Main Article Content
Objective: To study the predictive powers of disability, comorbidity and nutritional status
on cognitive impairment in postoperative brain tumour patients at their frst post-discharge
Design: Predictive cross-sectional study.
Methodology: This study was conducted on a sample of 77 pairs of postoperative brain tumor patients and their caregivers at their frst post-discharge follow-ups at the neurosurgery outpatient department of a super-tertiary hospital in Bangkok. Data were collected using 1) the Charlson Comorbidity Index (CCI); 2) the Disability Rating Scale (DRS); 3) the Nutrition Alert Form (NAF); and 4) the Mini-Mental State Examination (MMSE). Stepwise regression analysis was employed for statistical analysis.
Results: The subjects were averagely aged 50.32 years (SD ± 12.82), and cognitive impairment was detected in 94.7% of the subjects, at a mean severity level of 17.87 (SD = 4.66). The subjects’ average degrees of disability (6.39; SD = 2.47) and malnutrition (10.47; SD = 3.19) were moderate, whilst their average degree of comorbidity (1.51; SD = 2.32) was low.
Disability and nutritional status were capable of predicting 63.1% of cognitive impairment
in postoperative brain tumor patients. Disability was identifed as the most powerful predictor
for cognitive impairment (β = -0.678, p < .01), over malnutrition (β = -0.195, p < .05),
whereas comorbidity did not have any signifcant predictive power.
Recommendations: It is recommended that nurses screen cognitively impaired brain tumour patients before the operation, before discharge and during their frst post-discharge follow-ups. The screening should be conducted with the patients’ nutritional status and disability taken into consideration, in order to provide them with proper care and advice. The post-screening information can also be used to facilitate case-by-case care coordination between healthcare teams.
syndrome as a predictor of poor outcomes in patients undergoing brain tumor surgery: a pilot study: clinical
article. JNS 2013; 118(6): 1279-87.
2. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA Cancer J Clin 2018; 68(1): 7-30.
3. Ostrom QT, Gittleman H, Truitt G, Boscia A, Kruchko C, Barnholtz-Sloan JS. CBTRUS statistical
report: primary brain and other central nervous system tumors diagnosed in the United States in 2011- 2015. Neuro Oncol 2018; 20(suppl 4): 1-86.
4. Veerasarn K, Yuthagovit S, Chailorrat A. Prevalence of brain tumor in Thailand from 2005 to 2014: data from the National Health Security Offce. J Med Assoc Thai 2016; 99: 62.
5. Tankumpuan T, Utriyaprasit K, Chayaput P, Itthimathin P. Predictors of physical functioning in postoperative brain tumor patients. JNN 2015; 47(1): 11-21.
6. Armstrong TS, Vera-Bolanos E, Acquaye AA, Gilbert MR, Ladha H, Mendoza T. The symptom burden of primary brain tumors: evidence for a core set of tumor- and treatment-related symptoms. Neuro Oncol 2016; 18(2): 252-60.
7. Johnson DR, Sawyer AM, Meyers CA, O’Neill BP, Wefel JS. Early measures of cognitive function predict survival in patients with newly diagnosed glioblastoma. Neuro Oncol 2012; 14(6): 808-16.
8. Bunevicius A, Tamasauskas S, Deltuva V, Tamasauskas A, Radziunas A, Bunevicius R. Predictors of healthrelated quality of life in neurosurgical brain tumor patients: focus on patient-centered perspective. Acta Neurochir (Wien) 2014; 156(2): 367-74.78
9. Back M, Back E, Kastelan M, Wheeler H. Cognitive defcits in primary brain tumours: a framework for management and rehabilitation. JCT 2014; 1(5): doi:10.4236/jct.2014.51010
10. Sachdev PS, Blacker D, Blazer DG, Ganguli M, Jeste DV, Paulsen JS, et al. Classifying neurocognitive disorders: the DSM-5 approach. Nat Rev Neurol 2014; 10(11): 634-42.
11. Talacchi A, Santini B, Savazzi S, Gerosa M. Cognitive effects of tumour and surgical treatment in glioma patients. J Neurooncol 2011; 103(3): 541-9.
12. Zarghi A, Zali A, Tehranidost M, Zarindast M, Ashraf F. Cognitive and mental changes in patients
with brain tumor after surgery. Global Journal of Surgery 2013; 1(3): 37-40.
13. Satoer D, Visch-Brink E, Smits M, Kloet A, Looman C, Dirven C, et al. Long-term evaluation of cognition after glioma surgery in eloquent areas. J Neurooncol 2014; 116(1): 153-60.
