Top

Published in:

01-05-2019 | Care | Clinical Study

Cognitive rehabilitation for executive dysfunction in brain tumor patients: a pilot randomized controlled trial

Authors: Nadine M. Richard, Lori J. Bernstein, Warren P. Mason, Normand Laperriere, Catherine Maurice, Barbara-Ann Millar, David B. Shultz, Alejandro Berlin, Kim Edelstein

Published in: Journal of Neuro-Oncology | Issue 3/2019

Abstract

Purpose

Patients with brain tumors face unique quality of life challenges. Executive dysfunction is common and functionally limiting, with no established treatments as standard care. This pilot study evaluated the efficacy of Goal Management Training (GMT), a behavioral intervention combining mindfulness and strategy training, for improving executive and real-life functioning in this population.

Methods

Twenty-five primary brain tumor survivors were randomized to GMT, an active control (Brain Health Program, BHP), or a wait-list (WAIT) control group. The BHP was a supportive care intervention offering education and activities to promote general brain health, without cognitive strategy training. Participants in GMT and BHP completed eight individual sessions and homework between sessions; those in WAIT received usual care. Assessments at baseline, immediately post-training, and 4-month follow-up used a battery of objective and subjective measures, including functional goal attainment.

Results

Adherence (% sessions completed) was high for both GMT (98.9%) and BHP (84.4%). Executive functions improved with GMT but not BHP or WAIT (repeated measures analysis of variance, time-by-group interaction, post-training P = 0.077, follow-up P = 0.046). Both intervention groups reported fewer cognitive concerns at post-training (P = 0.049) and follow-up (P < 0.001). Functional goal attainment was greatest with GMT (post-training P = 0.027, follow-up P = 0.064).

Conclusions

GMT improved executive and real-life functioning in brain tumor survivors, with gains maintained at 4-month follow-up. Clinical implementation of this adaptable program merits consideration for clinically stable patients with cognitive dysfunction. Further development and larger prospective cognitive rehabilitation trials appear warranted.

Available only for authorised users

www.goalmanagementtraining.com.

Liu R, Page M, Solheim K, Fox S, Chang SM (2009) Quality of life in adults with brain tumors: current knowledge and future directions. Neuro-oncology 11(3):330–339. https://doi.org/10.1215/15228517-2008-093 CrossRefPubMedPubMedCentral

Gehrke AK, Baisley MC, Sonck AL, Wronski SL, Feuerstein M (2013) Neurocognitive deficits following primary brain tumor treatment: systematic review of a decade of comparative studies. J Neuro-oncol 115(2):135–142. https://doi.org/10.1007/s11060-013-1215-2 CrossRef

Meyers CA, Hess KR (2003) Multifaceted end points in brain tumor clinical trials: cognitive deterioration precedes MRI progression. Neuro-oncology 5(2):89–95. https://doi.org/10.1093/neuonc/5.2.89 CrossRefPubMedPubMedCentral

Tucha O, Smely C, Preier M, Lange KW (2000) Cognitive deficits before treatment among patients with brain tumors. Neurosurgery 47(2):324–334. https://doi.org/10.1097/00006123-200008000-00011 CrossRefPubMed

Robertson IH (1996) Goal management training: a clinical manual. PsyConsult, Cambridge

Levine B, Manly T, Robertson IH (2012) Goal management training: trainer’s manual. Baycrest Centre for Geriatric Care, Toronto

Norman DA, Shallice T (1986) Attention to action: willed and automatic control of behavior. In: Davidson RJ, Schwartz GE, Shapiro D (eds) Consciousness and self regulation. Plenum, New York, pp 1–17

Duncan J, Emslie H, Williams P, Johnson R, Freer C (1996) Intelligence and the frontal lobe: the organization of goal-directed behavior. Cogn Psychol 30:257–303CrossRefPubMed

Stamenova V, Levine B (2018) Effectiveness of goal management training(R) in improving executive functions: a meta-analysis. Neuropsychol Rehabil. https://doi.org/10.1080/09602011.2018.1438294 CrossRefPubMed

10.

