Disruptive and protective outcomes to memory and attention when treating diffuse glioma


Surgical resection with adjuvant chemotherapy and radiotherapy are effective treatments to delay glioma progression and improve survival. Nevertheless, a large proportion of patients have treatment-induced cognitive deficits that dramatically reduce their life quality. Predicting the treatment-induced functional impairments is difficult due to the complex interlocking and diffusely spread networks that underpin different aspects of cognition. Here we investigated glioma interactions with brain networks in relation to cognitive recovery after surgical resection and during chemo-radiotherapy treatment. Seventeen patients with diffuse non-enhancing glioma (aged 22-56 years) were longitudinally MRI-scanned and cognitively assessed using a tablet-based screening tool before and after surgery, and during a 12-months recovery period. Using structural MRI and Neurite Orientation Dispersion and Density Imaging (NODDI) derived from diffusion-weighted images, we respectively estimated tumour overlap and Neurite Density (as an in-vivo proxy measure of axon and dendrite concentration) with brain networks and functional maps derived from normative data in healthy participants. We found that neither total lesion volume nor tumour location based on traditional lobular divisions were associated with memory or attention deficits. However, tumour and lesion overlap with the Default Mode Network (DMN), Attention Network and attention-related regions located in frontal and parietal cortex was associated with memory and attention deficits. This association was above and beyond the contributions of preoperative cognitive status and tumour volume (Linear Mixed Model, Pfdr