{"title":"Mapping glioma's impact on cognition: Insights from macrostructure, microstructure, and beyond.","authors":"Nuria Cayuela, Cristina Izquierdo, Lucía Vaquero, Estela Càmara, Jordi Bruna, Marta Simó","doi":"10.1093/noajnl/vdaf003","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Cognitive impairment (CI) significantly impacts the quality of life of glioma patients. The main contributing risk factors include tumor characteristics, treatment-related factors, and their complex interplay. This review explores the role of advanced structural neuroimaging techniques in understanding CI in glioma patients.</p><p><strong>Methods: </strong>A literature search was conducted in PubMed, PsycINFO, and ISI Web of Knowledge using specific keywords. We included studies with advanced magnetic resonance imaging techniques and objective neuropsychological exams.</p><p><strong>Results: </strong>At diagnosis, during the pre-surgery phase, associations between glioma characteristics and cognitive outcomes have been described. Specifically, patients with isocitrate dehydrogenase (IDH)-wild-type gliomas exhibit more adverse cognitive outcomes, accompanied by disruptions in gray (GM) and white matter (WM) networks when compared to IDH-mutant. In addition, pre- and post-surgery imaging analyses highlight the importance of preserving specific WM tracts, such as the inferior longitudinal and arcuate fasciculus, in mitigating verbal memory and language processing decline. Furthermore, examining gliomas in perisylvian regions emphasizes deleterious effects on various cognitive domains. Additionally, it has been suggested that neuroplastic reorganization could serve as a compensatory mechanism against CI. Lastly, a limited number of studies suggest long-term CI linked to GM atrophy and leukoencephalopathy induced by radiotherapy ± chemotherapy in glioma survivors, highlighting the need for improving treatment approaches, particularly for patients with extended survival expectations.</p><p><strong>Conclusion: </strong>This review underscores the need for nuanced understanding and an individual approach in the management of glioma patients. Neuroplastic insights offer clinicians valuable guidance in surgical decision-making and personalized therapeutic approaches thus improving patient outcomes in neuro-oncology.</p>","PeriodicalId":94157,"journal":{"name":"Neuro-oncology advances","volume":"7 1","pages":"vdaf003"},"PeriodicalIF":3.7000,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11795312/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Neuro-oncology advances","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1093/noajnl/vdaf003","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/1 0:00:00","PubModel":"eCollection","JCR":"Q1","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Cognitive impairment (CI) significantly impacts the quality of life of glioma patients. The main contributing risk factors include tumor characteristics, treatment-related factors, and their complex interplay. This review explores the role of advanced structural neuroimaging techniques in understanding CI in glioma patients.
Methods: A literature search was conducted in PubMed, PsycINFO, and ISI Web of Knowledge using specific keywords. We included studies with advanced magnetic resonance imaging techniques and objective neuropsychological exams.
Results: At diagnosis, during the pre-surgery phase, associations between glioma characteristics and cognitive outcomes have been described. Specifically, patients with isocitrate dehydrogenase (IDH)-wild-type gliomas exhibit more adverse cognitive outcomes, accompanied by disruptions in gray (GM) and white matter (WM) networks when compared to IDH-mutant. In addition, pre- and post-surgery imaging analyses highlight the importance of preserving specific WM tracts, such as the inferior longitudinal and arcuate fasciculus, in mitigating verbal memory and language processing decline. Furthermore, examining gliomas in perisylvian regions emphasizes deleterious effects on various cognitive domains. Additionally, it has been suggested that neuroplastic reorganization could serve as a compensatory mechanism against CI. Lastly, a limited number of studies suggest long-term CI linked to GM atrophy and leukoencephalopathy induced by radiotherapy ± chemotherapy in glioma survivors, highlighting the need for improving treatment approaches, particularly for patients with extended survival expectations.
Conclusion: This review underscores the need for nuanced understanding and an individual approach in the management of glioma patients. Neuroplastic insights offer clinicians valuable guidance in surgical decision-making and personalized therapeutic approaches thus improving patient outcomes in neuro-oncology.
背景：认知障碍（CI）显著影响胶质瘤患者的生活质量。主要的危险因素包括肿瘤特征、治疗相关因素及其复杂的相互作用。这篇综述探讨了先进的结构神经成像技术在理解神经胶质瘤患者CI中的作用。方法：在PubMed、PsycINFO和ISI Web of Knowledge中使用特定关键词进行文献检索。我们纳入了采用先进磁共振成像技术和客观神经心理学检查的研究。结果：在诊断时，在手术前阶段，胶质瘤特征和认知结果之间的关联已经被描述。具体而言，与IDH突变体相比，异柠檬酸脱氢酶（IDH）野生型胶质瘤患者表现出更多不良的认知结果，并伴有灰质（GM）和白质（WM）网络的破坏。此外，术前和术后的影像学分析强调了保留特定的WM束，如下纵束和弓形束，在减轻言语记忆和语言处理能力下降方面的重要性。此外，检查脑外围区域的胶质瘤强调对各种认知领域的有害影响。此外，有研究表明，神经可塑性重组可能是脑损伤的代偿机制。最后，有限数量的研究表明，长期CI与胶质瘤幸存者放疗±化疗引起的GM萎缩和脑白质病有关，强调需要改进治疗方法，特别是对于延长生存期的患者。结论：这篇综述强调了在胶质瘤患者的治疗中需要细致入微的理解和个性化的方法。神经肿瘤学的见解为临床医生在手术决策和个性化治疗方法方面提供了宝贵的指导，从而改善了神经肿瘤学患者的预后。
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