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Neurocognitive outcomes following glioma diagnosis and treatment: A systematic review
Maria D Karagianni1, Christina Arvaniti1, Evie-Paraskevi Fountas2,3
1Department of Neurosurgery, University General Hospital of Larissa, Biopolis, Larissa, 41110, Greece.
Introduction:
Gliomas are the most common primary malignant brain tumors in adults and are often accompanied by cognitive disturbances, which profoundly affect daily functioning and quality of life. Although survival and neurological deficits are routinely reported, neurocognitive outcomes remain insufficiently integrated into clinical decision-making.
Research Question:
This review seeks to describe the patterns and progression of neurocognitive dysfunction in adult glioma patients and to clarify how tumor characteristics, patient-related factors, and treatment strategies influence cognitive outcomes. Additionally, we explore whether cognitive function may serve as a predictor of clinical outcome.
Material And Methods:
A systematic literature review was performed following PRISMA guidelines. PubMed, Scopus, and Web of Science were searched from inception to August 2025. Studies involving adult glioma patients assessed with standardized neurocognitive instruments and reporting cognitive outcomes in relation to tumor features or treatment modalities were included. Study quality was evaluated using established risk-of-bias tools.
Results:
Twenty-five studies met our inclusion criteria. Cognitive impairment was frequently present at diagnosis, particularly in patients with tumors affecting eloquent brain regions. Surgical treatment was commonly associated with short-term cognitive decline, followed by stabilization or improvement in many patients over time. The effects of chemotherapy and radiotherapy on cognition were inconsistent. Tumor location, laterality, and histopathological grade emerged as key factors influencing cognitive trajectories. Preserved cognitive function was also associated with better quality of life and overall survival.
Discussion And Conclusion:
Neurocognitive dysfunction in glioma patients is common, heterogeneous, and shaped by multiple interacting factors. Routine, standardized cognitive assessment and longitudinal follow-up are essential to better capture these changes and to incorporate cognitive outcomes into individualized glioma care.