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Cognitive functioning in a cohort of high-grade glioma patients

Andreja Cirila Skufca Smrdel

Andreja Cirila Skufca Smrdel

  • Department of Psycho-Oncology, Institute of Oncology LjubljanaLjubljana, Slovenia
  • Department of Psychology, Faculty of Arts, University of LjubljanaSlovenia
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Skufca Smrdel, Andreja Cirila
, 
Anja Podlesek

Anja Podlesek

Department of Psychology, Faculty of Arts, University of LjubljanaSlovenia
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Podlesek, Anja
, 
Marija Skoblar Vidmar

Marija Skoblar Vidmar

  • Division of Radiotherapy, Institute of Oncology LjubljanaLjubljana, Slovenia
  • Faculty of Medicine, University of LjubljanaSlovenia
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Skoblar Vidmar, Marija
, 
Jana Markovic

Jana Markovic

Department of Psycho-Oncology, Institute of Oncology LjubljanaLjubljana, Slovenia
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Markovic, Jana
, 
Jana Jereb

Jana Jereb

Department of Psycho-Oncology, Institute of Oncology LjubljanaLjubljana, Slovenia
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Jereb, Jana
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Manja Kuzma Okorn

Manja Kuzma Okorn

University Medical Centre LjubljanaSlovenia
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Okorn, Manja Kuzma
 and 
Uros Smrdel

Uros Smrdel

  • Division of Radiotherapy, Institute of Oncology LjubljanaLjubljana, Slovenia
  • Faculty of Medicine, University of LjubljanaSlovenia
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Smrdel, Uros
  
Jun 21, 2023
Cognitive functioning in a cohort of high-grade glioma patients's Cover Image
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Article Category: Research Article
Published Online: Jun 21, 2023
Page range: 201 - 210
Received: Nov 29, 2022
Accepted: Dec 31, 2022
DOI: https://doi.org/10.2478/raon-2023-0009
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© 2023 Andreja Cirila Skufca Smrdel et al., published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.

FIGURE 1.

Recruitment protocol, N = 275
Recruitment protocol, N = 275

Number of patients with different combinations of IDH1 mutation expression and methyl guanine methyl transferase (MGMT) methylation

MGMT-met MGMT-unmet Total
IDH1-mut 5 10 15
IDH1-wt 49 26 75
Total 54 36 90

Cognitive functioning regarding to isocitrate dehydrogenase 1 (IDH1) mutation

IDH1–wt IDH-mut Result of the statistical test IDH1–wt IDH1-mut Result of the statistical test
N Mean Z score (SD) N Mean Z score (SD) % of impaired % of impaired
TMT A 53 3.121 (3.84) 15 2.06 (2.23) U = 345.000, z = −0.77, df = 66, p= 0.437 72 46 χ2(1) = 3.67, V = 0.20, p = 0.055
TMT B 33 2.821 (3.11) 13 2.76 (2.57) U = 221.500, z = −0.17, df = 66, p = 0.864 82 60 χ2(1) = 3.87, V = 0.21, p = 0.050
SCOWA 66 −1.28 (0.87) 15 −0.86 (0.84) t = −1.69, df = 79, p = 0.095 51 27 χ2(1) = 2.89, V = 0.18, p = 0.089
SVLT-ir 65 −1.98 (1.06) 15 −1.15 (1.12) t = −2.729, df = 78, p = 0.008 71 33 χ2(1) = 7.60, V = 0.29, p = 0.006
SVLT-sr 65 −2.20 (1.29) 15 −1.37 (1.22) t = −2.25, df = 78, p = 0.027 84 53 χ2(1) = 7.06, V = 0.28, p = 0.008
SVLT-dr 65 −2.14 (1.27) 15 −0.98 (1.34) t = −3.13, df = 78, p =0.002 69 33 χ2(1) = 6.98, V = 0.28, p = 0.008
SVLT-recog 65 −3.061 (3.54) 15 −1.24 (1.91) U = 611.000, z = −2.25, df = 78, p = 0.023 29 26 χ2(1) = 3.00, V = 0.18, p = 0.083

