Abstract
Background
Meningioma patients are faced with deficits in several cognitive domains before and after surgery. We examined individual changes in cognitive performance over time and identified pre-operative predictors of cognitive functioning 12 months after surgery in a large sample of meningioma patients.
Material and Methods
Patients underwent neuropsychological assessment using the computerized neuropsychological battery CNS Vital Signs one day before (T0), and 3 (T3) and 12 (T12) months after surgery. Performance on 7 cognitive domains was compared to a normative sample using one-sample z-tests. Reliable Change Indices (RCIs) with correction for practice effects were calculated for individual patients. We used linear mixed effects models to identify pre-operative predictors of cognitive functioning at T12.
Results
So far, 261 patients were assessed at T0, and 229 and 82 patients were retested at T3 and T12 respectively. We found significantly lower performance on all cognitive domains at T0, T3, and T12 in patients. RCIs demonstrated improved and declined cognitive performance over time in respectively 3% to 29% and 1% to 15% of the individual patients over domains. Lower age, male sex, and higher educational level, as well as a left-sided non-frontal tumor, the absence of comorbidities and a lower anxiety score significantly predicted better cognitive performance on specific domains at T12. In addition, better preoperative cognitive performance predicted better late cognitive performance.
Conclusion
Improvements in cognitive performance seemed more common than declines, yet, the majority of meningioma patients showed stable cognitive functioning from pre- to postsurgery. Preoperative cognitive performance of meningioma patients turned out to be the most indicative for late cognitive performance, and in addition, sociodemographic, clinical, and psychological predictors were identified. These results can help to inform patients and clinicians on late cognitive status at an early stage, and emphasize the need for cognitive rehabilitation in meningioma patients who are at risk for cognitive impairment after surgery.