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Ebook Textbook of clinical neuropsychology (2/E): Part 2

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Ebook Textbook of clinical neuropsychology (2/E): Part 2

23 Cognitive Functions in Adults With Central Nervous System and Non-Central Nervous System Cancers ♦Denise D. Correa and James c. RootIntroductionCog

Ebook Textbook of clinical neuropsychology (2/E): Part 2gnitive dysfunction is common in many cancer patients and can be related to the disease and to treatment with chemotherapy and/or radiotherapy (RT). T

he neuropsychological domains affected and the severity of the deficits may vary as a result of disease and treatment type, but difficulties in execut Ebook Textbook of clinical neuropsychology (2/E): Part 2

ive functions, motor speed, and learning, and retrieval of information are the most prevalent. In a significant number of cancer patients, changes in

Ebook Textbook of clinical neuropsychology (2/E): Part 2

cognitive functions interfere with their ability to resume work and social activities at prediagnosis levels.There has been an increase in the number

23 Cognitive Functions in Adults With Central Nervous System and Non-Central Nervous System Cancers ♦Denise D. Correa and James c. RootIntroductionCog

Ebook Textbook of clinical neuropsychology (2/E): Part 2ous system (CNS: see Correa. 2006; Taphoorn & Klein. 2004). New developments have been described in the study of the cognitive side effects of chemoth

erapy for non-CNS cancers (Correa & Ahles, 2008). These lines of research have provided valuable information about the incidence of cognitive dysfunct Ebook Textbook of clinical neuropsychology (2/E): Part 2

ion in patients with various cancers, and the contribution of treatments involving different regimens and modalities. Studies have also begun to inves

Ebook Textbook of clinical neuropsychology (2/E): Part 2

tigate the underlying mechanisms that may contribute to the neurotoxicity of RT and chemotherapy ( Dietrich. Han. Yang. Mayer-Proschel. & Noble. 2006:

23 Cognitive Functions in Adults With Central Nervous System and Non-Central Nervous System Cancers ♦Denise D. Correa and James c. RootIntroductionCog

Ebook Textbook of clinical neuropsychology (2/E): Part 2 (Gehring. Sitskoom. Aaronson. & Taphoorn. 2008).The current chapter reviews studies involving patients with brain tumors and breast cancer, consideri

ng that most of the research has been conducted in these patient groups. Of note, other emerging areas of study include cognitive dysfunction associat Ebook Textbook of clinical neuropsychology (2/E): Part 2

ed with androgen ablation for prostate cancer (Jamadar. Winters. & Maki. 2012; Nelson. Lee. Gamboa. & Roth. 2008). chemotherapy for ovarian cancer (Co

Ebook Textbook of clinical neuropsychology (2/E): Part 2

rrea & Hess. 2012: Correa et al.. 2012; Correa. Zhou. Thaler. Maziarz. Hurley. & Hensley. 2010). and high-dose chemotherapy and stem cell transplantat

23 Cognitive Functions in Adults With Central Nervous System and Non-Central Nervous System Cancers ♦Denise D. Correa and James c. RootIntroductionCog

Ebook Textbook of clinical neuropsychology (2/E): Part 2rain tumors arc classified by their predominant histologic appearance and location: they account for less than 2% of all cancers. Gliomas are the most

common primary tumors accounting for approximately 40% of all CNS neoplasms (Greenberg. Chandler. & Sandler, 1999). High-grade gliomas (WHO Grade III Ebook Textbook of clinical neuropsychology (2/E): Part 2

-IV) include glioblastoma multiforme, anaplastic astrocytomas, anaplastic oligodendrogliomas. and anaplastic mixed gliomas. Low-grade gliomas (WHO Gra

Ebook Textbook of clinical neuropsychology (2/E): Part 2

de l-l I) include astrocytomas, oligodendrogliomas. and mixed gliomas. Other less frequent brain tumors are primary CNS lymphoma (PCNSL). ependymomas.

23 Cognitive Functions in Adults With Central Nervous System and Non-Central Nervous System Cancers ♦Denise D. Correa and James c. RootIntroductionCog

Ebook Textbook of clinical neuropsychology (2/E): Part 2as. 2004)Figure 23.1 Coronal and axial MR Is showing a brain tumor involving cortical and subcortical regionsAs effective treatment interventions have

increased survival, there has been greater awareness that many brain tumor patients experience cognitive dysfunction, despite adequate disease contro Ebook Textbook of clinical neuropsychology (2/E): Part 2

l (Poortmans el al.. 2003). This dysfunction can be related to both the disease and its treatment including surgery. RT. and chemotherapy. The side ef

Ebook Textbook of clinical neuropsychology (2/E): Part 2

fects of medications such as corticosteroids and antiepileptics often contribute to or exacerbate these cognitive difficulties. The relevance of inclu

23 Cognitive Functions in Adults With Central Nervous System and Non-Central Nervous System Cancers ♦Denise D. Correa and James c. RootIntroductionCog

Ebook Textbook of clinical neuropsychology (2/E): Part 2. 2013; Meyers & Brown. 2006)and the National Cancer Institute (NCI) Brain Tumor Progress Review Group report has recommended that routine cognitive a

nd QoL assessment become the standard care for patients with brain tumors (BTPRG. 2000). Meyers and Brown (2006) published guidelines for the neuropsy Ebook Textbook of clinical neuropsychology (2/E): Part 2

chological assessment of patients with brain tumors within the context of clinical trials. The suggested core neuropsychological test batteries includ

Ebook Textbook of clinical neuropsychology (2/E): Part 2

e standardized instruments with demonstrated sensitivity to the neurotoxic effects of cancer treatment and include tests of attention, executive funct

