Intérêt de Paced Auditory Serial Addition Test dans l'évaluation des troubles cognitifs des patients atteints de sclérose en plaques

BORDEAUX2-BU Santé (330632101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

La batterie du Groupe de Réflexion sur les Evaluations Cognitives en ONCOlogie ( GREC-ONCO)

International audienc

Tumeurs cérébrales : neurotoxicité des traitements et évaluations cognitives

National audienceL’amélioration des traitements neuro-oncologiques ces dernières années permettant une survie plus longue des patients atteints de tumeurs cérébrales fait émerger la problématique des effets secondaires à long terme. Parmi ces effets secondaires, les troubles cognitifs sont au premier plan et impactent lourdement la qualité de vie des patients. Leur prise en compte constitue actuellement un challenge majeur en neuro-oncologie et nécessite un effort en recherche clinique ainsi que dans le suivi à moyen et à long terme des patients en pratique courante. Les troubles cognitifs peuvent être causés par la progression tumorale et/ou par la récidive tumorale, mais sont souvent provoqués par la neurotoxicité inhérente aux traitements. L’objectif de cet article est de présenter les troubles cognitifs induits par les traitements anti-tumoraux ainsi que par les traitements concomitants les plus courants en neuro-oncologie. Nous exposons ensuite les principaux biais auxquels se heurte l’évaluation neuropsychologique dans ce contexte et présentons la batterie cognitive proposée par le Grec-Onco, actuellement utilisée dans différents protocoles de recherche clinique

Prognostic value of health‐related quality of life for death risk stratification in patients with unresectable glioblastoma

International audienceGlioblastoma is the most common malignant brain tumor in adults. Baseline health‐related quality of life (HRQoL) is a major subject of concern for these patients. We aimed to assess the independent prognostic value of HRQoL in unresectable glioblastoma (UGB) patients for death risk stratification. One hundred and thirty‐four patients with UGB were enrolled from the TEMAVIR trial. HRQoL was evaluated at baseline using the EORTC QLQ‐C30 and BN20 brain cancer module. Clinical and HRQoL parameters were evaluated in univariable and multivariable Cox analysis as prognostic factors for overall survival (OS). Performance assessment and internal validation of the final model were evaluated with Harrel's C‐index, calibration plot, and bootstrap sample procedure. Two OS independent predictors were identified: future uncertainty and sensitivity deficit. The final model exhibited good calibration and acceptable discrimination (C statistic = 0.63). The internal validity of the model was verified with robust uncertainties around the hazard ratio. The prognostic score identified three groups of patients with distinctly different risk profiles with median OS estimated at 16.2, 9.2, and 4.5 months. We demonstrated the additional prognostic value of HRQoL in UGB for death risk stratification and provided a score that may help to guide clinical management and stratification in future clinical trials

CADASIL: pathogenesis, clinical and radiological findings and treatment CADASIL: patogênese, achados clínicos e radiológicos e tratamento

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is the most common genetic cause of ischemic strokes and a most important model for the study of subcortical vascular dementia. This unrelentlessly progressive disease affects many hundreds of families all over the world but is not well studied in Brazil. This manuscript reviews pathogenetic, clinical, radiological and therapeutic features of CADASIL. The causal mutations are now very well known, but the same can not be said about its intimate pathogenetic mechanisms. The variable clinical presentation should lead physicians to actively pursue the diagnosis in many settings and to more thouroughly investigate family history in first degree relatives. A rational approach to genetic testing is however needed. Treatment of CADASIL is still largely empiric. High-quality therapeutic studies involving medications and cognitive interventions are strongly needed in CADASIL.<br>CADASIL é a causa genética mais freqüente de infartos cerebrais e constitui modelo importante de estudo de demências vasculares subcorticais. De natureza inexoravelmente progressiva, afeta milhares de pessoas em todo o mundo. Sua importância é pouco reconhecida entre nós, o que nos levou à presente revisão dos principais aspectos patogenéticos, clínicos, neuroradiológicos e terapêuticos da doença. As mutações causais são hoje bem conhecidas, mas os mecanismos patogenéticos íntimos ainda permanecem misteriosos. A apresentação clínica variável deve fazer com que os médicos considerem o diagnóstico em vários contextos clínicos e investiguem de forma mais extensa que o usual a história familial deparentes de primeiro grau. Além disso, uma abordagem racional é necessária para reduzir custos e aumentar a eficiência do diagnóstico genético. O tratamento atual de pacientes com CADASIL é basicamente empírico. Estudos clínicos sobre medicamentos e intervenções cognitivas de alto nível metodológico constituem uma necessidade urgente