Group changes in cognitive performance after surgery mask changes in individual patients with glioblastoma

Object:  There is a growing interest to include evaluations of cognitive performance in the clinical management of patients with Glioblastoma (GBM). However, as changes in cognitive performance of a group may mask changes in individual patients, study results are often difficult to transfer into clinical practice. We focused on the comparison of group versus individual changes in neuropsychological performance of GBM patients after initial surgical treatment. Methods:  Patients underwent neuropsychological evaluation using CNS Vital Signs one day prior to, and three months after surgery. Two-tailed paired samples t-tests were conducted to assess changes on the group level. Reliable Change Indices (RCIs), that correct for practice effects and imperfect test-retest reliabilities, were used to examine change in individual patients. Results:  Cognitive dysfunction was common (>80%) both before and three months after surgery in this sample of 82 GBM patients. Whereas group analyses revealed minimal changes in performance over time, RCIs demonstrated that most patients (89%) showed changes in performance in at least one cognitive domain. Half of these individual patients solely showed improvements, a quarter solely showed declines, and another quarter showed both improvements and declines. Conclusions:  This study clearly demonstrates that important individual changes in performance are masked when looking only at group results. Future studies should more often use an individual patient approach to enhance knowledge transfer into clinical practice

Computerized neuropsychological screening in clinical care for patients with low-grade gliomas:Incidence and severity of cognitive deficits

Objective: Many patients with primary brain tumors suffer from cognitive deficits. Treatment options for these deficits are scarce, time-consuming and costly. Recent studies showed promising results on the efficacy of cognitive rehabilitation in these patients. Also, the cognitive rehabilitation program (CRP) developed by our group proved effective in an RCT. To increase its accessibility, it was converted into the app-based CRP ReMind. We performed a pilot study to evaluate feasibility and patient experience of this new method of training. Participants and Methods: Prior to surgery, 15 patients with a presumed meningioma or low-grade glioma were included in this study. The CRP ReMind incorporated both retraining of attention and practicing of compensational strategies of attention, memory and executive functioning. Patients started 3 months after neurosurgery and spent several hours per week on the program for 10 weeks. Neuropsychological assessments were conducted one day before surgery, 3 months after surgery (i.e. before starting the program) and 6 months after surgery (i.e. immediately after finishing the program). At all time-points, questionnaires on psychosocial and subjective cognitive functioning were administered to patients and caregivers. Results: Feasibility (i.e. percentages of interested, adhered and dropped-out patients) and patient experience will be presented. Also, results of paired t-tests will be presented for a first impression of possible changes in cognitive functioning and patient-reported outcomes (PROs). Conclusions: This is the first study that provides evidence-based cognitive rehabilitation via a tablet-app in brain tumor patients. An RCT on the effects of ReMind on cognitive functioning and PROs is forth-coming

Test-retest reliability and practice effects of a computerized neuropsychological battery: A solution-oriented approach

This study examined test-retest reliabilities and (predictors of) practice effects of the widely used computerized neuropsychological battery CNS Vital Signs. The sample consisted of 158 Dutch healthy adults. At 3 and 12 months follow-up, 131 and 77 participants were retested. Results revealed low to high test-retest reliability coefficients for CNS VS' test and domain scores. Participants scored significantly higher on the domains of Cognitive Flexibility, Processing Speed, and Reaction Time at the 3-month retest. No significant differences in performance were found over the second interval. Age, education, and retest-interval were not significantly associated with practice effects. These results highlight the need for methods that evaluate performance over time while accounting for imperfect test-retest reliabilities and practice effects. We provided RCI-formulae for determining reliable change, which may be possible solution for future work facing the methodological issues of retesting. Public Significance Statement Imperfect test-retest reliability and practice effects must be taken into account when interpreting change in neuropsychological test scores over time, for example by applying RCI-formulae for the determination of reliable change

Test-retest reliability and practice effects of the computerized neuropsychological test battery CNS Vital Signs: Evaluation in a Dutch healthy sample

