Longitudinal analysis of depression and anxiety symptoms as independent predictors of neurocognitive function in primary brain tumor patients Journal Article


Authors: Tibbs, M. D.; Huynh-Le, M. P.; Reyes, A.; Macari, A. C.; Karunamuni, R.; Tringale, K.; Burkeen, J.; Marshall, D.; Xu, R.; McDonald, C. R.; Hattangadi-Gluth, J. A.
Article Title: Longitudinal analysis of depression and anxiety symptoms as independent predictors of neurocognitive function in primary brain tumor patients
Abstract: Purpose: Primary brain tumor patients are vulnerable to depression and anxiety symptoms, which may affect their neurocognitive functioning. We performed a prospective longitudinal analysis to examine the association between depression and anxiety symptoms and domain-specific neurocognitive functioning in primary brain tumor patients receiving radiation therapy (RT). Methods and Materials: On a prospective trial, 54 primary brain tumor patients receiving RT underwent comprehensive neurocognitive evaluation at baseline (pre-RT), and 3, 6, and 12 months post-RT. Neurocognitive assessments measured attention/processing speed, verbal and visuospatial memory, and executive functioning, including Delis-Kaplan Executive Function System Trail-Making Test (DKEFS-TMT), DKEFS Verbal Fluency, and Brief Visuospatial Memory Test-Revised. Depression and anxiety symptoms were also assessed at each time point with Beck Depression and Anxiety Inventories (BDI-II and BAI), respectively. Higher scores reflect more numerous or severe depression or anxiety symptoms. Univariable and multivariable linear mixed-effects models assessed associations between BDI-II and BAI scores and domain-specific neurocognitive scores over time, controlling for pre-existing depression or anxiety disorders and other patient, tumor, and treatment characteristics. Results: Higher BAI scores were associated with worse attention and processing speed in univariable analyses: DKEFS-TMT visual scanning (P = .003), number sequencing (P = .011), and letter sequencing (P <.001). On multivariable analyses, these associations remained significant (all P ≤ .01). Higher BDI-II scores were also associated with poorer attention/processing speed (DKEFS-TMT Letter Sequencing) in univariable (P = .002) and multivariable (P = .013) models. Higher BAI scores were associated with worse visuospatial memory (Brief Visuospatial Memory Test-Revised Delayed Recall) on univariable (P = .012) but not multivariable analyses (P = .383). Similarly, higher BDI-II scores were associated with poorer executive functioning (DKEFS Verbal Fluency Category Switching) on univariable (P = .031) but not multivariable analyses (P = .198). Conclusions: Among primary brain tumor patients receiving RT, increased depression and anxiety were independently associated with worsened neurocognition, particularly in attention/processing speed. Depression and anxiety symptoms should be controlled for in prospective clinical trials and managed in the clinical setting to optimize neurocognitive functioning. © 2020 Elsevier Inc.
Keywords: brain; tumors; patient treatment; independent predictors; primary brain tumors; executive function; multivariable analysis; methods and materials; longitudinal analysis; neurocognitive functions; linear mixed-effects model
Journal Title: International Journal of Radiation Oncology, Biology, Physics
Volume: 108
Issue: 5
ISSN: 0360-3016
Publisher: Elsevier Inc.  
Date Published: 2020-12-01
Start Page: 1229
End Page: 1239
Language: English
DOI: 10.1016/j.ijrobp.2020.07.002
PUBMED: 32634542
PROVIDER: scopus
PMCID: PMC7680441
DOI/URL:
Notes: Article -- Export Date: 1 December 2020 -- Source: Scopus
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