Neurocognitive evaluation in older adult patients affected by glioma Antonio Tanzilli a, ⁎, Andrea Pace a , Alessandra Fabi b , Stefano Telera c , Antonello Vidiri d , Mariantonia Carosi e , Irene Terrenato f , Tatiana Koudriavtseva a , Riccardo Boccaletti c , Veronica Villani a a Neuro-Oncology Unit, I.R.C.C.S. Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy b Division of Medical Oncology, I.R.C.C.S. Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy c Division of Neurosurgery, I.R.C.C.S. Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy d Division of Radiology, I.R.C.C.S. Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy e Division of Neuropathology, I.R.C.C.S. Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy f Biostatistic Unit, Scientific Direction, I.R.C.C.S. Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy abstract article info Article history: Received 18 December 2018 Received in revised form 3 June 2019 Accepted 21 June 2019 Available online xxxx Background: Glioblastoma (GBM) has an increasing incidence and dismal prognosis in older adults. This study evaluated neurocognitive status of an older adult population with GBM and its correlation with clinical and de- mographical variables. Methods: Each patient underwent an extended neuropsychological evaluation by means of a battery of standard- ized tests describing eight cognitive domains: global function; verbal learning; short- and long-term memory (LTM); executive functions (EFs); abstract reasoning (AR); attention; and visuo-constructional abilities (CA). Results: We assessed 79 patients with GBM (median age: 74 years). Out of this initial sample, a subgroup of sev- enteen patients with six-month median time underwent a follow-up test session. 46 out of the 79 patients (58.2%) presented multi-domain cognitive impairment, 24 patients (30.3%) showed single-domain cognitive im- pairment and only seven (9%) showed no cognitive impairment. Kaplan Meier estimator showed that patients with AR deficit had a poorer prognosis in terms of progression-free survival and overall survival (p b .001). At the multivariate analysis AR (deficit vs non; hazard ratio (HR) = 5.07, 95%; confidence interval (CI): 1.91–13.46; p b .001) was correlated with disease progression and overall survival, AR (deficit vs non; HR = 7.24, 95% CI: 2.58–20.32; p b .001). Eight out of seventeen patients who underwent follow-up test session showed cognitive improvement, five re- sulted in further deterioration, and four patients remained stable. LTM, EF, and CA were the most affected func- tions at follow-up, while verbal learning was the most improved one in patients with cognitive improvement. Conclusions: Cognitive functioning evaluation should be included among the standard clinical endpoints in the treatment of older adult neuro-oncology patients. © 2019 Published by Elsevier Ltd. Keywords: Cognitive Older adults Glioma survival Progression-free survival 1. Introduction Glioblastoma (GBM) is the most common primary brain tumor in adults with an increasing incidence in patients between 75 and 85 years of age [1]. GBM is associated with a particularly dismal progno- sis in the older adults, with a median survival of less than six months. This decreased overall life expectancy likely reflects more aggressive tumor biology, lower functional reserve and greater number of pre- existing medical comorbidities compared with younger patients [2,3]. A recent study by Perry et al. supplied evidence in the role of O 6 - methylguanine-DNA methyltransferase (MGMT) methylation and high Mini Mental State Examination (MMSE) scores in terms of longer progression-free survival (PFS) and overall survival (OS) [3]. Given the poor prognosis, the primary objective of the therapy is to reduce morbidity and restore or preserve neurologic functions and quality of life. Patients with glioma, suffer cognitive impairment at diagnosis [4]. The rate of cognitive deficits varies from 29%, in the case of patients with low-grade glioma not receiving radiotherapy [5], to 90% in patients with brain tumors (BT), who underwent anti-cancer treatments [6–11]. Data variability can be explained by differences in inclusion criteria, treatment regimens, and assessment tools. Moreover, cognitive impair- ment is considered the greatest cause of burden and disability [12], re- ducing social, familial, and career-related activities [13]. However, in clinical practice and in clinical trials, cognitive impair- ment in older adult patients with glioma is under-studied. More re- cently, both patient-reported outcome (PRO) measures and Journal of Geriatric Oncology xxx (2019) xxx ⁎ Corresponding author at: Neuro-Oncology Unit, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy. E-mail address: antonio.tanzilli@ifo.gov.it (A. Tanzilli). JGO-00771; No. of pages: 8; 4C: https://doi.org/10.1016/j.jgo.2019.06.015 1879-4068/© 2019 Published by Elsevier Ltd. Contents lists available at ScienceDirect Journal of Geriatric Oncology Please cite this article as: A. Tanzilli, A. Pace, A. Fabi, et al., Neurocognitive evaluation in older adult patients affected by glioma, J Geriatr Oncol, https://doi.org/10.1016/j.jgo.2019.06.015