| Background and ObjectiveCognitive psychology is one of the psychology in the mid-1950s. Cognitive neuroscience was originated by George Miller who was one of psychol american psychologist after the mid-1970s, to be one of the main research directions in westward. The president of the United States of America has signatured "ten years of brain" in 1990, ane the scientific research of brain was launched allover the word. "Ten years of behavior" has been started by America in 21 st century, its aim was "All subjects do there best to study the behaviour and social science".21st century will become to "brain century", and to study the relations between cognition and brain will to be the hot point of science. Studying the relations between cognition and brain has been put into national medium-to long-range program.Studying the relations between cognition and brain tumors has became to be one of the hot point of science abroad, but is the cold point interiorly. Professor Chen working in Sun Yat-Sen University Cancer Center hold that there are all kinds of cognitive impairment in patient with brain tumors, and the tumor, complication (for example secondary epilepsy, obstructive hydrocephaly, hemorrhage in tumor) and therapeutic measure(for example operation, radiotherapy, chemotherapy, antiepileptic drug) can impairment cognitive. The impairment cognitive was the result of interaction with these factors. Simultaneously, the emotion also can impairment cognitive. Yin-Ling Zhang and Hui-Pu Huang working in the fourth military medical university support the opinions of Professor Chen after studied the cognitive impairment in patients with brain tumors using cognitive laterality battery (CLB). Simultaneously, they also pointed out that the different edema, volume, pathology, postions of tumors could impairment cognitive. Moreoverly, some scholars internal supported these opinions after studied the relations between cognition and brain used the wisconsin card sorting test(WCST).The cognitive of patients with brain tumors and their influencing factors will be studied in our country, and it can help the neurosurgeons pay their attention to the cognitive impairment of brain tumors and to therapy them at the cognitive impairment beginning. And it can prevention and reduce the incidence of cognitive impairment effectively, and raise the survival rate and the quality of life of patients.Methods1. This research enrolled 200 cases with brain tumors by the choice criterionins in Neurosurgery Department of Guangdong Provincial People's Hospital from June 2009 to January 2011. All patients has been checked by MRI, some of them by CT., and been made a diagnosis as brain tumors. The volume of tumors, El, position, center construction and complication has been measured by MRI, and the ages, sex, education and pathology of patients also has been taken notes.2. We want to get rid of anxiety and depression of patients using the SDC (self-rating depression scale) and SAS (self-rating anxiety scale) on admission. And to make the first evaluate by the MoCA (Montreal cognitive assessment Chinese version). To make the second evaluate on discharge. 3. We have selected age, sex, education, position(include different lobes and different halfsphere of brains), volume, El, complication(include secondary epilepsy, internal hydrocephaly and haemorrhage of tumors), pathology and the center construction to different variables, and analyticiced the connection between the cognitive function and influencing factors.4. Statistical methods:All data was managed by software package of SPSS 13. Firstly, we have used one-factor analysis of variance to screening the influencing factors:The Chi-Square test and McNemar test were mainly used in enumeration data. Two independent-Samples t test, Pared-Sample t test and One-Way ANOVA were mainly used in measurement data. And the Two independent-Samples t test and One-Way ANOVA should been made homogeneity test of variance. Secondly, the variance P<0.05 have been choose to make logistic regression alalysis after one-factor analysis. The inspection levelα=0.05 have been choose in logistic regression alalysis, and the inspection levelα'=α/[k (k-1)/2+1] in multivariate sample