Cognitive functioning in meningioma patients:A systematic review

This systematic review evaluates relevant findings and methodologic aspects of studies on cognitive functioning in meningioma patients prior to and/or following surgery with or without adjuvant radiotherapy. PubMed and Web of Science electronic databases were searched until December 2015. From 1012 initially identified articles, 11 met the inclusion criteria for this review. Multiple methodological limitations were identified which include the lack of pre-treatment assessments, variations in the number and types of neuropsychological tests used, the normative data used to identify patients with cognitive deficits, and the variety of definitions for cognitive impairment. Study results suggest that most of meningioma patients are faced with cognitive deficits in several cognitive domains prior to surgery. Following surgery, most of these patients seem to improve in cognitive functioning. However, they still have impairments in a wide range of cognitive functions compared to healthy controls. Suggestions are given for future research. Adequate diagnosis and treatment of cognitive deficits may ultimately lead to improved outcome and quality of life in meningioma patients

Cognitive outcomes in meningioma patients undergoing surgery: individual changes over time and predictors of late cognitive functioning

Background Meningioma patients are known to face cognitive deficits before and after surgery. We examined individual changes in cognitive performance over time and identified preoperative predictors of cognitive functioning 12 months after surgery in a large sample of meningioma patients. Methods Patients underwent neuropsychological assessment (NPA) using CNS Vital Signs 1 day before (T0), and 3 (T3) and 12 (T12) months after surgery. Patients’ sociodemographically-corrected scores on 7 cognitive domains were compared to performance of a normative sample using one-sample z tests and Chi-square tests of independence. Reliable change indices with correction for practice effects were calculated for individual patients. Linear mixed effects models were used to identify preoperative predictors of performance at T12. Results At T0, 261 patients were assessed, and 229 and 82 patients were retested at T3 and T12, respectively. Patients showed impaired cognitive performance before and after surgery, and although performance improved on the group-level, cognitive scores remained significantly lower than in the normative sample up to T12. On the individual level, performance remained stable in the majority of patients. Better preoperative performance, younger age, male sex, and higher educational level predicted better late cognitive performance. Conclusions Meningioma patients face serious and persistent pre- and postsurgical cognitive deficits. A preoperative NPA together with sociodemographic characteristics may provide valuable information on the late cognitive outcome of individual meningioma patients. These results can help to inform patients and clinicians on late cognitive outcomes at an early stage, and emphasizes the importance of presurgical NPA and timely cognitive rehabilitation

Major Depression Was not Found to be Associated with a Higher Rate of Myocardial Infarction Using a Large Inpatient Database

A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine.Importance: In 2014, the American Heart Association issued a statement proposing that depression be recognized as a risk factor for increased mortality from myocardial infarction (MI), but noted further research is needed. However, most studies that concluded this association evaluated depression after the occurrence of heart disease. Objective: To evaluate any association between depression and myocardial infarction using a large inpatient database. Design: Retrospective study using the Nationwide Inpatient Sample (NIS) database in the U.S. from 2005 to 2020. Patients discharged from hospitals using the NIS and ICD-9 and ICD-10 codes consistent with depression and acute MI. IBM SPSS Statistics 25.0 was applied to data. Demographics, clinical details, and hospital features were presented with 95% confidence intervals. Chi-squared and univariate linear regression for trend analysis. Multivariable logistic regression determined odds for binary clinical outcomes considering patient and hospital characteristics, and temporal evolution. Analyses incorporated population discharge weights, with statistical significance set at p ≤ 0.05 Setting: Hospitals that use the NIS database ICD codes. Database is publicly available and is the largest all-payer inpatient care database in the US from the Healthcare Cost and Utilization Project (HCUP). Its data are used to analyze national trends in healthcare utilization, healthcare quality, and patient outcomes. www.hcup-us.ahrq.gov. Participants: Inclusion criteria: adults aged 30 and above (exclusion < 30), discharged from hospitals using the NIS. Included 4,413,113 STEMI (mean age of 67) patients, 224,430 with depression, and 10,421,346 NSTEMI patients (mean age 69), including 437,058 NSTEMI with depression. Exposure: Is depression associated with a higher rate of myocardial infarction (STEMI & Non-STEMI) in adults 30 and over? We hypothesize that there will be a positive correlation between depression and myocardial infarction. Main Outcome and Measure: Primary outcomes: Myocardial Infarction (STEMI and non-STEMI) Results: We did not find any significant association between depression and myocardial infarction. Interestingly MI including STEMI and NSTEMI occurred to a lesser degree in patients with a diagnosis of depression. Our data showed this as a consistent trend over 15 15-year period. For instance, in 2005, within the depression STEMI group, the odds ratio (OR) was 0.12, with a 95% confidence interval (CI) of 0.10-0.15, and a p < 0.001. In 2020, the depression STEMI OR was 0.71, with a 95% CI of 0.69-0.73, and a p < 0.001. A similar pattern was observed within the NSTEMI group. The 2005 NSTEMI depression OR was 0.14, with a 95% CI of 0.13-0.16, p-value < 0.001. In 2020, the NSTEMI depression OR was 0.69, with a 95% CI of 0.68-0.71, p-value < 0.001. Conclusions and Relevance: Our study did not identify an increased association between myocardial infarction and major depression. The results suggest that depression may not independently be a significant risk factor for myocardial infarction. Prospective cohort or intervention studies are necessary to elucidate the cause-and-effect relationships between depression, anxiety, and cardiac events. Future studies should delve into the specifics of depression treatment, including dosages and types of medications, to provide a clearer picture of how these factors influence MI prevalence. The implications are far-reaching, and our findings should serve as a catalyst for a deeper understanding of the complex connections between mental health and heart health.This item is part of the College of Medicine - Phoenix Scholarly Projects collection. For more information, contact the Phoenix Biomedical Campus Library at [email protected]

Cognitive improvement in meningioma patients after surgery:Clinical relevance of computerized testing

Cognitive dysfunction is common in patients with primary brain tumors, and may have a major impact on activities of daily living and on quality of life. This is the first prospective study that investigated the incidence and severity of cognitive dysfunction in meningioma patients before and after surgery, and the change in dysfunction over time, both at group and individual patient level. Sixty-eight meningioma patients were neuropsychologically tested one day before brain surgery. Sixty-two patients were followed up 3 months after surgery. All patients were assessed with a brief (30 min) computerized screening battery of neuropsychological tests (i.e., CNS Vital Signs). Pre- and post-operatively, meningioma patients demonstrated significantly lower scores in all cognitive domains; memory, psychomotor speed, reaction time, complex attention, cognitive flexibility, processing speed, and executive functioning, in comparison with normative data. Pre-operatively, 47 out of 68 patients (69 %) scored low or very low in one or more cognitive domains. Post-operatively, 27 out of 62 patients (44 %) scored within this range. Test performance improved in all cognitive domains post-operatively, with the exception of psychomotor speed and reaction time. In line with previous studies with conventional neuropsychological tests, meningioma patients are faced with cognitive dysfunction in several cognitive domains both pre- and post-operatively. However, a large proportion of patients shows post-operative improvement in cognitive functioning. Longer-term follow-up is recommended to identify potential predictors of cognitive improvement after surgery. Diagnosis and treatment of these cognitive deficits will improve outcomes and quality of life in meningioma patients. Keywords: Cognitive functioning, Meningioma, Quality of life, Brain tumor surger