Predict and recover: treating cognitive damage after a brain tumor
Being diagnosed with a brain tumor can be a frightening event. There is relief if the tumor has been successfully treated. However, a technically successful operation does not necessarily mean that patients can just pick up their lives again. They will often have cognitive complaints like fatigue, memory problems, sensitivity to stimuli, and difficulty planning things.
How frequent are these complaints? Is it possible to make predictions on the risk of these complaints occurring? How does brain damage cause these cognitive complaints? And what can you do about them? Tilburg University has joined forces with the Elisabeth-TweeSteden Hospital (ETZ) in the project Predict and recover to study brain tumors and cognitive damage.
Helping patients cope with or treating cognitive complaints and dysfunctions, that is the ultimate purpose of this study. The focus of the treatment of a tumor is first of all on the tumor. From an oncological point of view it has to be, but what about the rest of the brain? That is where the healing potential is. Neuroplasticity is the ability of the brain to adapt to changing circumstances and to make new connections. You can not only train your muscles but also your brain. Besides training the brain, it is also possible to teach patients strategies to better cope with their cognitive damage. For instance, they can learn to better deal with fatigue and stimuli, train their memory, and plan tasks.
The first step is to map deficiencies and complaints. The next step is to identify the factors involved in the damage. Is there a connection between the complaints and the medical condition? Are there things going on in the brain that can help predict complaints in individual patients? Based on this research, researchers can estimate whether it is possible to remedy the damage. The third step is to find out how that is best done.
In more detail:
- Complaints and dysfunctions are identified before and three months after brain cancer surgery. Patients answer personal questions, complete questionnaires, and undergo tests. Those data are linked to the medical data and recorded for research.
- In order to map neural networks, a functional MRI (fMRI) is made, whereby patients perform a cognitive task while inside an MRI scanner. What parts of the brain are activated? This is called ‘imaging’. New MRI methods are being developed to image patients’ cognitive functions.
- Data have been collected from a new control group. If the hospital wants to assess a patient’s cognitive abilities, the test data are always compared to those of a control group. The ETZ used to use American data, but they proved to be no longer representative. Therefore, data were collected from local people.
- A study is going on into precision radiation with a gamma knife compared to whole brain radiation therapy. The question is whether precision radiation leads to less cognitive damage. The research results will hopefully contribute to adapting the treatment guidelines for brain metastases.
- Researcher Karin Gehring of Tilburg University developed the ReMind app in Dutch and English based on training of cognitive functions and learning to deal with cognitive problems. The app has now been tested in a pilot study in Tilburg. There is also a larger ongoing study in the Netherlands, and a pilot study in San Francisco. Promoting the app and making it accessible to a larger audience is currently being investigated.
- The research team is also looking at the effect of sports in damage repair. For example, it has been proven for Alzheimer’s that exercise can improve memory and slow down the disease. Recently, a pilot study with brain tumor patients in the ETZ, The Hague, and Rotterdam has been concluded. The results are promising and require further research on a larger scale.
- Data from some 1000 patients in the Brabant region have been collected. They are used to make prediction models for cognitive functioning after neurosurgery.
- The mindset is changing in the medical world: the focus is shifting from treating a condition to treatment combined with attention to post-operative quality of life. The experiences of the individual patient are central.
- There is international dialogue on how to deal with cognitive damage after neurological conditions.
- The ReMind app has been developed for cognitive training in the home situation.
Partners and sponsors
- Elisabeth-TweeSteden Hospital (ETZ)
- CZ Fonds
- KWF Kankerbestrijding (Dutch Cancer Society)
- Innovatiefonds zorgverzekeraars
- University of California, San Francisco (UCSF)