have been choose, k was the number of sample.Results1. The consistency of Montreal Cognitive Asssessment (MoCA) Chinese Version was better when evaluating the cognitive function of brain tumors (Cronbach a>0.7).2. The incidence of cognitive impairment in 200 cases with brain tuomrs was 54.5% on admission,65.0% on discharge. The incidence of cognitive impairment on discharge was higher than it on admission (P=0.004<0.05).3. The damaged of cognitive function of brain tumors on admission was visuospatial/executive(EF),naming(NAM),memory(MEM), attention(ATT) (t=8.191, P=0.000),language(LANG) (t=7.266, P=0.000), absteaction(ABS) (t=5.711, P=0.000) and orientation(ORT) (t=3.803, P=0.000), and was EF(t=12.211, P=0.000), NAM(t=4.940, P=0.000), MEM(t=15.182, P=0.000), ATT(t=11.050, P=0.000), LANG(t=9.289, P=0.000), ABS(t=9.726, P=0.000) and ORT(t=5.040, P=0.000) on discharge, and the EF(t=3.019, P=0.003),NAM(t=2.710, P=0.007),MEM(t=9.313, P=0.000),ATT(t=10.326, P=0.000,ABS(t=4.989, P=0.000) and ORT(t=5.290, P=0.000) on discharge were worse than on admission.4. In all kinds of influential factors, position(x2=35.164,P=0.000<0.05), volume(x2=35.570, P=0.000<0.05), El (x2=43.613, P=0.000<0.05)and the center construction of cases(x2=27.920, P=0.000<0.05) had statistically significant effects on cognitive impairment.5. It had statistically significant effects on cognitive impairment (P<0.05) when the tumors were in frontal lobe, temporal lobe and frontal-temporal lobe. The mainly damage of cognition function were EF(t=5.225, P=0.000), MEM(t=7.988, P=0.000), ATT(t=6.864, P=0.000), ABS(t=3.265, P=0.002), ORT(t=3.587, P=0.001) and LANG(t=3.334, P=0.001) when the tumors were in frontal lobe, and were EF(t=5.300, P=0.000), MEM(t=4.996, P=0.000), NAM(t=2.739, P=0.011), ABS(t=2.487, P=0.017),ORT (t=4.629, P=0.000)and LANG (t=2.739, P=0.009) when the tumors were in temporal lobe, and were EF, MEM, ABS and LANG when the tumors were in frontal-temporal lobe. There were no statistical significance among these three groups.6. The cognitive function impairment were worse when the volume of tumors were bigger. The cognitive function impairment of big-volume tumor group were worse than small-volume tumor group(x2=12.999, P=0.000<0.007), the extra large-volume tumor group were worse than small-volume tumor group(x2 33.585, P=0.0000<0.007), middle-volume tumor group(x2=14.342, P= 0.000<0.007) and big-volume tumor group(x2=8.078, P=0.004<0.007). 7. The cognitive function impairment were worse when the El of tumors were worse. The cognitive function impairment of severe-El group were worse than moderate-EI group(x2=15.501,P=0.000<0.0125), and severe-EI group were worse than mild-El group(x2=43.610,P=0.000<0.0125), and moderate-El group were worse than mild-EI group(x2=6.974,P=0.008<0.0125).8. The cognitive function impairment were worse when the center construction changed were more than 1.0cm (x2=15.501,P=0.000<0.0125).ConclusionsThere were extensive cognitive function impairment, and the impairment items were EF, NAM, MEM, ATT, ABS and ORT. Surgical operations could damage the cognition function of patients with brain tumors, especially were EF, NAM, MEM, ATT, ABS and ORT. The position, volume, El of tumors and the center construction of brains were the statistically significant factors, and the tumor have grew in frontal lobe, temporal lobe and frontal-temporal lobe were the risk factors, and the bigger volum of tumors were the rick factors, and the worse El were the rick factors too, and the center construction changed were the rick factors. There were different impairtal items when the tumors have grew in frontal lobe, temporal lobe and frontal-temporal lobe. The cognitive function impairment were worse when the volume of tumors were bigger. The cognitive function impairment were worse when the El of tumors were worse. As the center construction changed were more than 1.0cm, the cognitive function impairment make sense.The operation was one of the kinds which could damage the cognition function of patients. We could evaluate the cognition function of patients with brain tumors clinically by Montreal Cognitive Asssessment Chinese Version. |
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