Simone Goebel

Distress in patients with newly diagnosed brain tumours

Objective: Patients with intracranial tumours often suffer from clinically relevant psychological distress. However, levels of distress and contributing factors have not been systematically evaluated for the early course of the disease. Using the National Comprehensive Cancer Networks Distress Thermometer (DT), we evaluated the extent and sources of distress within a population of patients with intracranial neoplasms.

Normative data and psychometric properties for qualitative and quantitative scoring criteria of the Five-point Test

The Five-point Test (Regard, Strauss, & Knapp, 1982) was introduced for the measurement of figural fluency as part of the examination of executive functions. Until now, no differentiated norms exist. We present normative data for adults aged 18–80 (n = 280) for the number of unique designs (productivity), the percent of perseverations (flexibility), the percent of rotated (strategic) designs, and the number of rule breakings. As age and education were correlated with test performance, norms were stratified by these two variables. Test–retest reliability and inter-rater reliability were calculated. Moreover, convergent and divergent validity as well as factorial validity were assessed through intercorrelations and correlations with other neuropsychological tests. All together, the Five-point Test proved to be reliable and valid.

Measuring Preoperative Anxiety in Patients With Intracranial Tumors: The Amsterdam Preoperative Anxiety and Information Scale

Background Preoperative anxiety is a major problem in patients with brain tumors and is of high clinical relevance. However, to date no instruments have been validated for the assessment of preoperative anxiety for this patient group. The Amsterdam Preoperative Anxiety and Information Scale (APAIS) has shown promising results for the assessment of preoperative anxiety. The aim of this study was to determine its psychometric properties and the optimal cutoff score for patients with intracranial tumors to make it applicable in the neurosurgical setting. Methods The sample totaled 180 neurosurgical patients with intracranial tumors. Patients were administered the APAIS along with the Hospital Anxiety and Depression Scale as the gold standard against which the APAIS was compared. Patients scoring 11 or above in the anxiety subscale of the Hospital Anxiety and Depression Scale were defined as clinical cases having anxiety. The psychometric properties of the APAIS were evaluated for a postulated 2-factor structure, Cronbach &agr;, and correlations. Results The postulated 2-factor structure could not be replicated. Instead, we found a 3-factor solution (anxiety about the operation, anxiety about the anesthesia, information requirement). The area under the receiver operating characteristics curve ranged from ≥0.65 to ≥0.77. Optimal cutoff scores were calculated. The cutoff score for the anxiety scale was ≥10 for the whole sample and men only, and was ≥11 for women only. Analysis of the psychometric properties yielded satisfactory results (eg. Cronbach &agr; for the anxiety scale >0.84). Conclusions Despite its brevity, the APAIS is valid and recommendable for the assessment of preoperative anxiety in patients with intracranial tumors. As this is the first validation study focusing on patients with severe diseases and major surgeries, we recommend the application of our cutoff scores also for patients similar to our study population with regard to disease and surgery severity.

Strategy instruction in Parkinson's disease: Influence on cognitive performance

OBJECTIVES Though strategic deficits are extensively investigated in Parkinsons disease (PD), little is known about the effects of instruction for PD patients. Thus, we compared the ability to internally generate a cognitive strategy with the ability to use a strategy after elaborate strategy instruction. METHODS Patients with PD (n=14) and matched healthy controls (n=22) were administered a Numerosity Judgement task in which they had to determine different numerosities of blocks presented in a square grid. In more complex task configurations, healthy participants tend to use a subtraction strategy. Participants in our study were confronted with a counting condition (A), a strategy initiation condition without instruction (B), and a strategy elaboration and strategy training condition (C). RESULTS Patients and controls were comparable with respect to basic cognitive measures. PD patients and controls performed equivalently within the counting condition (A), but patients needed significantly more trials to initiate the subtraction strategy. With the exception of 1 PD patient, all patients were able to internally initiate the strategy (condition B). In condition C, both groups increased reaction times, but patients were significantly slower than controls. Moreover, only patients significantly increased error rates after strategy instruction. CONCLUSION As long as sufficient time is provided for solving the task, results do not show a general deficit in the ability to internally generate a cognitive strategy in PD. Failures in strategy utilization strongly depend on cognitive load (working memory, executive functions). This bears important implications for the neuropsychological rehabilitation of PD patients.

Affective state and cognitive functioning in patients with intracranial tumors: validity of the neuropsychological baseline assessment

The aim of this paper is to investigate the relationship between the affective and cognitive states of neurooncological patients prior to the neurosurgical treatment to assess associations between distress levels and neuropsychological test performance in this sample and setting.

Deep brain stimulation for movement disorders and its neuropsychological implications

Deep brain stimulation (DBS) has gained increasing attention as a therapy for movement disorders. Neuropsychological alterations can accompany the disease evolution and medical therapy of PD. Also, interfering abruptly with the biological balance by means of a surgical intervention into complex circuits with motor but also cognitive and limbic functions, could potentially cause severe problems. Because cognitive or emotional impairments may have an even stronger impact on quality of life, than motor symptoms, care must be taken to perform surgery in the safest possible way to exclude adverse effects in these domains. Detailed neuropsychological evaluations may become helpful to further understand the mechanisms underlying some aspects of the clinical pictures both pre- and postoperatively and to define risk populations, that should be excluded from this intervention.

