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Review
. 2020 Nov 4;8(2):117-128.
doi: 10.1093/nop/npaa072. eCollection 2021 Apr.

Cognitive impact of lower-grade gliomas and strategies for rehabilitation

Christina Weyer-Jamora  1   2 , Melissa S Brie  1   2 , Tracy L Luks  3 , Ellen M Smith  1 , Steve E Braunstein  4 , Javier E Villanueva-Meyer  3 , Paige M Bracci  5 , Susan Chang  1 , Shawn L Hervey-Jumper  1 , Jennie W Taylor  1   6
Affiliations
Review

Cognitive impact of lower-grade gliomas and strategies for rehabilitation

Christina Weyer-Jamora et al. Neurooncol Pract. .

Abstract

Outcomes for patients with lower-grade gliomas (LrGGs) continue to improve with advances in molecular characterization and treatment. However, cognitive sequela from the tumor and its treatment leave a significant impact on health-related quality of life for these patients. Several factors affect each patient's cognition, such as tumor location, treatment, medication, and comorbidities. However, impairments of processing speed, attention, concentration, working memory, and executive function are common across LrGG patients. Cognitive rehabilitation strategies, well established in traumatic brain injury and stroke populations, are based on neural plasticity and functional reorganization. Adapting these strategies for implementation in patients with brain tumors is an active area of research. This article provides an overview of cognitive domains commonly impaired in LrGG patients and evidence for the use of cognitive rehabilitation strategies to address these impairments with the goal of improving health-related quality of life in this patient population.

Keywords: cognitive outcomes; cognitive rehabilitation; low-grade glioma; neurocognitive outcomes; primary brain tumor.

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Figures

Figure 1.
Figure 1.
Factors that influence cognitive impairment in lower-grade glioma (LrGG) patients.
Figure 2.
Figure 2.
The “Triple A” Model of Cognitive Rehab: 1, Acquisition; 2, Application; and 3, Adaptation.
Figure 3.
Figure 3.
Schema of Longitudinal Trajectory of Cognitive Impairment Across Disease Trajectory. The blue line represents environmental demands and expectations such as work, school, and family responsibilities. The green line depicts the patient’s current cognitive skills such as attention/concentration, processing speed, memory, and executive functioning. The gray space between environmental demands and cognitive skills is the cognitive gap. The gap is narrow at “Presumed pretumor baseline” because the patient is well equipped with cognitive skills to manage his or her environmental demands and expectations. During “Tumor development,” the gap widens as skills decline and demands increase. The gap widens further with “Tumor treatment” given that the impact of surgery, radiotherapy, and chemotherapy on cognitive skills and environmental demand increases with factors such as returning to work after treatment. The dotted green line reflects natural recovery of cognitive skills after surgery. With “Rehab,” the gap is narrowed by improving cognitive skills using the Triple A model. Concurrently, environmental demands and expectations are decreased through environmental interaction strategies such as work accommodation, school accommodation, and managing family and patient performance expectations.
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