23 Cognitive Functions in Adults With Central Nervous System and Non-Central Nervous System Cancers ♦Denise D. Correa and James c. RootIntroductionCog

Ebook Textbook of clinical neuropsychology (2/E): Part 2rating a relatively brief cognitive test battery in multi-institutional clinical trials within the context of the Radiation Therapy Oncology Group (RT

OG) has also been demonstrated (Meyers Ct al.. 2004; Rcginc et al.. 2004).Recent longitudinal studies documented that along with age. histology, and p Ebook Textbook of clinical neuropsychology (2/E): Part 2

erformance status, cognitive functioning is a sensitive and important factor in clinical trials involving patients with high-grade tumors (Reardon Ct

Ebook Textbook of clinical neuropsychology (2/E): Part 2

al.. 2011; Wefel et al.. 2011). Performance on a test of verbal memory was independently and strongly related to survival after accounting for age. pe

23 Cognitive Functions in Adults With Central Nervous System and Non-Central Nervous System Cancers ♦Denise D. Correa and James c. RootIntroductionCog

Ebook Textbook of clinical neuropsychology (2/E): Part 2oma (Meyers. Hess. Yung. & Levin. 2000). Neuropsychological test performance predicted survival in patients with metastases and leptomeningeal disease

(Meyers Ct al.. 2004). and glioblastomas (Johnson. Sawyer. Meyers. O'Neill. & Wefel. 2012; Klein et al.. 2003). Cognitive decline preceded radiograph Ebook Textbook of clinical neuropsychology (2/E): Part 2

ic evidence of tumor progression by several weeks in glioma patients (Armstrong. Goldstein. Shera. Ledakis. & Tallent. 2003; Brown et al.. 2006; Meyer

Ebook Textbook of clinical neuropsychology (2/E): Part 2

s & Hess. 2003). However, these results are interpreted with caution considering that some studies had missing data, lacked a control group, and did n

23 Cognitive Functions in Adults With Central Nervous System and Non-Central Nervous System Cancers ♦Denise D. Correa and James c. RootIntroductionCog

Ebook Textbook of clinical neuropsychology (2/E): Part 2ure, focal neurological signs, and cognitive impairment arc common presenting symptoms in patients with brain tumors. Several studies documented cogni

tive impairment at diagnosis and prior to RT or chemotherapy in patients with high-gradeCognitive Fundigliomas (Klein Ct al.. 2001). low-grade gliomas Ebook Textbook of clinical neuropsychology (2/E): Part 2

I Klein Ct al.. 2002). and PCNSLs (Correa. DeAngelis. & Shi. 2007). Cognitive difficulties present al the time of diagnosis are often related to the

Ebook Textbook of clinical neuropsychology (2/E): Part 2

location of the tumor (Klein et al.. 2001). but a diffuse pattern of deficits has also been reported (Crosson. Goldman. Dahlborg. & Ncuwelt. 1992). Ra

23 Cognitive Functions in Adults With Central Nervous System and Non-Central Nervous System Cancers ♦Denise D. Correa and James c. RootIntroductionCog

Ebook Textbook of clinical neuropsychology (2/E): Part 2itive dysfunction than rapidly growing tumors (e.g.. high-grade gliomas) (Anderson. Damasio. & Tranel. 1990; Hom & Reitan. 1984). Tumor type or volume

has not been found to predict cognitive performance (Kayl & Meyers. 2003).Surgical resection can be associated with transient neurological and cognit Ebook Textbook of clinical neuropsychology (2/E): Part 2

ive deficits due to damage to tumorsurrounding tissue and edema (Bosma Ct al.. 2007; Duffau. 2005). with impairments often consistent with tumor locat

Ebook Textbook of clinical neuropsychology (2/E): Part 2

ion (Klein. 2012). Intraoperative stimulation mapping has been used in patients undergoing surgical resection for gliomas. and a recent mcta-analysis

23 Cognitive Functions in Adults With Central Nervous System and Non-Central Nervous System Cancers ♦Denise D. Correa and James c. RootIntroductionCog

Ebook Textbook of clinical neuropsychology (2/E): Part 2more extensive resections. However, the incidence and extent of cognitive dysfunction related to tumor surgical resection is unknown, given the relati

vely limited number of studies including pre- and postsurgical neuropsychological evaluations In addition, the specific contribution of the tumor to c Ebook Textbook of clinical neuropsychology (2/E): Part 2

ognitive performance is difficult to ascertain considering that the majority of patients receive corticosteroids and antiepileptic medications followi

Ebook Textbook of clinical neuropsychology (2/E): Part 2

ng diagnosis and perioperatively. Steroids may improve cognitive deficits due to resolution of edema (Klein et al.. 2001). but can also be associated

23 Cognitive Functions in Adults With Central Nervous System and Non-Central Nervous System Cancers ♦Denise D. Correa and James c. RootIntroductionCog

Ebook Textbook of clinical neuropsychology (2/E): Part 2aspects of cognitive functions in brain tumor patients, particularly graphomotor speed and executive abilities (van Breemen. Wilms. & Vceht. 2007).Who

le-Brain and Conformal RadiotherapyMECHANISMS OF CNS INJURYThe pathophysiological mechanisms of radiation injury involve interactions between multiple Ebook Textbook of clinical neuropsychology (2/E): Part 2

cell types within the brain including astrocytes, endothelial cells, microglia, neurons. and oligodendrocytes (Greene-Schloesser. Moore. & Robbins. 2

Ebook Textbook of clinical neuropsychology (2/E): Part 2

013; Greene-Schloesser Ct al.. 2012). Suggested mechanisms include depletion of glial progenitor cells and perpetuation of oxidative stress (Tofilon &

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