Gliomchirurgie und Neuropsychologie

Etwa 90% der Gliompatienten leiden unter neuropsychologischen Storungen, das heist unter Veranderungen kognitiver Funktionen und/oder des affektiven Befindens infolge der Tumorerkrankung selbst bzw. ihrer Behandlung. Neuropsychologische Storungen haben eine ausgesprochen hohe Relevanz fur Lebensqualitat und Partizipation der Betroffenen. Der Beitrag gibt einen Uberblick uber Ursachen und Art der neuropsychologischen Veranderungen bei Gliompatienten. Im Einzelnen wird auf die unterschiedlichen neuropsychologischen Funktionsbereiche (z. B. Aufmerksamkeit, Gedachtnis), ihre pra- und postoperative diagnostische Erfassung, die Bedeutung fur die neurochirurgische Operations- und Gesamttherapieplanung sowie ihre spezifische Therapie eingegangen. Das Motto »Vom ›Uberleben ob‹ zum ›Uberleben wie‹« steht fur eine starkere Berucksichtigung der neurokognitiven Defizite der Patienten.

A missing piece? Neuropsychiatric functioning in untreated patients with tumors within the cerebellopontine angle

PurposeTo date, little is known about neuropsychiatric symptoms in patients with tumors within the cerebellopontine angle (CPA). These, however, might be of clinical relevance. Aim of this study was thus to assess possible impairment in cognition, elevation in mood symptoms, and fatigue in this specific patient group.MethodsForty-five patients with an untreated CPA tumor (27 vestibularis schwannoma, 18 meningioma) were tested within a cross-sectional observational study in a single institution prior to neurosurgical treatment. Patients were administered a multifaceted battery comprising of widely-used tests for assessment of neuropsychiatric functioning.ResultsThe majority of the included patients (69%) showed neurocognitive impairment, most frequently in the areas of attention and visuo-motor speed (e.g., alertness) (62%) as well as visuo-construction (44%). Impaired structural integrity of the brain stem was accompanied by more serious neurocognitive deficits. About one-third of the sample reported clinically relevant depression and/or anxiety and an even higher proportion (48%) described high levels of fatigue. Cognitive and affective symptoms as well as fatigue contributed significantly to patients’ Quality of Life, indicating the clinical relevance of neuropsychiatric symptoms in patients with CPA tumors.ConclusionsAlthough patients with untreated CPA tumors often suffer from devastating and prominent physical symptoms, neuropsychiatric problems are also frequent. Including these aspects in the routine clinical assessment and initiating treatment accordingly might thus improve clinical management of the patients and improve Quality of Life.

Social cognition in patients with intracranial tumors: do we forget something in the routine neuropsychological examination?

PurposeSocial cognitive functions are of high clinical relevance. To date, little is known about social cognition in neurooncological patients and this domain is usually not included in standardized neurocognitive test batteries. Aim of this study was thus to assess whether social cognition could pose a useful contribution to the neurocognitive assessment in patients with intracranial tumors.MethodsWe included 30 preoperative patients with a brain tumor. Patients completed a comprehensive test battery for assessment of social cognition. Thirty healthy participants matched for age, gender, and education, served as control group. Clinical relevance of social cognitive deficits was assessed via various self-report measures as well as a clinical rating scale assessing social and occupational functioning.ResultsTwenty-five patients (83%) were impaired in at least one measure of social cognition. Whereas patients with lesions to the temporal lobes were most severely impaired, deficits occurred in patients with tumors of a variety of localizations, sizes and malignancies. There was some evidence for missing patients’ awareness as well as clinical significance of social cognitive deficits in terms of impaired interactional and occupational functioning. By combination of the Faux-Pas and the Eyes-Test, 77% of patients who were impaired in any social cognitive task were detected.ConclusionsDeficits in social cognition are frequent and clinically relevant in patients with intracranial tumors. The inclusion of social cognitive measures in the routine neuropsychological examination for brain tumor patients might add valuable information about the patient whilst requiring reasonable additional resources.

Assessment of preoperative anxiety in neurosurgical patients: Comparison of widely used measures and recommendations for clinic and research

OBJECTIVE Preoperative anxiety is frequent in neurosurgical patients and of high clinical relevance (e. g., associated with anestesiological requirements and surgery outcome). Little however is known about the quality of instruments for assessment of preoperative anxiety in this specific patient group and setting. This paper therefore focused on the psychometric properties of widely used questionnaires. Aim of this study was thus to enable both the clinician and the researcher to select appropriate instruments for assessment of surgery-related anxiety. PATIENTS AND METHODS The following instruments for assessment of preoperative anxiety were administered in a pseudo-randomized order one day prior to surgery in sample of 158 neurosurgical patients: The State Trait Operation Anxiety Inventory (STOA) - state scale, the Amsterdam Preoperative Anxiety and Information Scale (APAIS), and the one-item visual analogue scale (VAS). The questionnaires were psychometrically tested according to classical test theory (validity, reliability, diagnostic accuracy). RESULTS Construct validity was supported in all applied measures (convergent and divergent validity, known-group comparisons). For the STOA state, we found a one factor scale structure and thus no support for the proposed subscales covering cognitive and affective anxiety. The proposed scale structure of the APAIS, measuring anxiety and information requirement, was replicated. Internal consistency as indicator for reliability of the STOA and the APAIS was excellent (Cronbachs alpha = 0.937/0.868). All instruments showed adequate diagnostic accuracy with the most favourable results of the STOA. CONCLUSIONS All instruments included in this study can be recommended for assessment of surgery-related anxiety in neurosurgical patients with regard to their psychometric properties. Each instrument offers distinct advantages. Thus, clinicians and researchers can base their individual choice on specific aims and available resources.