Neurocognition of patients on whole brain radiotherapy: A prospective study
Notice bibliographique
Résumé
INTRODUCTION: The greatest fear with the application of WBRT is the fear of neurocognitive decline. The main component of this WBRT related cognitive decline is the immediate and delayed verbal memory. But the decline in performance is seen in various other neurocognitive and executive function. Cognitive decline is said to be the main reason for poor quality of life. So we performed a prospective study on patients who were on WBRT and made an attempt to assess the correlation of WBRT on Neurocognition and quality of life. AIMS AND OBJECTIVES: 1. To study the neurocognitive change that can occur due to whole brain radiotherapy. 2. To measure the MMSE, MoCA, HVLT, and Trail making test scores of patients on WBRT. 3. To study the quality of life of the whole brain radiotherapy patients using Katz ADL, LBADL and WHO QOL Bref scales. METHODOLOGY: The study was conducted in Barnard institute of radiology, Madras Medical College. The abstract was presented before ethics committee and approval was obtained. The study was done from March 2017 to September 2017. Patients suffering from brain metastasis were chosen for study based on inclusion and exclusion criteria. A detailed informed consent was taken from the patient and then recruited for our study. Initially their IQ was measured with BKT. Later whole brain radiotherapy sessions were conducted and relevant data was collected for study. The relevant scales were applied thrice i.e. immediately after WBRT, 3 months and after 6 months. The collected data were analyzed using SPSS package and necessary results obtained. Inclusion criteria: 1. Age 40 to 70, 2. Ability to give informed consent, 3. Karnofsky performance status >70. Exclusion criteria: 1. Mental retardation (IQ < 70), 2. Known major psychiatric illness, 3. Patients on chemotherapy, 4. Past therapeutic radiation exposure to brain. Neurocognitive assessment tools: 1. Mini mental status examination, 2. Montreal cognitive assessment test, 3. Hopkins verbal learning test, 4. Activity of Daily Living Scale, 5. Binet Kamath Test, 6. WHO QOL Bref. RESULTS: A total of 43 subjects were selected for the study. After the analysis we found that MMSE scores had dropped in 3 and 6 months and there was significant drop from 0 months to 6 months [p=0.000] and from 3months to 6 months [p=0.008].Montreal cognitive assessment also showed that there is cognitive decline during 6 months of radiotherapy. On applying the Katz ADL and Lawton body instruments of daily living we could find the ability of the patient to perform daily activities dropped after radiotherapy. Next we applied the WHO QOL Bref scale to measure the patient’s quality of life in various domains and found a significant drop in scores over 6 months. CONCLUSION: At the present neurocognitive decline is an important concern for the patients undergoing WBRT for brain metastasis and tumors. But until today no treatment has demonstrated better efficacy than WBRT in managing the brain metastasis. WBRT has given the best response in terms of palliation in brain metastasis with significantly good overall survival. Thus it has been widely used until today in spite of known side effects.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».