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Quantifying Cognitive Decrements Caused by Cranial Radiotherapy
Published on: October 18, 2011
Factors Associated With Perceived Cognitive Dysfunction in Patients With Primary Brain Tumors: The Utility of the
Morgan Johnson1, Kimberly Reinhart1, Vivian A Guedes1
1Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA.
Background:
Primary brain tumor (PBT) patients commonly experience cognitive dysfunction. This study aims to describe the prevalence and factors associated with perceived cognitive function (PCF) in PBT patients enrolled in a natural history study (NCT02851706: Principal Investigator T. S. Armstrong).
Methods:
The Neuro-QoL Cognition Function was used to measure PCF with T-scores < 40 categorized as cognitively impaired. Clinical and demographic characteristics, patient-reported outcomes (PROs: symptom burden, depression, anxiety), and KPS were collected and characterized using descriptive statistics. Univariate tests on PCF with p-value < 0.10 were performed and included in a subsequent multivariate logistic regression with backward selection. Clinical variables and PROs were evaluated separately, then combined for a final multivariate model with p-value < 0.05.
Results:
The cohort included 327 patients (median age: 47 years [range: 18-85], primarily white [78%] males [55%] with high-grade tumors [73%]). Perceived cognitive impairment occurred in 29% of patients. Patients presenting with cognitive dysfunction at diagnosis, or who had undergone multiple surgeries, were more likely to have poor PCF, as were those currently on corticosteroids and reporting cognitive symptoms and symptom interference. Evaluated together, a multivariate model found that only higher scores on symptom interference and the cognitive symptom factor increased the likelihood of cognitive impairment (symptom interference odds ratio [OR] = 1.25, 95% confidence interval [CI] [1.09, 1.44], p < 0.001; cognitive symptom factor OR = 1.81, 95% CI [1.50, 2.19], p < 0.001) with an 84% classification rate.
Conclusions:
Self-reported cognitive symptoms and interference were the strongest patient-reported correlates of PCF and should be interpreted as concurrent associations among related constructs. Further psychometric and longitudinal work is needed to clarify the incremental clinical value of the Neuro-QoL Cognition Function Short Form in PBT care and research.