Demographic and medical data

Variable Levels f (%) Descriptive statistics
Gender Male 57 (63%)
Female 33 (37%)
Age < 50 years 17 (19%) M = 58.78, SD = 11.31min = 30, max = 84
50–70years 60 (67%)
> 70 years 13 (14%)
Education ≤9 years 14 (16%)
10–13 years 48 (53%)
14–19 years 26 (29%)
≥20 years 2 (2%)
Tumour grade Grade III 12 (13%)
Grade IV 78 (87%)
Tumour location Frontal 34 (38%)
Parietal 21 (23%)
Temporal 26 (29%)
Occipital 4 (4%)
central 3 (3%)
Diffuse 2 (2%)
Hemisphere Right 38 (42%)
Left 44 (49%)
Both 8 (9%)
Surgery type Biopsy 11 (12%)
Reduction 49 (54%)
Gross tumour resection 30 (33%)
Karnoffsky performance status 70 32 (36%)
80 37 (41%)
90 18 (20%)
100 3 (3%)
Corticosteroids (Yes/no, mg) Yes 66 (73%) M = 5.55, SD = 4.73min 0, max 24
No 24 (27%)
Radio-chemotherapy (intention to treat) Yes 90 (100%)
No 0 (0%)
Time to beginning of adjuvant treatment (in weeks) ≤ 6 weeks 60 (67%) M = 5.98, SD = 2.25min 3, max 15
≥ 7 weeks 30 (33%)
Epilepsy Yes 27 (30%)
No 63 (70%)
IDH1 mutation IDH1 mutation 15 (17%)
IDH1 wild type 75 (83%)
MGMT methylation* Yes 36 (42%)
No 50 (58%)

Patient characteristics, regarding isocitrate dehydrogenase 1 (IDH1) mutation

IDH1-wt (N = 75) IDH1-mut (N=15) Result of the statistical test and effect size
Age mean (min/max/SD) 61.50 (31 / 84 / 9.21) 38.75 (30 / 67 / 3.86) t = −5.97, df = 88, p< 0.001
Sex (female / male) 29 / 46 4 / 11 χ2(1) = 0.775, f = −0.93, p = 0.379
Education level (≤ 9 years /10–13 years / 14–19 years / ≥ 20 years) 11 / 40 / 22 / 2 3 / 8 / 4 / 0 τb(3) = −0.06, z = −0.83, p = 0.547
KPS (70/80/90/100) 31 / 34 / 7 / 3 1 / 3 / 11 / 0 τb(3) = 0.403, z = 18.95, p < 0.001
WHO grade (III / IV) 1 /74 11 /4 χ2(1) = 56.08, f = −0.789, p < 0.001
Corticosteroids mg (min/max/SD) 2 (0 / 16 / 6) 5 (0 / 24 / 4.5) t = −1.16, df = 88, p = 0.251
biopsy/reduction/gross tumour resection 9 / 44 / 22 2 / 5 / 8 χ2(2) = 3.65, V = 0.210, p = 0.161
Tumour location (frontal / temporal / parietal / occipital / diffuse / central) 26 / 20 / 21 / 4 / 2 / 2 8 / 1 / 5 / 0 / 1 / 0 NA
Hemisphere (right / left / both) 21 / 27 / 6 17 / 17 / 2 χ2(2) = 1.14, V = 0.113, p = 0.566
MGMT (yes / no) 10 / 5 26 /49 χ2(1) = 5.33, f = 0.24, p = 0.021

Cognitive functioning regarding methyl guanine methyl transferase (MGMT) methylation

