Preoperative verbal memory problems and their clinical prognostic value in meningioma patients: A prospective study

Cognition in Meningioma: Effects of Tumor Location and Tumor Removal

BACKGROUND

Meningiomas are the most common type of primary intracranial tumor, yet very few studies have assessed the effects of tumor removal.

METHODS

Here we report analysis of patients with meningiomas who underwent routine neuropsychological assessment and surgery at a National Health Service (NHS) hospital in the North East of England over a 6-year period.

RESULTS

Surgical removal of tumors significantly improved both phonemic and semantic verbal fluency and some measures of working memory and declarative memory. There were no signs of deleterious effects of surgery. Postoperative improvements in cognition did not appear to rely upon changes in anxiety and mood.

CONCLUSIONS

In summary, we conclude that tumor removal in meningioma can be associated with some benefits in cognition.

Cognitive brain activity before and after surgery in meningioma patients

Neuropsychological studies have demonstrated that meningioma patients frequently exhibit cognitive deficits before surgery and show only limited improvement after surgery. Combining neuropsychological with functional imaging measurements can shed more light on the impact of surgery on cognitive brain function. We aimed to evaluate whether surgery affects cognitive brain activity in such a manner that it may mask possible changes in cognitive functioning measured by neuropsychological tests. Twenty-three meningioma patients participated in a fMRI measurement using a verbal working memory task as well as three neuropsychological tests focused on working memory, just before and 3 months after surgery. A region of interest based fMRI analysis was used to examine cognitive brain activity at these timepoints within the central executive network and default mode network. Neuropsychological assessment showed impaired cognitive functioning before as well as 3 months after surgery. Neuropsychological test scores, in-scanner task performance as well as brain activity within the central executive and default mode network were not significantly different between both timepoints. Our results indicate that surgery does not significantly affect cognitive brain activity in meningioma patients the first few months after surgery. Therefore, the lack of cognitive improvement after surgery is not likely the result of compensatory processes in the brain. Cognitive deficits that are already present before surgery appear to be persistent after surgery and a considerable recovery period. Our study shows potential leads that comprehensive cognitive evaluation can be of added value so that cognitive functioning may become a more prominent factor in clinical decision making.

The unseen impact - a deep dive into neurocognitive impairment among patients with intracranial meningiomas: a comprehensive systematic review of the literature

Meningiomas are the most common intracranial tumors, predominantly affecting adults, with a higher incidence in female and elderly populations. Despite their prevalence, research on neurocognitive impairment in meningioma patients remains limited compared to intra-axial tumors such as gliomas. We conducted a comprehensive systematic review of the current literature on neurocognitive outcomes in meningioma patients pre- and post-surgery. Our review revealed significant disparities in reported neurocognitive outcomes, with prospective studies suggesting tumor-related factors as the primary contributors to postoperative deficits, while retrospective studies imply surgical intervention plays a significant role. Regardless of study design or specifics, most studies lack baseline preoperative neurocognitive assessments and standardized protocols for evaluating neurocognitive function. To address these gaps, we advocate for standardized neurocognitive assessment protocols, consensus on neurocognitive domains to be targeted in this population by tailored test batteries, and more prospective studies to elucidate correlations between tumor characteristics, patient attributes, surgical interventions, neurocognitive status, and planning for implementing tailored neurocognitive rehabilitation strategies early in the postoperative course which is crucial for achieving optimal long-term neurocognitive outcomes and enhancing patients' quality of life.

Meningiomas and Cognitive Impairment after Treatment: A Systematic and Narrative Review

Simple Summary

Assessment of cognition is crucial in brain tumor care, and clinical outcome along this axis is frequently neglected. As a result, a patient’s quality of life seems more impacted than usually reported in clinical series. With this article, we review the current state of affairs and search for patient- and meningioma-related outcome predictors. We found a great variety in the number and types of neuropsychological tests used and in the dimensions of cognition studied. Furthermore, data mostly originate from a selected part of the globe and therefore may not reflect a global reality. Treatment has an early cognitive impact in the majority of meningioma patients. Further long-term conclusions are precluded by a mean follow-up time shorter than one year. Anticipating cognition outcomes prior to, during, and after treatment of meningiomas remains difficult. Future research should aim for a reliable and worldwide reproducible standard battery of tests.

Abstract

Clinical outcomes after surgery for intracranial meningiomas might be overvalued as cognitive dimensions and quality of life are probably underreported. This review aims to summarize the current state of cognitive screening and treatment-related outcomes after meningioma surgery. We present a systematic review (Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA-P) 2015-based) of cognitive outcomes after intracranial meningioma surgery. A total of 1572 patients (range 9–261) with a mean age of 58.4 years (range 23–87), and predominantly female (n = 1084, 68.9%) were identified. Mean follow-up time after treatment was 0.86 ± 0.3 years. Neuropsychological assessment was very heterogeneous, but five dimensions of cognition were described: memory (19/22); attention (18/22); executive functions (17/22); language (11/22); flexibility (11/22 studies). Cognitive abilities were impaired in 18 studies (81.8%), but only 1 showed deterioration in all dimensions simultaneously. Memory was the most affected. with significant post-therapy impairment in 9 studies (40.9%). Postoperatively, only 4 studies (18.2%) showed improvement in at least one dimension. Meningioma patients had significantly lower cognitive scores when compared to healthy subjects. Surgery and radiotherapy for meningiomas were associated with cognitive impairment, probably followed by a partial recovery. Cognition is poorly defined, and the assessment tools employed lack standardization. Cognitive impairment is probably underreported in meningioma patients.