9, 11 The nonstatic waxing and waning disease trajectory experienced by brain tumor patients is not unique to cancer, and is also experienced by patients with movement disorders such as Parkinson's disease and stroke. 16-18 However, other data indicate that many patients remain impaired, or decline further, as a consequence of subsequent treatment with radiation and chemotherapy, and/or tumor progression. Some reports suggest that cognition improves 3 to 6 mo following tumor resection. Prevalence of cognitive impairments may vary across the disease trajectory. 10-12 At presentation, 31% to 81% of patients report cognitive impairments, which is more than any other cancer type, 11, 13-15 with high-grade glioma demonstrating greater rates of cognitive impairment (69%) 11 when compared to low-grade glioma. The reported prevalence of cognitive impairments in glioma varies widely 10 and ranges from 19% to 83%. 3, 5 Despite these diagnostic and treatment advances, patients often experience significant decrements in cognitive and emotional functioning that impact their health-related quality of life (HRQOL) and survival. 3-5 Median survival across all molecular subtypes ranges from 1.5 to 15 yr. 1, 2 Survival outcomes for diffuse glioma patients are improving due to advances in neurosurgical techniques (particularly as it relates to awake mapping for eloquent tumors), molecular characterization, advanced radiotherapy, and chemotherapy. In this review, we summarize the history and usefulness of postacute cognitive rehabilitation for adult brain tumor patients.ĪBBREVIATIONS FLAIR fluid-attenuated inversion recovery HGG high-grade glioma HRQOL health-related quality of life KPS Karnofsky Performance Score LGG low-grade glioma Mets metastases MNG meningioma MRI magnetic resonance imaging PA postacute outpatient VR virtual realityĪpproximately 100 000 people are diagnosed with a primary brain tumor each year, with gliomas comprising 72% of malignant brain tumors and 21% of all central nervous system tumors in adults. There is promising research to support the use of cognitive rehabilitation in adult brain tumor patients. Multidisciplinary cognitive rehabilitation is the standard of care for addressing cognitive impairments in many neurological diseases. However, cognitive symptoms impacting health-related quality of life, particularly processing speed, attention, concentration, working memory, and executive function, often persist after the postoperative recovery period and treatment. Advances in our understanding of tumor-network integration, human cognition and language processing, and multiparametric imaging, combined with refined intraoperative tumor resection techniques, have enhanced surgical management of intrinsic brain tumors within eloquent areas. Intrinsic brain tumors often occur within functional neural networks, leading to neurological impairment and disability of varying degrees.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |