Factors Associated with Cognitive Impairment in Brain Tumor Patients: A Cross-Sectional Study

Brain tumors are the leading cause of death among all systemic tumors both primary and metastatic types. Cognitive impairment is an early symptom in approximately 58% of brain tumor patients, particularly affecting executive functions. Brain tumors can lead to physical disability, reduced hope and quality of life, and increased financial burden. However, cognitive impairment is often not recognized in its early stages and subsequently becomes a psychological burden for both patients and their families due to the resulting decline in quality of life. Early recognition of cognitive decline provides more time and opportunity to prevent further deterioration.

This cross-sectional study was conducted from September 2024 to February 2025 at the outpatient neurology clinic of Dr. Saiful Anwar General Hospital, East Java, Indonesia. Adult patients with primary or metastatic brain tumors on contrast-enhanced MRI were enrolled. Cognitive function was assessed using MoCA-INA, and associated factors were analyzed using simple and multiple binary logistic regression.

Of 92 patients analyzed, 56 (60.8%) had cognitive impairment. In bivariate analysis, tumor type, lesion count, and several tumor locations were significantly associated with cognitive impairment. In multivariable analysis, only tumor type and lesion count remained independent predictors. Primary tumors were associated with lower odds of cognitive impairment than metastatic tumors (aOR 0.265; 95% CI 0.095-0.742; p = 0.011), while fewer lesions were associated with lower odds compared with multiple lesions (aOR 0.442; 95% CI 0.226-0.864; p = 0.017).

Cognitive impairment was common in patients with brain tumors. Tumor type and lesion count were independently associated with cognitive dysfunction, with metastatic tumors and multiple lesions showing higher risk.