Decline in word-finding: The objective cognitive finding most relevant to patients after mesial temporal lobe epilepsy surgery |
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| Affiliation: | 1. Serviço de Neurocirurgia, Hospital Governador Celso Ramos, Florianópolis, SC, Brazil;2. Centro de Neurociências Aplicadas (CeNAp), Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil;3. Serviço de Psiquiatria, Departamento de Clínica Médica, HU-UFSC, Florianópolis, SC, Brazil;4. Serviço de Neurologia, Departamento de Clínica Médica, HU-UFSC, Florianópolis, SC, Brazil;5. Departamento de Cirurgia, Serviço de Neurocirurgia, HU-UFSC, Florianópolis, SC, Brazil;6. Centro de Epilepsia de Santa Catarina (CEPESC), HU-UFSC, Florianópolis, SC, Brazil;7. Physiological Psychology, University of Bielefeld, Bielefeld, Germany;8. Danish Epilepsy Centre, Dianalund, Denmark;9. Department of Clinical Neurosciences, University of Calgary, Canada;1. Saint Louis University, Department of Psychology, 3700 Lindell Blvd., St. Louis, MO 63108, United States;2. St. Louis Children''s Hospital, Department of Psychology, 1 Children''s Place, St. Louis, MO 63110, United States;1. Melbourne School of Psychological Sciences, The University of Melbourne, Victoria, Australia;2. Comprehensive Epilepsy Program, Austin Health, Victoria, Australia;3. Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, NIHR University College London Hospitals Biomedical Research Centre, London, UK;1. Sector of Neuropsychology for Children and Adolescents, Hp KG 01.327.1, Brain Center Rudolf Magnus, University Medical Center Utrecht, P.O. Box 85090, 3508 AB Utrecht, The Netherlands;2. Bio Research Center for Children, Wekeromseweg 8, 6816 VS Arnhem, The Netherlands;3. Department of Child Neurology, Hp KC 03.063.0, Brain Center Rudolf Magnus, University Medical Center Utrecht, P.O. Box 85090, 3508 AB Utrecht, The Netherlands;4. Department of Neurosurgery, Hp G 03.124, Brain Center Rudolf Magnus, University Medical Center Utrecht, P.O. Box 85500, 3508 GA Utrecht, The Netherlands;5. SEIN, Epilepsy Institute of the Netherlands Foundation, Location Meer en Bosch, P.O. Box 540, 2103 SW Heemstede, The Netherlands;6. Department of Behavioural Sciences, Kempenhaeghe Expertise Centre for Epileptology, Sleep Medicine and Neurocognition, P.O. Box 61, 5590 AB Heeze, The Netherlands;7. Donders Institute for Brain, Cognition and Behaviour, Radboud University, P.O. Box 9104, 6500 HE Nijmegen, The Netherlands;1. Department of Psychology, University of Sydney, Sydney, NSW, Australia;2. ARC Centre of Excellence in Cognition and Its Disorders, Australia;3. Department of Psychology, University of Toronto Mississauga, Mississauga, ON, Canada;4. Neuroscience and Mental Health Program, Hospital for Sick Children, Toronto, ON, Canada |
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| Abstract: | PurposeThe purpose of this study was to investigate the following: i) the objective impairment in neuropsychological tests that were associated with the subjective perception of cognitive function decline in Brazilian patients who underwent mesial temporal lobe epilepsy (MTLE) surgery and ii) the predictive variables for those impaired objective neuropsychological tests.MethodsForty-eight adults with MTLE (27 right HS and 23 male) were divided according to their perception of changes (Decline or No-decline) of cognitive function domain of the QOLIE-31 questionnaire applied before and 1 year after the ATL. The mean (SD) of changes in the raw score difference of the neuropsychological tests before and after the ATL was compared between Decline and No-decline groups. Receiver Operating Characteristic curves, sensitivity, specificity, and predictive values were used to assess the optimum cutoff points of neuropsychological test score changes to predict patient-reported subjective cognitive decline.Key findingsSix (12.5%) patients reported a perception of cognitive function decline after ATL. Among the 25 cognitive tests analyzed, only changes in the Boston Naming Test (BNT) were associated with subjective cognitive decline reported by patients. A reduction of ≥ 8 points in the raw score of BNT after surgery had 91% of sensitivity and 45% specificity for predicting subjective perception of cognitive function decline by the patient. Left side surgery and age older than 40 years were more associated with an important BNT reduction with overall accuracy of 91.7%, 95% predictive ability for no impairment, and 75% for impairment of cognitive function.SignificanceImpairment in word-finding seems to be the objective cognitive finding most relevant to Brazilian patients after mesial temporal lobe epilepsy surgery. Similar to American patients, the side of surgery and age are good predictors for no decline in the BNT, but shows a lower accuracy to predict its decline. If replicated in other populations, the results may have wider implications for the surgical management of patients with drug-resistant MTLE. |
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