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Extensive domain-specific neuropsychological testing is more sensitive to these changes in cerebral network organization than MMSE and we, therefore, hypothesized that domain-specific scores from the extensive neuropsychological assessment are more strongly associated with survival than MMSE. We studied five predefined cognitive domains, with special focus on the domains executive functioning and memory based on the high prevalence of impairments in these domains in glioma patients, we hypothesize that deficits in executive functioning and memory are most strongly related to survival in patients with diffuse glioma. In this work, we performed a retrospective cohort study with the aim to confirm the independent relationship between cognitive functioning in treatment-naive patients with diffuse gliomas (of all different grades) and survival, and to discuss the potential mechanisms that underly this relationship. To our knowledge, research in this field has been focused mainly on HGG and no data have been published about cognition as a predictor of survival for diffuse gliomas based on the World Health Organization (WHO) 2016-classification of (Central Nervous System) CNS tumors. More specific scores for cognitive functioning can possibly predict survival in diffuse glioma patients more precisely and may reveal a causal relation of cognition, or its subcomponents, with survival. MMSE is a screening tool that provides a measure of global cognitive dysfunction and is developed to screen for Alzheimer’s disease Although it has a proven prognostic value, it is neither a sensitive score nor can it be used to identify problems in given cognitive domains. Of note, in most research, the MMSE score was used as the objective cognitive measure. Whether this relationship between cognitive functioning and survival is truly independent, after correction for all known possible confounders, is unknown. However, as the focus of this previous research was prognostic rather than etiologic, important covariates that influence both cognitive functioning and survival may have biased this relationship. Several studies already revealed that these deficits are significantly associated with survival in diffuse gliomas. Additionally, identification of certain molecular or cognitive prognostic markers can lead to new insights in the pathophysiological mechanisms of diffuse glioma.Ĭognitive deficits occur in all different grades of glioma.
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These prognostic factors are important to personalize treatment and rehabilitation. For high-grade glioma: MGMT promoter methylation status, extent of resection and MMSE (minimal mental state examination) score. Additionally, several prognostic factors for specific grades of tumors were reported: for low-grade glioma, presence of neurologic deficits before surgery (regardless of epilepsy), pre-operative tumor-volume, and midline crossing.
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Until now, research yielded several important predictors of survival, including age, Karnofsky performance status, and tumor grade (and histomolecular classification) for both high and low-grade glioma. Diffuse gliomas (WHO grade II–IV) are progressive primary brain tumors with a variable, but generally poor prognosis, despite recent progress in treatment options.
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