Cabrera S, Edelstein K, Mason WP, Tartaglia MC (2016) Assessing behavioral syndromes in patients with brain tumors using the frontal systems behavior scale (FrSBe). Neuro-oncol Pract 3(2):113–119. https://doi.org/10.1093/nop/npv055 CrossRef

11.

Zwinkels H, Dirven L, Vissers T, Habets EJJ, Vos MJ, Reijneveld JC, van den Bent MJ, Taphoorn MJB (2016) Prevalence of changes in personality and behavior in adult glioma patients: a systematic review. Neuro-oncol Pract 3(4):222–231. https://doi.org/10.1093/nop/npv040 CrossRef

12.

Day J, Zienius K, Gehring K, Grosshans D, Taphoorn M, Grant R, Li J, Brown PD (2014) Interventions for preventing and ameliorating cognitive deficits in adults treated with cranial irradiation. Cochrane Database Syst Rev 12:Cd011335. https://doi.org/10.1002/14651858.CD011335.pub2 CrossRef

13.

Levine B, Schweizer T, O’Connor C, Turner GR, Gillingham S, Stuss DT, Manly T, Robertson IH (2011) Rehabilitation of executive functioning in patients with frontal lobe damage with goal management training. Front Hum Neurosci. https://doi.org/10.3389/fnhum.2011.00009 CrossRefPubMedPubMedCentral

14.

Tombaugh TN (2004) Trail making test A and B: normative data stratified by age and education. Arch Clin Neuropsychol 19(2):203–214. https://doi.org/10.1016/s0887-6177(03)00039-8 CrossRefPubMed

15.

Reitan RM, Wolfson D (1985) The Halstead–Reitan neuropsycholgical test battery: therapy and clinical interpretation. Neuropsychological Press, Tucson

16.

Robertson IH, Ward T, Ridgeway V, Nimmo-Smith I (1994) Test of everyday attention. Thames Valley Test Company, Suffolk

17.

Robertson IH, Manly T, Andrade J, Baddeley BT, Yiend J (1997) “Oops!” performance correlates of everyday attentional failures in traumatic brain injured and normal subjects. Neuropsychologia 35(6):747–758CrossRefPubMed

18.

Manly T, Hawkins K, Evans JJ, Woldt K, Robertson IH (2002) Rehabilitation of executive function: facilitation of effective goal management on complex tasks using periodic auditory alerts. Neuropsychologia 40(3):271–281CrossRefPubMed

19.

Wilson BA, Alderman N, Burgess PW, Emslie H, Evans JJ (1996) Behavioural assessment of the dysexecutive syndrome (BADS). Thames Valley Test Company, Bury St. Edmunds

20.

Benedict RHB, Schretlen D, Groninger L, Brandt J (1998) Hopkins verbal learning test—revised: normative data and analysis of inter-form and test-retest reliability. Clin Neuropsychol 12(1):43–55. https://doi.org/10.1076/clin.12.1.43.1726 CrossRef

21.

Brandt J, Benedict R (2001) Hopkins verbal learning test-revised: professional manual. Psychological Assessment Resources, Lutz

22.

Roth RM, Isquith PK, Gioia GA (2006) Behavior rating inventory of executive function-adult version (BRIEF-A). Psychological Assessment Resources, Lutz

23.

Grace J, Malloy P (2001) The frontal systems behavior scale: professional manual. Psychological Assessment Resources, Lutz

24.

Watson D, Clark LA, Tellegen A (1988) Development and validation of brief measures of positive and negative affect: the PANAS scales. J Pers Soc Psychol 54(6):1063–1070CrossRefPubMed

25.

Zigmond AS, Snaith RP (1983) The hospital anxiety and depression scale. Acta Psychiatr Scand 67(6):361–370CrossRefPubMed

26.

Crawford JR, Henry JD, Crombie C, Taylor EP (2001) Normative data for the HADS from a large non-clinical sample. Br J Clin Psychol 40(Pt 4):429–434CrossRefPubMed

27.

