Mental fatigue and cognitive functioning in patients presenting with non-enhancing gliomas
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By
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Alice Neimantaite
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Tomás Gómez Vecchio
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Isabelle Rydén
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Dima Harba
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Asgeir S. Jakola
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Anja Smits
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March 8, 2025
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Clinical Scorecard: Cognitive Performance and Mental Exhaustion in Patients with Non-Enhancing Gliomas
At a Glance
| Category | Detail |
|---|
| Condition | Lower-grade diffuse gliomas (LGG), WHO grade 2–3, IDH-mutated astrocytomas and oligodendrogliomas |
| Key Mechanisms | Invasive tumor growth causing cognitive deficits and mental fatigue; tumor localization and growth rate impact brain function |
| Target Population | Adult patients with radiologically presumed LGG prior to surgical treatment |
| Care Setting | Neurosurgical department and neuropsychological assessment prior to surgery |
Key Highlights
- LGG patients exhibit cognitive deficits and persistent mental fatigue even before treatment.
- Mental fatigue and cognitive impairment have a complex bidirectional relationship impacting patient quality of life.
- Baseline evaluation prior to treatment is essential to distinguish tumor effects from treatment effects on cognition and fatigue.
Guideline-Based Recommendations
Diagnosis
- Use MRI to identify intrinsic tumor mass with T2 hyperintensity and absence of significant contrast enhancement to presume LGG.
- Perform neuropsychological testing including RAVLT, D-KEFS, TMT, and WAIS-IV to assess cognitive domains.
- Utilize self-reported questionnaires such as EORTC QLQ-C30 Cognitive Functioning and MFI-20 Mental Fatigue for symptom assessment.
Management
- Consider cognitive rehabilitation strategies to potentially reduce mental fatigue.
- Focus on symptom burden and health-related quality of life alongside tumor treatment.
- Plan patient counseling and rehabilitation based on baseline cognitive and fatigue assessments.
Monitoring & Follow-up
- Monitor cognitive function and mental fatigue longitudinally to differentiate tumor progression effects from treatment effects.
- Use standardized neuropsychological tests and patient-reported outcome measures for follow-up.
Risks
- Cognitive impairment and mental fatigue may worsen over time impacting daily functioning and quality of life.
- Potential confounding effects of tumor location and growth rate on cognitive and fatigue symptoms.
Patient & Prescribing Data
Patients with radiologically presumed LGG prior to any surgical or oncological treatment.
Baseline cognitive and fatigue assessments are critical to guide individualized treatment and rehabilitation planning.
Clinical Best Practices
- Conduct comprehensive baseline neuropsychological and fatigue assessments before initiating treatment.
- Interpret cognitive and fatigue symptoms considering tumor characteristics and patient-reported outcomes.
- Integrate multidisciplinary approaches including neurosurgery, neuropsychology, and supportive care for optimal management.
References
