BackgroundPatients’ reduced awareness of neurocognitive functioning (NCF) may negatively affect the reliability of patient-reported outcomes (PROs) and clinical decision-making. This study... Show moreBackgroundPatients’ reduced awareness of neurocognitive functioning (NCF) may negatively affect the reliability of patient-reported outcomes (PROs) and clinical decision-making. This study evaluated cognitive awareness, defined as the association between NCF and neurocognitive complaints, over the disease course of patients with recurrent high-grade glioma (HGG).MethodsWe assessed NCF using the EORTC core clinical trial battery and neurocognitive complaints using the Medical Outcome Study questionnaire. Patients were categorised as impaired or intact, based on their neurocognitive performance. Spearman’s rank correlations were calculated between NCF and neurocognitive complaints at baseline and each 12 weeks, until 36. The association between changes in NCF and neurocognitive complaints scores between these follow-up assessments was determined using Pearson’s correlation.ResultsA total of 546 patients were included. Neurocognitively impaired patients (n = 437) had more neurocognitive complaints (range: 10.51 [p < 0.001] to 13.34 [p = 0.001]) than intact patients (n = 109) at baseline, at 12 and 24 weeks. In intact patients, NCF and neurocognitive complaints were correlated for only one domain at baseline (0.202, p = 0.036), while in impaired patients correlations were more frequently found in various domains and time points (range: 0.164 [p = 0.001] to 0.334 [p = 0.011]). Over the disease course, NCF and neurocognitive complaints were correlated for only one domain at baseline (0.357, p = 0.014) in intact patients while in impaired patients they were correlated for more domains and time points (range: 0.222 [p < 0.001] to 0.366 [p < 0.001]).ConclusionNeurocognitively impaired patients with recurrent HGG are aware of their neurocognitive limitations at study entry and during follow-up, which should be considered in clinical decision-making and when interpreting PRO results. Show less
Children with SCT have an increased vulnerability for adverse neurobehavioral outcomes and an increased risk for neurocognitive difficulties in the language and communication domain. This... Show moreChildren with SCT have an increased vulnerability for adverse neurobehavioral outcomes and an increased risk for neurocognitive difficulties in the language and communication domain. This vulnerability starts from a young age and may increase when children get older. Neurocognitive functions within the language and communication domain serve as early markers of at-risk pathways with unfavorable neurobehavioral outcomes. These findings come with important clinical implications for the SCT population andwill ideally fuel the implementation of early monitoring, and implementation and development of preventive support and intervention. Show less
Caramanna, I.; Klein, M.; Bent, M. van den; Idbaih, A.; Wick, W.; Taphoorn, M.J.B.; ... ; EORTC Brain Tumor Grp 2022
Purpose: The rate of missing data on patient-reported health-related quality of life (HRQOL) in brain tumor clinical trials is particularly high over time. One solution to this issue is the use of... Show morePurpose: The rate of missing data on patient-reported health-related quality of life (HRQOL) in brain tumor clinical trials is particularly high over time. One solution to this issue is the use of proxy (i.e., partner, relative, informal caregiver) ratings in lieu of patient-reported outcomes (PROs). In this study we investigated patient-proxy agreement on HRQOL outcomes in high-grade glioma (HGG) patients. Methods: Generic and disease-specific HRQOL were assessed using the EORTC QLQ-C30 and QLQ-BN20 in a sample of 501 patient-proxy dyads participating in EORTC trials 26101 and 26091. Patients were classified as impaired or intact, based on their neurocognitive performance. The level of patient-proxy agreement was measured using Lin's concordance correlation coefficient (CCC) and the Bland-Altman limit of agreement. The Wilcoxon signed-rank test was used to evaluate differences between patients' and proxies' HRQOL. Results: Patient-proxy agreement in all HGG patients (N = 501) ranged from 0.082 to 0.460. Only 18.8% of all patients were neurocognitively intact. Lin's CCC ranged from 0.088 to 0.455 in cognitively impaired patients and their proxies and from 0.027 to 0.538 in cognitively intact patients and their proxies. Conclusion: While patient-proxy agreement on health-related quality of life outcomes is somewhat higher in cognitively intact patients, agreement in high-grade glioma patients is low in general. In light of these findings, we suggest to cautiously consider the use of proxy's evaluation in lieu of patient-reported outcomes, regardless of patient's neurocognitive status. Show less
Najafabadi, A.H.Z.; Meer, P.B. van der; Boele, F.W.; Taphoorn, M.J.B.; Klein, M.; Peerdeman, S.M.; ... ; Dirven, L. 2020
