Improve the management of cancer-related cognitive impairment in clinical settings: a European Delphi study

PURPOSE

Cancer-related cognitive impairment (CRCI) is under-addressed by healthcare professionals owing to a lack of clinical management guidelines. This European Delphi study proposes recommendations to healthcare professionals for the management of CRCI in patients with non-central nervous system (non-CNS) cancers.

METHODS

Twenty-two recommendations were developed based on a literature review and authors' clinical experience, split into three categories: screening, cognitive assessment, intervention. The survey included European professionals, experts in CRCI. The Delphi method was used: experts rated the clinical relevancy of recommendations on a 9-point Likert scale in three rounds. A recommendation was accepted if all votes were between 7 and 9. Recommendations not accepted in round 1 and round 2 were deleted, or modified and rated in round 3.

RESULTS

Eighteen professionals (psychologists, physicians, researchers) voted and accepted 15 recommendations. Experts recommended the systematic screening of CRCI, followed by a short objective cognitive assessment, if complaints screened. A comprehensive evaluation is recommended if CRCI persists 6 months post-treatment. Cognitive rehabilitation, physical activity, meditative-movement therapy, and multimodal intervention should be offered. Recommendations about frequency and duration of interventions, the professional to administer cognitive rehabilitation and the use of meditation and cognitive training without psychoeducation were not accepted.

CONCLUSIONS

This survey provides 15 recommendations to assist healthcare professionals in detecting, assessing and offering interventions for CRCI.

IMPLICATIONS FOR CANCER SURVIVORS

These recommendations should be included in supportive care to help healthcare professionals to detect CRCI and propose the best available intervention for patients with cognitive complaints. Developing CRCI management in clinical settings would improve patients' quality of life.

Psychiatric Symptoms and Cognitive Disorders in Behçet's Disease: A Single-Center, Cross-Sectional Study

BACKGROUND

Behçet's disease (BD) is a rare form of vasculitis involving both veins and arteries of all calibers. Psychological symptoms and cognitive impairment appear to be frequent, but few data are available.

METHODS

All consecutive patients in our center fulfilling the 2013 BD criteria underwent a psychometric evaluation with auto- (SCL-90-R and Modified Fatigue Index) and hetero-questionnaires (MINI). A standardized test battery assessed cognitive dysfunction. Data were correlated with BD activity as well as quality of life (SF-36).

RESULTS

We included 20 consecutive patients (16 men, four women) with a median [IQR] age of 38 (30.0-45.5) and a median disease duration of 7 years (1.8-11.0). Five patients had an abnormal brain MRI. The SCL-90-R questionnaire highlighted eight psychopathological profiles (42.1%) that correlated with altered quality of life and more severe fatigue. The most frequent symptoms were anxiety (9/19, 47.4%), somatization (8/19, 42.1%) and phobia (5/19, 26.3%). Psychopathological symptoms appeared to be more severe, but not more frequent, in neuro-Behçet's patients. Based on standardized cognitive evaluation, nine patients had cognitive impairment defined by three or more altered tests. Notably, 6/9 patients did not have any complaint of memory loss and were thus considered ansognostic.

CONCLUSION

Cognitive involvement was significantly associated with BD activity score (BSAS) but not with brain MRI abnormalities.

Cognitive change in breast cancer patients up to 2 years after diagnosis

BACKGROUND

Using the large nationwide French, national, multicenter, prospective cancer and toxicities (CANTO) cohort, we assessed cognitive functioning change after cancer treatments in a subgroup of breast cancer (BC) patients.

METHODS

We included patients with newly diagnosed invasive stage I-III BC enrolled in the CANTO substudy focused on cognitive evaluation and healthy control women matched for age and education. Episodic and working memory, executive functions, processing speed, attention, self-report cognitive difficulties (SRCD), fatigue, anxiety and depression were assessed with neuropsychological tests and self-report questionnaires before treatment (baseline) and approximately 1 (year 1) and 2 years (year 2) after diagnosis. We used linear mixed models to study changes in cognition and tested the effect of adjuvant chemotherapy.

RESULTS

We studied 276 localized BC patients (62% chemotherapy) compared with 135 healthy controls (HC). After adjustment, patients had lower baseline working memory, processing speed, and attention scores than HC (P ≤ .001), and the difference remained statistically significant over follow-up for working memory and processing speed. Executive function scores were similar between groups at baseline but decreased at year 1 among patients compared with HC (Pchange = .006). This decrease in chemotherapy patients was statistically significant compared with HC scores (Pchange < .001). After adjustment, SRCD were similar between BC patients and HC at baseline but increased in patients after treatment at year 1 (Pchange = .002).

CONCLUSIONS

Cognitive difficulties are an important concern in BC patients, starting at diagnosis. Cancer treatments induce executive function decline and SRCD, which decrease over follow-up.

