured literature search and study selection process was performed. Results: Cognitive deficits represent a heterogeneous clinical problem affecting the majority of patients diagnosed with gliomas. These impairments are multifactorial in origin, resulting both from direct infiltration of white matter by the tumor process and from the cumulative toxicity of treatment modalities, including radiotherapy, chemotherapy, corticosteroid therapy, and long-term use of antiseizure medications. Analysis of the current literature confirms that modern radiotherapy techniques (e.g., hippocampal-sparing approaches) and isocitrate dehydrogenase (IDH)-targeted therapies, such as vorasidenib, may significantly delay cognitive decline. Standardized neuropsychological batteries for the objective assessment of these disturbances remain the preferred tools recommended by the International Cognition and Cancer Task Force (ICCTF). Regarding therapeutic interventions, potential benefits have been demonstrated for supportive pharmacotherapy (including memantine), while individualized neuropsychological rehabilitation has also been shown to improve patients' quality of life.