Schwarzer R, Jerusalem M (1995) Generalized Self-Efficacy Scale. In: Weinman J, Wright S, Johnston M (eds) Measures in health psychology: a user’s portfolio. Causal and control beliefs. NFER-Nelson, Windsor, pp 35–37

28.

Devins GM (2010) Using the illness intrusiveness ratings scale to understand health-related quality of life in chronic disease. J Psychosom Res 68(6):591–602. https://doi.org/10.1016/j.jpsychores.2009.05.006 CrossRefPubMed

29.

Kiresuk TJ, Smith A, Cardillo JE (1994) Goal attainment scaling: applications, theory, and measurement. Erlbaum, London

30.

Bovend’Eerdt TJ, Botell RE, Wade DT (2009) Writing SMART rehabilitation goals and achieving goal attainment scaling: a practical guide. Clin Rehabil 23(4):352–361CrossRefPubMed

31.

Sullivan GM, Feinn R (2012) Using effect size—or why the P value is not enough. J Grad Med Educ 4(3):279–282. https://doi.org/10.4300/jgme-d-12-00156.1 CrossRefPubMedPubMedCentral

32.

Lakens D (2013) Calculating and reporting effect sizes to facilitate cumulative science: a practical primer for t-tests and ANOVAs. Front Psychol 4:863. https://doi.org/10.3389/fpsyg.2013.00863 CrossRefPubMedPubMedCentral

33.

Scott BM (2007) Estimating effect sizes from pretest-posttest-control group designs. Organ Res Methods 11(2):364–386. https://doi.org/10.1177/1094428106291059 CrossRef

34.

Cohen JD (1988) Statistical power analysis for the behavioral sciences, 2nd edn. L. Erlbaum Associates, Hillsdale

35.

Perneger TV (1998) What’s wrong with Bonferroni adjustments. BMJ 316:1236–1238. https://doi.org/10.1136/bmj.316.7139.1236 CrossRefPubMedPubMedCentral

36.

Tang V, Rathbone M, Park Dorsay J, Jiang S, Harvey D (2008) Rehabilitation in primary and metastatic brain tumours: impact of functional outcomes on survival. J Neurol 255(6):820–827. https://doi.org/10.1007/s00415-008-0695-z CrossRefPubMed

37.

Piil K, Juhler M, Jakobsen J, Jarden M (2014) Controlled rehabilitative and supportive care intervention trials in patients with high-grade gliomas and their caregivers: a systematic review. BMJ Support Palliat Care. https://doi.org/10.1136/bmjspcare-2013-000593 CrossRefPubMedPubMedCentral

38.

Metzler-Baddeley C, Jones RW (2010) Brief communication: cognitive rehabilitation of executive functioning in a case of craniopharyngioma. Appl Neuropsychol 17(4):299–304. https://doi.org/10.1080/09084282.2010.523394 CrossRefPubMed

39.

Whiting DL, Simpson GK, Koh ES, Wright KM, Simpson T, Firth R (2012) A multi-tiered intervention to address behavioural and cognitive changes after diagnosis of primary brain tumour: a feasibility study. Brain Inj 26(7–8):950–961. https://doi.org/10.3109/02699052.2012.661912 CrossRefPubMed

40.

Sacks-Zimmerman A, Duggal D, Liberta T (2015) Cognitive remediation therapy for brain tumor survivors with cognitive deficits. Cureus 7(10):e350. https://doi.org/10.7759/cureus.350 CrossRefPubMedPubMedCentral

41.

Svoboda E, Richards B, Polsinelli A, Guger S (2010) A theory-driven training programme in the use of emerging commercial technology: application to an adolescent with severe memory impairment. Neuropsychol Rehabil 20(4):562–586. https://doi.org/10.1080/09602011003669918 CrossRefPubMed

42.

Maschio M, Dinapoli L, Fabi A, Giannarelli D, Cantelmi T (2015) Cognitive rehabilitation training in patients with brain tumor-related epilepsy and cognitive deficits: a pilot study. J Neuro-oncol 125(2):419–426. https://doi.org/10.1007/s11060-015-1933-8 CrossRef

43.