Cognitive rehabilitation program to improve cognition of cancer patients treated with chemotherapy: A 3-arm randomized trial

Background

There is no treatment for cancer‐related cognitive impairment, an important adverse effect that negatively impacts quality of life (QOL). We conducted a 3‐arm randomized controlled trial to evaluate the impact of computer‐assisted cognitive rehabilitation (CR) on cognition, QOL, anxiety, and depression among cancer patients treated with chemotherapy.

Methods

Patients who reported cognitive complaints during or after completing chemotherapy were randomly assigned to 1 of 3 12‐week CR programs: computer‐assisted CR with a neuropsychologist (experimental group A), home cognitive self‐exercises (active control group B), or phone follow‐up (active control group C). Subjective cognition was assessed by the Functional Assessment of Cancer Therapy–Cognitive Function (FACT‐Cog), objective cognition was assessed by neuropsychological tests, QOL was assessed by the FACT‐General, and depression and anxiety were assessed by psychological tests. The primary endpoint was the proportion of patients with a 7‐point improvement in the FACT‐Cog perceived cognitive impairment (PCI) score.

Results

Among the 167 enrolled patients (median age, 51 years), group A had the highest proportion of patients with a 7‐point PCI improvement (75%), followed by groups B (59%) and C (57%), but the difference was not statistically significant (P = .13). Compared with groups B and C, the mean difference in PCI score was significantly higher in group A (P = .02), with better perceived cognitive abilities (P < .01) and a significant improvement in working memory (P = .03). Group A reported higher QOL related to cognition (FACT‐Cog QOL) (P = .01) and improvement in depression symptoms (P = .03).

Conclusions

These results suggest a benefit of a computer‐based CR program in the management of cancer‐related cognitive impairment and complaints.

In this 3‐arm randomized clinical trial of 167 patients, computer‐assisted cognitive rehabilitation improved cognitive complaints, with significant improvement in working memory, quality of life related to cognition, and depression symptoms. Computer‐assisted cognitive rehabilitation is a compelling approach toward the management of cancer‐related cognitive impairment and complaints.

Validation study of a French version of the modified telephone interview for cognitive status (F-TICS-m) in elderly women

OBJECTIVE

To evaluate the performance of a French version of the modified Telephone Interview for Cognitive Status (F-TICS-m) in identifying cognitive decline among elderly women.

METHODS

All women aged 72-86 participating in the 'Etude Epidémiologique auprès de Femmes de l'Education Nationale' (E3N) cohort and living in or near Paris constituted the target population of the validation study. Volunteer women (n = 120) underwent both a 20-min telephone interview and a face-to-face neuropsychological examination at an interval of few days (median interval: 10 days). The telephone interview included F-TICS-m, as well as a recall of key elements of a short story, arithmetic/verbal problems and two verbal fluency tests. Neuropsychological examination consisted of a standardized battery of cognitive tests (including the Mini-Mental State Examination (MMSE), the Free and Cued Selective Reminding Test-FCSRT, Trailmaking tests A and B, the similarities subtest of the Wechsler Adult Intelligence Scale-III, etc.) the Instrumental Activities of Daily Living questionnaire, and the Geriatric Depression Scale. Neuropsychological examination led to classification of each subject as cognitively normal (n = 92) or impaired/demented (n = 28).

RESULTS

F-TICS-m showed satisfactory internal consistency (Cronbach's alpha = 0.69). It correlated linearly with MMSE (Pearson's r = 0.72). Concurrent validity against the gold-standard classification was satisfactory, with an area under the ROC curve (AUC) of 0.83. The combination of F-TICS-m and the other telephone tests had no additional effect on discrimination power in our sample (AUC = 0.81).

CONCLUSION

F-TICS-m is a valid instrument for assessing the overall cognitive status of French elderly women. Its validity in men and its reproducibility warrant further studies.

Changes in interhemispheric transfer rate and the development of bimanual coordination during childhood

In this study, we investigated the effect of the development of interhemispheric communication on age-related change in bimanual coordination. Interhemispheric communication was assessed by comparing the latency of a manual response to a visual stimulus when the hemisphere perceiving the stimulus and the hemisphere controlling the manual response were the same (uncrossed condition) to the latency when they were different (crossed condition). In the first experiment (5- to 10-year-old children) we used a two-choice response-time task, and in the second experiment (3- to 7-year-old children) we used a simple response-time task. In both studies, bimanual coordination was tested on a line-drawing task, and we compared performance on mirror and parallel movements. The crossed-uncrossed difference decreased with age in both experiments. When estimated on the simple response-time task, the crossed-uncrossed difference was related to the difference in performance between mirror and parallel movements on the bimanual task. Thus, improved interhemispheric communication contributes to progress in bimanual coordination, especially that which requires resisting the attraction of mirror movements in order to rotate both hands with parallel movements.