title: Prospective evaluation of pretreatment executive cognitive impairment and depression in patients referred for radiotherapy.
abstract: OBJECTIVE
  Cancer patients are at risk of cognitive impairment and depression. We sought to ascertain the prevalence of executive, visuospatial, memory, and general cognitive performance deficits before radiotherapy in a radiation oncology clinic referral population and correlate the neurocognitive measures with the depression symptom burden.
  
  
  METHODS
  A total of 122 sequential patients referred for radiotherapy evaluation were administered a test battery composed of the Executive Interview (EXIT25), Executive Clock Drawing Task (CLOX1 and CLOX2), Mini Mental State Examination (MMSE), Memory Impairment Screen (MIS), and Geriatric Depression Scale (GDS). The mean age +/- standard deviation was 58 +/- 17 years. Of 122 patients, 24 (20%) had been referred for breast cancer, 21 (17%) for gastrointestinal cancer, 17 (14%) for genitourinary disease, and 8 (7%) for brain lesions; the rest were a variety of tumor sites. The cognitive performance among the tumor cohorts was compared using Bonferroni-corrected analysis of variance and Tukey-Kramer tests. Pearson correlation coefficients were determined between each cognitive instrument and the GDS.
  
  
  RESULTS
  Of the 122 patients, 52 (43%) exhibited a detectable executive cognition decrement on one or more test measures. Five percent had poor memory performance (MIS), 18% had poor visuospatial performance (CLOX2), and 13% had poor global cognition (MMSE). Patients with brain tumors performed substantially worse on the EXIT25. No between-group differences were found for CLOX1, CLOX2, MIS, or GDS performance. The EXIT25 scores correlated significantly with the GDS scores (r = 0.26, p = 0.005).
  
  
  CONCLUSIONS
  The results of this study have shown that patients referred for radiotherapy exhibit cognitive impairment profiles comparable to those observed in acutely ill medical inpatients. Executive control impairment appears more prevalent than global cognitive deficits, visuospatial impairment, or depression.
authors.affiliation: Department of Radiation Oncology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA. fullercd@uthscsa.edu
authors.forename: Clifton D
authors.initials: CD
authors.lastname: Fuller
authors.forename: Jason E
authors.initials: JE
authors.lastname: Schillerstrom
authors.forename: William E
authors.initials: WE
authors.lastname: Jones
authors.forename: Melissa
authors.initials: M
authors.lastname: Boersma
authors.forename: Donald R
authors.initials: DR
authors.lastname: Royall
authors.forename: Martin
authors.initials: M
authors.lastname: Fuss
mesh_terms: D000704:Analysis of Variance; D003072:Cognition Disorders / Q000175:diagnosis*; D003863:Depression / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008569:Memory Disorders / Q000175:diagnosis*; D008609:Mental Status Schedule; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology* / Q000532:radiotherapy; D009483:Neuropsychological Tests; D011446:Prospective Studies; D018787:Radiation Oncology; D013028:Space Perception; D014796:Visual Perception