Miotto EC, Savage CR, Evans JJ, Wilson BA, Martin MGM, Balardin JB, Barros FG, Garrido G, Teixeira MJ, Amaro Junior E (2013) Semantic strategy training increases memory performance and brain activity in patients with prefrontal cortex lesions. Clin Neurol Neurosurg 115(3):309–316. https://doi.org/10.1016/j.clineuro.2012.05.024 CrossRefPubMed

44.

Hassler M, Elandt K, Preusser M, Lehrner J, Binder P, Dieckmann K, Rottenfusser A, Marosi C (2010) Neurocognitive training in patients with high-grade glioma: a pilot study. J Neuro-oncol 97(1):109–115. https://doi.org/10.1007/s11060-009-0006-2 CrossRef

45.

Gehring K, Sitskoorn MM, Gundy CM, Sikkes SAM, Klein M, Postma TJ, van den Bent MJ, Beute GN, Enting RH, Kappelle AC, Boogerd W, Veninga T, Twijnstra A, Boerman DH, Taphoorn MJB, Aaronson NK (2009) Cognitive rehabilitation in patients with gliomas: a randomized, controlled trial. J Clin Oncol 27(22):3712–3722. https://doi.org/10.1200/jco.2008.20.5765 CrossRefPubMed

46.

Gehring K, Aaronson N, Taphoorn M, Sitskoorn M (2011) A description of a cognitive rehabilitation programme evaluated in brain tumour patients with mild to moderate cognitive deficits. Clin Rehabil 25(8):675–692. https://doi.org/10.1177/0269215510395791 CrossRefPubMed

47.

Yang S, Chun MH, Son YR (2014) Effect of virtual reality on cognitive dysfunction in patients with brain tumor. Ann Rehabil Med 38(6):726–733. https://doi.org/10.5535/arm.2014.38.6.726 CrossRefPubMedPubMedCentral

48.

Simons DJ, Boot WR, Charness N, Gathercole SE, Chabris CF, Hambrick DZ, Stine-Morrow EA (2016) Do “brain-training” programs work? Psychol Sci Public Interest 17(3):103–186. https://doi.org/10.1177/1529100616661983 CrossRefPubMed

49.

Sherer M, Meyers CA, Bergloff P (1997) Efficacy of postacute brain injury rehabilitation for patients with primary malignant brain tumors. Cancer 80(2):250–257CrossRefPubMed

50.

Mateer CA (1999) The rehabilitation of executive disorders. In: Stuss DT, Winocur G, Robertson IH (eds) Cognitive neurorehabilitation. Cambridge University Press, Cambridge, pp 314–332

Title: Cognitive rehabilitation for executive dysfunction in brain tumor patients: a pilot randomized controlled trial
Authors: Nadine M. Richard
Lori J. Bernstein
Warren P. Mason
Normand Laperriere
Catherine Maurice
Barbara-Ann Millar
David B. Shultz
Alejandro Berlin
Kim Edelstein
Publication date: 01-05-2019
Publisher: Springer US
Keywords: Care
Brain Tumor
Published in: Journal of Neuro-Oncology / Issue 3/2019
Print ISSN: 0167-594X
Electronic ISSN: 1573-7373
DOI: https://doi.org/10.1007/s11060-019-03130-1

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Cognitive rehabilitation for executive dysfunction in brain tumor patients: a pilot randomized controlled trial

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 3/2019

Proton therapy for skull-base chondrosarcoma, a single-institution outcomes study

Monitoring of intracerebellarly-administered natural killer cells with fluorine-19 MRI

Targeted next-generation sequencing panel (TruSight Tumor 170) in diffuse glioma: a single institutional experience of 135 cases

pH-weighted amine chemical exchange saturation transfer echoplanar imaging (CEST-EPI) as a potential early biomarker for bevacizumab failure in recurrent glioblastoma

High-dose radiation therapy is needed for intracranial control and long-term survival in patients with non-seminomatous germ cell tumor brain metastases

Longer genotypically-estimated leukocyte telomere length is associated with increased meningioma risk