A systematic review of cognitive interventions for adult patients with brain tumours

Matthew A Kirkman; Justyna O Ekert; Benjamin H M Hunn; Michael S C Thomas; Andrew K Tolmie

doi:10.1002/cam4.5760

A systematic review of cognitive interventions for adult patients with brain tumours

Cancer Med. 2023 May;12(10):11191-11210. doi: 10.1002/cam4.5760. Epub 2023 Mar 7.

Authors

Matthew A Kirkman^{1

2}, Justyna O Ekert³, Benjamin H M Hunn^{4

5

6}, Michael S C Thomas⁷, Andrew K Tolmie¹

Affiliations

¹ Department of Psychology and Human Development, UCL Institute of Education, University College London, London, UK.
² Department of Neurosurgery, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK.
³ Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, London, UK.
⁴ Department of Neurosurgery, Royal Melbourne Hospital, Melbourne, Australia.
⁵ Department of Neurosurgery, Royal Hobart Hospital, Hobart, Australia.
⁶ School of Medicine, University of Tasmania, Hobart, Australia.
⁷ Department of Psychological Sciences, Birkbeck, University of London, London, UK.

Abstract

Background: Neurocognitive impairments are common in patients with current or previously treated brain tumours, and such impairments can negatively affect patient outcomes including quality of life and survival. This systematic review aimed to identify and describe interventions used to ameliorate (improve) or prevent cognitive impairments in adults with brain tumours.

Methods: We performed a literature search of the Ovid MEDLINE, PsychINFO and PsycTESTS databases from commencement until September 2021.

Results: In total, 9998 articles were identified by the search strategy; an additional 14 articles were identified through other sources. Of these, 35 randomised and nonrandomised studies were deemed to meet the inclusion/exclusion criteria of our review and were subsequently included for evaluation. A range of interventions were associated with positive effects on cognition, including pharmacological agents such as memantine, donepezil, methylphenidate, modafinil, ginkgo biloba and shenqi fuzheng, and nonpharmacological interventions such as general and cognitive rehabilitation, working memory training, Goal Management Training, aerobic exercise, virtual reality training combined with computer-assisted cognitive rehabilitation, hyperbaric oxygen therapy and semantic strategy training. However, most identified studies had a number of methodological limitations and were judged to be at moderate-to-high risk of bias. In addition, it remains unclear whether and to what extent the identified interventions lead to durable cognitive benefits after cessation of the intervention.

Conclusion: The 35 studies identified in this systematic review have indicated potential cognitive benefits for a number of pharmacological and nonpharmacological interventions in patients with brain tumours. Study limitations were identified and further studies should focus on improved study reporting, methods to reduce bias and minimise participant drop-out and withdrawal where possible, and consider standardisation of methods and interventions across studies. Greater collaboration between centres could result in larger studies with standardised methods and outcome measures, and should be a focus of future research in the field.

Keywords: brain tumour; cognitive outcomes; interventions; pharmacological; rehabilitation.

Publication types

Systematic Review
Review
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Brain Neoplasms* / complications
Brain Neoplasms* / therapy
Cognition
Cognition Disorders*
Cognitive Dysfunction* / etiology
Cognitive Dysfunction* / therapy
Humans
Quality of Life