Introduction: CNS Vital Signs (CNS VS) is a computerized neuropsychological test battery that is translated into many languages. Test-retest reliability and potential practice effects of CNS VS were evaluated. Method: Dutch healthy participants were tested with CNS VS (T0), and retested after 3 (T1) and 12 months (T2). CNS VS consists of 7 tests (i.e., Verbal Memory, Visual Memory, Finger Tapping, Symbol Digit Coding, Stroop, Shifting Attention and Continuous Performance), which cover multiple cognitive domains. Test- retest reliability was determined using Pearson’s/Spearman’s correlations. To evaluate potential practice effects, paired- sample t-tests were conducted (T0 versus T1, and T1 versus T2). Results: 159 (57% female) subjects, aged 20 to 80 years, were included. At T1 and T2, 132 and 63 subjects were retested, respectively. Low to high test-retest correlations were found for CNS VS’ tests and domains (r/ρ ranging from .17 to .89). At T1, participants performed significantly better on CNS VS’ Stroop Test, Shifting Attention Test and Symbol Digit Coding Test, resulting in significantly higher scores on the domains of Cognitive Flexibility, Processing Speed and Reaction Time, but Cohen’s d effect sizes were small. No significant differences in performance were found between T1 and T2. Discussion: The observed test-retest reliabilities varied considerably. Practice effects were present between the first and second assessment, but not thereafter. Practice effects must be considered when interpreting performance on CNS VS at follow-up assessment. Our findings are in line with previous studies that evaluated CNS VS and correspond to existing literature on conventional (paper and pencil) tests

Lesion symptom mapping at the regional level in patients with a meningioma

Objective:  The majority of meningioma patients suffer from presurgical cognitive deficits. Since meningiomas do not directly damage the brain, this is presumably caused by a functional integrity reduction of the surrounding brain tissue through perilesional edema and/or mass effect of the tumor. Tumor location is a key feature in determining neurological symptoms in brain tumor patients, but the relationship between meningioma location and cognitive performance remains unclear. This study aimed to identify brain areas where the presence of a meningioma forms a potential risk factor for worse cognitive performance as compared to meningiomas at other locations.  Method:  Neuropsychological data (CNS Vital Signs) and MRI were collected in 224 meningioma patients one day before surgery. Sociodemographically corrected scores were calculated for 7 cognitive domains. Tumors were semiautomatically segmented and mapped into MNI-space for use in Statistical Region of Interest analyses. For each cognitive domain, we tested whether larger proportions of tumor overlap with each of the 150 defined regions were associated with worse performance.  Results:  After multiple comparison (Bonferroni) and lesion volume correction, larger proportions of tumor overlap with both the left middle and superior frontal gyms were associated with worse complex attention scores. Larger proportions of tumor overlap with the left middle frontal gyms were associated with worse cognitive flexibility scores. For the other domains, no association between tumor overlap with a region and cognitive performance was found.  Conclusions:  The current results suggest that, compared to patients with a meningioma at other locations, patients with a meningioma at the left middle frontal gyrus are at potential risk for worse performance on cognitive flexibility and complex attention whereas patients with a meningioma at the left superior frontal gyms are at potential risk for worse performance on complex attention

Evaluation of normative data of a widely used computerized neuropsychological battery:Applicability and effects of sociodemographic variables in a Dutch sample

Introduction: Central Nervous System Vital Signs (CNS VS) is a computerized neuropsychological battery that is translated into many languages. However, published CNS VS’ normative data were established over a decade ago, are solely age-corrected, and collected in an American population only. Method: Mean performance of healthy Dutch participants on CNS VS was compared with the original CNS VS norms (N = 1,069), and effects of sociodemographic variables were examined. Results: z tests demonstrated no significant differences in performance on four out of seven cognitive domains; however, Dutch participants (N = 158) showed higher scores on processing and psychomotor speed, as well as on cognitive flexibility. Although the original CNS VS norms are solely age-corrected, effects of education and sex on CNS VS performance were also identified in the Dutch sample. Discussion: Users should be cautious when interpreting CNS VS performance based on the original American norms, and sociodemographic factors must also be considered