A systematic review of cognitive interventions for adult patients with brain tumours

Abstract

Background: Neurocognitive impairments are common in patients with current or previously treated brain tumours, and such impairments can negatively affect patient outcomes including quality of life and survival. This systematic review aimed to identify and describe interventions used to ameliorate (improve) or prevent cognitive impairments in adults with brain tumours.

Methods: We performed a literature search of the Ovid MEDLINE, PsychINFO and PsycTESTS databases from commencement until September 2021.

Results: In total, 9998 articles were identified by the search strategy; an additional 14 articles were identified through other sources. Of these, 35 randomised and nonrandomised studies were deemed to meet the inclusion/exclusion criteria of our review and were subsequently included for evaluation. A range of interventions were associated with positive effects on cognition, including pharmacological agents such as memantine, donepezil, methylphenidate, modafinil, ginkgo biloba and shenqi fuzheng, and nonpharmacological interventions such as general and cognitive rehabilitation, working memory training, Goal Management Training, aerobic exercise, virtual reality training combined with computer-assisted cognitive rehabilitation, hyperbaric oxygen therapy and semantic strategy training. However, most identified studies had a number of methodological limitations and were judged to be at moderate-to-high risk of bias. In addition, it remains unclear whether and to what extent the identified interventions lead to durable cognitive benefits after cessation of the intervention.

Conclusion: The 35 studies identified in this systematic review have indicated potential cognitive benefits for a number of pharmacological and nonpharmacological interventions in patients with brain tumours. Study limitations were identified and further studies should focus on improved study reporting, methods to reduce bias and minimise participant drop-out and withdrawal where possible, and consider standardisation of methods and interventions across studies. Greater collaboration between centres could result in larger studies with standardised methods and outcome measures, and should be a focus of future research in the field.

Keywords: brain tumour; cognitive outcomes; interventions; pharmacological; rehabilitation.

FIGURE 1

Study flow chart.

FIGURE 2

Graphic showing the results of the risk of bias assessment of the randomised studies in our review, ordered by the surname of the first author. The risk of bias for randomised studies was performed using the Cochrane Risk of Bias assessment tool.

FIGURE 3

Graphic showing the results of the risk of bias assessment of the randomised studies in our review, separated by specific Cochrane Risk of Bias domain.

FIGURE 4

Graphic showing the results of the risk of bias assessment of the nonrandomised studies in our review, ordered by the surname of the first author. The risk of bias for nonrandomised studies was performed using the National Heart, Lung and Blood Institute (NHLBI) Quality Assessment Tool for Before‐After (Pre–Post) Studies With No Control Group.

FIGURE 5

Graphic showing the results of the risk of bias assessment of the nonrandomised studies in our review, separated by specific question from the National Heart, Lung and Blood Institute (NHLBI) Quality Assessment Tool for Before–After (Pre–Post) Studies With No Control Group.