Innovations In Clinical Neuroscience

JAN-FEB 2018

A peer-reviewed, evidence-based journal for clinicians in the field of neuroscience

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R E V I E W 39 ICNS Innovations in Clinical Neuroscience • January–February 2018 • Volume 15 • Number 1–2 is a crucial component of a comprehensive oncological treatment plan. The delineation of cognitive changes over time is particularly helpful when clarity is needed to guide possible management and treatment intervention. 5 Evaluation of cognitive functioning in patients with cancer might also be needed for evaluation of disability benefits or work limitations. Oncology cognitive evaluations should emphasize tests that assess frontal-subcortical network functioning, including learning and memory, executive functioning, speed of processing, and speeded motor coordination. Table 1 describes the major domains that are often included in cognitive assessments. Ideally, a pretreatment, baseline evaluation followed by serial assessments to gauge the trajectory of cognitive changes and impairment over time are recommended. 5 Currently, a universally accepted, standardized set of cognitive assessment measures does not exist for the evaluation of cancer-associated cognitive changes and impairment. In fact, the literature on cancer and cancer therapy-related cognitive impairment reveals marked differences in the definitions used, the cognitive domains explored, and the types of assessment measures used to evaluate cognitive functioning. Meyers and Brown 87 and Wefel and colleagues 88 developed their own cognitive test batteries to assess cancer patients. These assessments consisted of reliable, well-known cognitive measures: Digit Span (attention); Digit Symbol (information processing); Block Design and Similarities of the WAIS-III (visuoconstruction and conceptual formation, respectively); Trail Making Test: Trails A and B (attention and executive functioning); Hopkins Verbal Learning Test (verbal learning and memory); Grip Strength (motor functioning); Grooved Pegboard (fine motor coordination); Boston Naming Test (naming objects); Token Test (receptive language); and Controlled Word Association Test (COWA) (executive functioning spontaneous language production). However, some of these measures were not designed for repeated, serial assessment, and the lack of parallel versions for some of the measures undermines their utility in longitudinal studies. TABLE 1. Cognitive Domains Assessed in Neuropsychological Evaluations MA JOR COGNITIVE DOMAINS COGNITIVE FUNCTIONS DIFFICULTIES ASSOCIATED WITH IMPAIRMENTS MA JOR COGNITIVE DOMAINS COGNITIVE FUNCTIONS DIFFICULTIES ASSOCIATED WITH IMPAIRMENTS Verbal learning and memory Learning, encoding, storing, and retrieval of verbal information, including working memory, immediate free and cued recall, short-term and long-term free and cued recall, and recognition of verbal information Difficulty in encoding, retaining, and retrieval of verbal information Executive function Higher order cognitive functions necessary for purposeful, goal- directed behavior, including planning, conceptualizing, organizing, reasoning, insight, problem solving, evaluative judgment, and effective execution of action, particularly in novel situations. Simplified or confused mental tracking of actions, problems with organizing and following plans, difficulties with reasoning, decision making, and concept formation, perseveration of speech and action Visual learning and memory Learning, encoding, storing, and retrieval of visual information, including working memory, immediate free and cued recall, short-term and long-term free and cued recall, and recognition of visual stimuli Difficulty in encoding, retaining, and retrieval of visual information Sensory- perceptual functions Somatosensory function, sensory perception and discrimination, including tactile, pressure, and localization, right-left discrimination Somatosensory alterations (especially lateralized or confined to one limb), right-left disorientation Speech and language Oral and written abilities to comprehend information, repeat information, and express information; word finding and naming Wording finding difficulties, paraphasias, dysarthria, dysfluency, communication difficulties Motor speed and strength Gross and manual fine-motor abilities and grip strength Lateralized weakness or clumsiness, problems with fine motor coordination, diminished ability in performing fine-motor manual skills Visuospatial processing Abilities and skills involved in making sense of the visual world, including shapes, angles, details, overall gestalts, the meaning of forms, reproduction of what one sees, locating objects in space, and spatial analysis of parts related to more complex objects Visual field alterations, diplopia, neglect or inattention, impairment in spatial orientation, judgment, and relationships Emotion and personality functioning Current affective and emotional states and stable traits, personality characteristics Affective changes, diminished emotional control with temper outbursts, increased irritability, personality changes Attention and concentration Ability to focus awareness on a given stimulus or task, to concentrate on a stimulus or task long enough to accomplish a goal, and to shift awareness, if appropriate. Attentional processes include alertness/arousal, focused attention, selective attention, divided attention, and sustained attention or vigilance. Diminished ability to focus awareness and concentration, difficulty with focused searching, problems with filtering irrelevant from relevant information, disrupted interactions and completion of tasks Academic skills Reading, reading comprehension, writing skills, spelling, computation, and functional academic skills that might be relevant to independent activities of daily living and work situations (e.g., handling finances; reading rate and retention) Alterations in reading and reading comprehension, writing of words, letters and numbers, manipulating numbers, calculations

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