Introduction Meningioma is a heterogeneous disease and patients may suffer from long-term tumor- and treatment-related sequelae. To help identify patients at risk for these late effects, we first... Show moreIntroduction Meningioma is a heterogeneous disease and patients may suffer from long-term tumor- and treatment-related sequelae. To help identify patients at risk for these late effects, we first assessed variables associated with impaired long-term health-related quality of life (HRQoL) and impaired neurocognitive function on group level (i.e. determinants). Next, prediction models were developed to predict the risk for long-term neurocognitive or HRQoL impairment on individual patient-level. Methods Secondary data analysis of a cross-sectional multicenter study with intracranial WHO grade I/II meningioma patients, in which HRQoL (Short-Form 36) and neurocognitive functioning (standardized test battery) were assessed. Multivariable regression models were used to assess determinants for these outcomes corrected for confounders, and to build prediction models, evaluated with C-statistics. Results Data from 190 patients were analyzed (median 9 years after intervention). Main determinants for poor HRQoL or impaired neurocognitive function were patients' sociodemographic characteristics, surgical complications, reoperation, radiotherapy, presence of edema, and a larger tumor diameter on last MRI. Prediction models with a moderate/good ability to discriminate between individual patients with and without impaired HRQoL (C-statistic 0.73, 95% CI 0.65 to 0.81) and neurocognitive function (C-statistic 0.78, 95%CI 0.70 to 0.85) were built. Not all predictors (e.g. tumor location) within these models were also determinants. Conclusions The identified determinants help clinicians to better understand long-term meningioma disease burden. Prediction models can help early identification of individual patients at risk for long-term neurocognitive or HRQoL impairment, facilitating tailored provision of information and allocation of scarce supportive care services to those most likely to benefit. Show less
Sex chromosome trisomies (SCT) are among the most common chromosomal duplicationsin humans. Due to recent technological advances in non-invasive screening, SCTcan already be detected during... Show moreSex chromosome trisomies (SCT) are among the most common chromosomal duplicationsin humans. Due to recent technological advances in non-invasive screening, SCTcan already be detected during pregnancy. This calls for more knowledge about thedevelopment of (young) children with SCT. This review focused on neurocognitivefunctioning of children with SCT between 0 and 18 years, on domains of global intellectualfunctioning, language, executive functioning, and social cognition, in order toidentify targets that could benefit from early treatment.Online databases were used to identify peer-reviewed scientific articles using specificsearch terms. In total 18 studies were included. When applicable, effect sizes werecalculated to indicate clinical significance.Results of the reviewed studies show that although traditionally, the focus has been onlanguage and intelligence (IQ) in this population, recent studies suggest that executivefunctioning and social cognition may also be significantly affected already in childhood.These findings suggest that neuropsychological screening of children diagnosed withSCT should be extended, to also include executive functioning and social cognition.Knowledge about these neurocognitive risks is important to improve clinical care andhelp identify targets for early support and intervention programs to accommodatefor the needs of individuals with SCT. Show less
The studies described in this thesis aim to provide a better understanding of the mechanisms that result in vulnerability to autism and ADHD symptomatology in individuals with the 22q11 deletion... Show moreThe studies described in this thesis aim to provide a better understanding of the mechanisms that result in vulnerability to autism and ADHD symptomatology in individuals with the 22q11 deletion syndrome (22q11DS). The objective of the current thesis was to investigate the association between neurocognitive functioning and severity of autism and ADHD symptomatology in individuals with 22q11DS. For this purpose intellectual functioning, executive functioning and social cognition were assessed in a sample of children and adolescents (aged 9-18.5 years) with 22q11DS. Our findings show that children and adolescents with 22q11DS present with severe impairments on various domains of neurocognitive functioning. Some of these impairments are associated with the variable expression of social behavioral problems within the syndrome, underlining the importance of monitoring the cognitive development within this population. This knowledge can be used as a starting point for the development and adjustment of preventive interventions and for treatments of children and adolescents with 22q11DS who are at risk of these developmental problems. For clinical practice and future research it is important to be aware of the role of both genetic factors and neurocognitive functioning in the presence and severity of behavioral problems in syndromes like 22q11DS. Show less
