title: Neurocognitive Deficits and Neurocognitive Rehabilitation in Adult Brain Tumors.
abstract: Neurocognitive deficits are common with brain tumors. If assessed at presentation using detailed neurocognitive tests, problems are detected in 80 % of cases. Neurocognition may be affected by the tumor, its treatment, associated medication, mood, fatigue, and insomnia. Interpretation of neurocognitive problems should be considered in the context of these factors. Early post-operative neurocognitive rehabilitation for brain tumor patients will produce rehabilitation outcomes (e.g., quality of life, improved physical function, subjective neurocognition) equivalent to stroke, multiple sclerosis, and head injury, but the effect size and duration of benefit needs further research. In stable patients treated with radiotherapy +/- chemotherapy, the most frequent causes of distress include neurocognitive problems, psychological factors of anxiety, depression, fatigue, and sleep. Exercise, neurocognitive training, neurocognitive behavioral therapy, and medications to treat fatigue, behavior, memory, mood, and removal of drugs that may be associated with neurocognitive side effects (e.g., anti-epileptic drugs) all show promise in helping patients to manage the effects of their neurocognitive impairments better. As these are complex symptoms, multidisciplinary expertise is necessary to evaluate the influence of each variable to plan appropriate support and intervention. Neurocognitive rehabilitation should therefore occur in parallel with disease-centered, medical management from the outset. It should not occur in series, as a restricted phase in a patient's pathway. It should be considered in the pre- and post-operative period where there are good prospects of recovery, as one would for any brain-injured patient, so that the person may reach their optimal physical, sensory, intellectual, psychological, and social functional level. Yet the identification and selection of patients for early neurological rehabilitation and routine evaluation of cognition is uncommon in neurosurgical wards.
authors.affiliation: Department of Clinical Neuropsychology, Western General Hospital, Crewe Road, Edinburgh, EH4 2XU, Scotland, UK.
authors.forename: Julia
authors.initials: J
authors.lastname: Day
authors.affiliation: Department of Clinical Neuropsychology, Western General Hospital, Crewe Road, Edinburgh, EH4 2XU, Scotland, UK.
authors.forename: David C
authors.initials: DC
authors.lastname: Gillespie
authors.affiliation: Division of Psychiatry, University of Edinburgh, Royal Edinburgh Hospital, Edinburgh, EH10 5HF, Scotland, UK.
authors.forename: Alasdair G
authors.initials: AG
authors.lastname: Rooney
authors.affiliation: Brainstrust (the brain cancer people), Yvery Court, Castle Road, Cowes, Isle of Wight, PO31 7QG, UK.
authors.forename: Helen J
authors.initials: HJ
authors.lastname: Bulbeck
authors.affiliation: Edinburgh Centre for Neuro-Oncology, Western General Hospital, Crewe Road, Edinburgh, EH4 2XU, Scotland, UK.
authors.forename: Karolis
authors.initials: K
authors.lastname: Zienius
authors.affiliation: Edinburgh Centre for Neuro-Oncology, Western General Hospital, Crewe Road, Edinburgh, EH4 2XU, Scotland, UK.
authors.forename: Florien
authors.initials: F
authors.lastname: Boele
authors.affiliation: Edinburgh Centre for Neuro-Oncology, Western General Hospital, Crewe Road, Edinburgh, EH4 2XU, Scotland, UK. Robin.Grant@nhslothian.scot.nhs.uk.
authors.forename: Robin
authors.initials: R
authors.lastname: Grant
keywords: Brain tumor; Depression; Fatigue; Neuro-rehabilitation; Neurocognitive