MGMT-met MGMT-unmet Result of the statistical test MGMT-met MGMT –unmet Result of the statistical test
N Mean Z score (SD) N Mean Z score (SD) % of impaired % of impaired
TMT A 26 2.67 (3.01) 42 3.031 (3.90) U = 530.000, z = −0.20, df = 67, p = 0.840 69 66 χ2(1) = 0.08, V = 0.03, p = 0.782
TMT B 20 3.22 (2.30) 26 2.481 (3.37) U = 334.000, z = 1.64, df = 45, p = 0.101 86 74 χ2(1) = 1.88, V = 0.14, p = 0.170
SCOWA 33 −1.25 (0.87) 48 −1.181 (0.89) U = 756.000, z = −0.35, df = 70, p = 0.729 50 44 χ2(1) = 0.27, V = 0.05, p = .605
SVLT-ir 32 −1.85 (1.27) 48 −1.821 (1.01) U = 771.000, z = 0.03, df = 78, p = 0.975 64 67 χ2(1) = 0.01, V = 0.01, p = 0.928
SVLT-sr 32 −2.03 (1.32) 48 −2.06 (1.32) t = 0.09, df = 78, p = 0.926 75 81 χ2(1) = 0.54, V = 0.08, p = 0.460
SVLT-dr 32 −1.98 (1.52) 48 −1.89 (1.25) t = −0.30, df = 78, p = 0.763 66 61 χ2(1) = 0.29, V = 0.06, p = 0.592
SVLT-recog 32 −2.731 (4.24) 48 −2.721 (2.71) U = 784.000, z = 0.828, df = 78, p = 0.407 58 61 χ2(1) = 0.07, V = 0.03, p = 0.792

Patient characteristics regarding methyl guanine methyl transferase (MGMT) methylation

MGMT-unmet (N=54) MGMT-met (N = 36) Result of the statistical test and effect size
Age mean (min/max/SD) 58.94 (31 / 84 / 10.42) 1 58,53 (30 / 78 / 12.67) t = −0.17, df = 88, p = 0.86
Sex (female / male) 19 / 35 14 / 22 χ2(1) = 0.13, f = 0.04, p = 0.721
Education level (≤9 years /10–13 years / 14–19 years / ≥ 20 years) 8 / 19 / 11 / 0 9 / 29 / 15 / 2 τb (3) = −0.03, z = −1.41, p = 0.776
KPS (70/80/90/100) 20 / 23 / 9 / 2 12 / 14 / 9 /1 τb (3) =0.06, z = 2.82, p = 0.541
WHO grade (III / IV) 3 / 51 9 / 27 χ2(1) = 7.07, f= −0.28, p = 0.008
Corticosteroids mg (min/max/SD) 5.67 (0 /24 / 5,04) 5.48 (0 / 16 / 4.22) t = 0.18, df = 88, p = 0.857
Biopsy/reduction/gross tumour resection 9 / 31 / 14 2 / 18 / 16 χ2(2) = 4.62, V = 0.23, p = 0.099
Tumour location (frontal / temporal / parietal / occipital / diffuse / central) 26 / 20 / 21 / 4 / 2 / 2 8 / 1 / 5 / 0 / 1 / 0 NA
Hemisphere (right / left / both) 28 / 40 / 7 10 / 4 / 1 χ2(2) = 4.46, V = 0.223, p = 0.107
IDH1 (yes / no) 5 / 49 10 / 26 χ2(1) = 5.33, f = 0.24, p = 0.021

Descriptive statistics for standardized test scores (z–values) and proportion of impaired patients in psychological cognitive functioning tests

Domain Test % impaired / all N % impaired / capable Mean z score SD of z scores
Visual – motor speed TMT A 68 68 57 2.89 3.57
Executive function TMT B 78 46 59 2.80 2.94
Verbal fluency SCOWA 47 81 41 −1.21 0.88
Memory
  immediate recall SVLT-ir 64 80 60 −1.83 1.11
  short delayed recall SVLT-sr 79 76 −2.05 1.31
  delayed recall SVLT-dr 63 58 −1.92 1.35
  recognition SVLT-recog 60 52 −2.73 3.36
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