14. Mukdaprawat P, Danaidutsadeekul S, Chanruangwanich W, Itthimathin P. Relationships between brain tumor
grading, severity of neurological defcit, nutritional status and functional status in primary brain tumor
patients during hospital stay. J Nurs Sci 2012; 30(3): 46-54.
15. Saxena SK, Ng TP, Yong D, Fong NP, Koh G. Subthreshold depression and cognitive impairment but not demented in stroke patients during their rehabilitation. Acta Neurol Scand 2008; 117(2): 133-40.
16. Khedr EM, Hamed SA, El-Shereef HK, Shawky OA, Mohamed KA, Awad EM, et al. Cognitive impairment after cerebrovascular stroke: relationship to vascular risk factors. Neuropsychiatr Dis Treat
2009; 5: 103-16.
17. Akbari S, Ashayeri H, Fahimi MA, Kamali M, Lyden PD. The correlation of independency in activities of
daily living performance with cognitive status and the intensity of neurological impairment in right-handed
stroke patients. NeuroRehabilitation 2011; 29(3): 311-6.
18. Angsuwan P, Suanprasert N. Complications of hypertension in the nervous system. Bangkok: Veterans Organization Publishing; 2012.
19. MohdZulkiﬂy MF, Ghazali SE, Che Din N, Singh DKA, Subramaniam P. A review of risk factors for
cognitive impairment in stroke survivors. TSWJ 2016: https://dx.doi.org/10.1155/2016/3456943
20. Arvanitakis Z, Wilson RS, Li Y, Aggarwal NT, Bennett DA. Diabetes and function in different cognitive systems in older individuals without dementia. Diabetes Care 2006; 29(3): 560-5.
21. McCall M, Leone A, Cusimano MD. Nutritional status and body composition of adult patients with
brain tumours awaiting surgical resection. Can J Diet Pract Res 2014; 75(3): 148-51.
22. Malara A, Sgrò G, Caruso C, Ceravolo F, Curinga G, Renda GF, et al. Relationship between cognitive
impairment and nutritional assessment on functional status in Calabrian long-term-care. J Clin Interv
Aging 2014; 9: 105-10.
23. Aquilani R, Sessarego P, Iadarola P, Barbieri A, Boschi F. Nutrition for brain recovery after ischemic
stroke: an added value to rehabilitation. J Nutr Clin Pract 2011; 26(3): 339-45.
24. MorariA,StevisC,NeocleousC,GiaginisC.Nutritional status of elderly and its association with the degree
of cognitive decline. Clin Nutr ESPEN 2016; 13: 64
25. Charlson ME, Charlson RE, Peterson JC, Marinopoulos SS, Briggs WM, Hollenberg JP. The Charlson comorbidity
index is adapted to predict costs of chronic disease in primary care patients. J Clin Epidemiol 2008;
26. Utriyaprasit K. The relationship between recovery symptoms and functional outcomes in thai cabg
patients [dissertation]. Ohio (OH): Case Western Reserve Univ.; 200179
27. Rappaport M, Hall KM, Hopkins K, Belleza T, Cope DN. Disability rating scale for severe head trauma:
coma to community. Arch Phys Med Rehabil 1982; 63(3): 118-23.
28. Ya-orm Y. The effect of promoting family participation in patient care of head injury patients on patient’s health
status [dissertation]. Bangkok: Mahidol Univ.; 2001
29. Komindrg S, Tangsermwong T, Janepanish P. Simplifed malnutrition tool for Thai patients. Asia Pac J Clin Nutr
2013; 22(4): 516-21. doi:10.6133/apjcn. 2013. 22.4.06
30. Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”. A practical method for grading the cognitive state
of patients for the clinician. J Psychiatr Res 1975; 12(3): 189-98.
31. Korhonen K, Auvinen A, Lyytinen H, Ylikorkala O, Pukkala E. A nationwide cohort study on the incidence
of meningioma in women using postmenopausal hormone therapy in Finland. Am J Epidemiol 2012;
32. Patterson A, Elashaal A. Fast-growing meningioma in a woman undergoing fertility treatments. Case Rep
Neurol Med 2016: 3287381-3. doi:10.1155/ 2016/ 3287381
33. Bunyaratavej K, Siwanuwatn R, Chantra K, Khaoroptham S. Duration of symptoms in brain tumors: inﬂuencing factors and its value in predicting malignant tumors. J Med Assoc Thai 2010; 93(8): 903-10.
34. Veretennikoff K, Walker D, Biggs V, Robinson G.Changes in cognition and decision making capacity
following brain tumour resection: lllustrated with two cases. Brain Sci 2017; 7(10): doi:10.3390/brainsci7100122
35. Sánchez-Moreno C, Jiménez-Escrig A, Martín A. Stroke: roles of B vitamins, homocysteine and antioxidants. NRR 2009; 22(1): 49-67.