Prospective evaluation of pretreatment executive cognitive impairment and depression in patients referred for radiotherapy.

in International journal of radiation oncology, biology, physics by Clifton D Fuller, Jason E Schillerstrom, William E Jones, Melissa Boersma, Donald R Royall, Martin Fuss

TLDR

  • The study found that people who are getting radiation therapy for cancer may have cognitive problems like trouble remembering things or difficulty with spatial skills. The study also found that people with brain tumors had the most trouble with cognitive problems. The study highlights the importance of checking for cognitive problems in people getting radiation therapy and finding ways to help them. The study also suggests that a test called EXIT25 may be helpful in checking for cognitive problems in people getting radiation therapy.

Abstract

Cancer patients are at risk of cognitive impairment and depression. We sought to ascertain the prevalence of executive, visuospatial, memory, and general cognitive performance deficits before radiotherapy in a radiation oncology clinic referral population and correlate the neurocognitive measures with the depression symptom burden. A total of 122 sequential patients referred for radiotherapy evaluation were administered a test battery composed of the Executive Interview (EXIT25), Executive Clock Drawing Task (CLOX1 and CLOX2), Mini Mental State Examination (MMSE), Memory Impairment Screen (MIS), and Geriatric Depression Scale (GDS). The mean age +/- standard deviation was 58 +/- 17 years. Of 122 patients, 24 (20%) had been referred for breast cancer, 21 (17%) for gastrointestinal cancer, 17 (14%) for genitourinary disease, and 8 (7%) for brain lesions; the rest were a variety of tumor sites. The cognitive performance among the tumor cohorts was compared using Bonferroni-corrected analysis of variance and Tukey-Kramer tests. Pearson correlation coefficients were determined between each cognitive instrument and the GDS. Of the 122 patients, 52 (43%) exhibited a detectable executive cognition decrement on one or more test measures. Five percent had poor memory performance (MIS), 18% had poor visuospatial performance (CLOX2), and 13% had poor global cognition (MMSE). Patients with brain tumors performed substantially worse on the EXIT25. No between-group differences were found for CLOX1, CLOX2, MIS, or GDS performance. The EXIT25 scores correlated significantly with the GDS scores (r = 0.26, p = 0.005). The results of this study have shown that patients referred for radiotherapy exhibit cognitive impairment profiles comparable to those observed in acutely ill medical inpatients. Executive control impairment appears more prevalent than global cognitive deficits, visuospatial impairment, or depression.

Overview

  • The study aims to determine the prevalence of executive, visuospatial, memory, and general cognitive performance deficits before radiotherapy in a radiation oncology clinic referral population and correlate the neurocognitive measures with the depression symptom burden. The study used a test battery composed of the Executive Interview (EXIT25), Executive Clock Drawing Task (CLOX1 and CLOX2), Mini Mental State Examination (MMSE), Memory Impairment Screen (MIS), and Geriatric Depression Scale (GDS). The mean age of the study population was 58 +/- 17 years, and the cognitive performance among the tumor cohorts was compared using Bonferroni-corrected analysis of variance and Tukey-Kramer tests. Pearson correlation coefficients were determined between each cognitive instrument and the GDS. The study found that 52 (43%) of the 122 patients exhibited a detectable executive cognition decrement on one or more test measures. Five percent had poor memory performance, 18% had poor visuospatial performance, and 13% had poor global cognition. Patients with brain tumors performed substantially worse on the EXIT25. No between-group differences were found for CLOX1, CLOX2, MIS, or GDS performance. The EXIT25 scores correlated significantly with the GDS scores (r = 0.26, p = 0.005).

Comparative Analysis & Findings

  • The study found that patients referred for radiotherapy exhibited cognitive impairment profiles comparable to those observed in acutely ill medical inpatients. Executive control impairment appeared more prevalent than global cognitive deficits, visuospatial impairment, or depression. Patients with brain tumors performed substantially worse on the EXIT25. No between-group differences were found for CLOX1, CLOX2, MIS, or GDS performance. The EXIT25 scores correlated significantly with the GDS scores (r = 0.26, p = 0.005).

Implications and Future Directions

  • The study's findings suggest that patients referred for radiotherapy may be at risk of cognitive impairment and depression. The results highlight the importance of assessing cognitive function in patients undergoing radiotherapy and identifying those at risk of cognitive impairment. Future research should focus on developing interventions to mitigate cognitive impairment and depression in patients undergoing radiotherapy. Additionally, the study's findings suggest that the EXIT25 may be a useful tool for assessing cognitive function in patients undergoing radiotherapy. Future research should investigate the use of the EXIT25 in clinical settings and its potential to predict cognitive impairment and depression in patients undergoing radiotherapy.
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