scholarly journals Longitudinal Connectome Analyses following Low-Grade Glioma Neurosurgery: Implications for Cognitive Rehabilitation

2021 ◽  
Vol 23 (Supplement_4) ◽  
pp. iv8-iv8
Author(s):  
Anujan Poologaindran ◽  
Mike Hart ◽  
Tom Santarius ◽  
Stephen Price ◽  
Rohit Sinha ◽  
...  
Keyword(s):  
Cognitive Deficits ◽  
Cognitive Rehabilitation ◽  
Fluid Intelligence ◽  
Higher Order ◽  
Optimal Time ◽  
Single Subject ◽  
Low Grade ◽  
Post Surgery ◽  
Cognitive Data

Abstract Aims Low-grade gliomas (LGG) slowly grow and infiltrate the brain's network architecture (the connectome). Unlike strokes that acutely damage the connectome, LGGs intricately remodel it, leading to varying deficits in executive function (i.e. attention, concentration, working memory). By longitudinally mapping the “mesoscale” architecture of the connectome, we may begin to systematically accelerate domain-general cognitive rehabilitation in LGG patients. In this study, we pursued the following aims: 1) track cognitive and connectome trajectories following LGG surgery, 2) determine optimal time period for cognitive rehabilitation, and 3) distinguish patients with perioperative predictors of long-term cognitive deficits (>1 year). Method With MRI and cognitive data from n=629 individuals across the lifespan, we first validated the structural, functional, and topological relevance of the multiple demand (MD) system for higher-order cognition. Next, in n=17 patients undergoing glioma surgery, we longitudinally acquired connectome and cognitive data: pre-surgery, post-surgery Day 1, Month 3, & 12. We assessed how glioma infiltration, surgery, and rehabilitation affected MD system trajectories at the single-subject level. Deploying transcriptomic and graph theoretical analyses, we tested if perioperative connectome modularity can accurately distinguish long-term cognitive trajectories. Results Controlling for age and sex, the MD system’s multi-scale architecture in health was positively associated with higher-order cognition (Catell’s fluid intelligence). Pre-operative glioma infiltration into the MD system was negatively associated with the number of long-term cognitive deficits (OCS-Bridge cognitive battery), suggesting its functional reorganisation. Mixed-effects modelling demonstrated the resilience of the MD system to infiltration and resection, while the early post-operative period was critical for effective neurorehabilitation. Graph analyses revealed perioperative modularity can distinguish patients with long-term cognitive deficits at one-year follow-up. Transcriptomic analyses of inter-module connector hubs revealed increased gene expression for mitochondrial metabolism and synaptic plasticity. Conclusion This is the first serial functional mapping of LGG patient trajectories for domain-general cognition. By assessing the mesoscale architecture, we demonstrate how connectomics can help overcome the intrinsic heterogeneity in LGG patients and predict long-term rehabilitation trajectories. We discuss how to identify neurobiologically-grounded personalised targets for 'interventional neurorehabilitation' following LGG surgery.

OS14.4.A The Neuroplastic Potential of the Human Brain before and After Glioma Surgery: Towards “Interventional Neurorehabilitation

2021 ◽  
Vol 23 (Supplement_2) ◽  
pp. ii16-ii16
Author(s):  
A Poologaindran ◽  
R Romero-Garcia ◽  
M Hart ◽  
I Young ◽  
T Santarius ◽  
...  
Keyword(s):  
Human Brain ◽  
Safety Profile ◽  
Brain Networks ◽  
Low Grade ◽  
Healthy Individuals ◽  
Glioma Surgery ◽  
Post Surgery ◽  
Post Operative Period ◽  
Cognitive Data

Abstract INTRODUCTION The human brain is a highly neuroplastic ‘complex’ network: it self-organises without a hard blueprint, adapts to evolving circumstances, and can withstand insults. However, similar to other naturally occurring networks, brain networks can only endure a finite amount of damage before cognitive processes are affected. In this study, we first sought to establish the brain networks governing domain-general cognition (DGC) in healthy individuals across the lifespan. We then sought to map, track, and potentially rehabilitate networks governing DGC through connectomics and non-invasive brain stimulation (NIBS) when damaged by low-grade gliomas (LGG) and surgical oncology. METHODS Using MRI and cognitive data from n=629 individuals (aged 18–88, Female= 51%), we assessed the structural, functional, and topological relevance of the spatially-distributed multiple-demand (MD) system for DGC. Next, in n=17 patients undergoing glioma surgery, we longitudinally acquired connectomic and cognitive data at multiple time points: pre-surgery and post-surgery Day 1, Month 3, Month 12. In an independent cohort of n=34 patients, we sought to establish the safety profile for “interventional neurorehabilitation”: connectome-driven NIBS in the acute post-operative period to accelerate cognitive recovery. RESULTS In healthy individuals, the MD system across multiple scales of biological organisation was positively associated with higher-order cognition (Catell’s fluid intelligence). In our patients, pre-operative LGG infiltration into the structural MD system was negatively associated with the number of long-term cognitive deficits, suggesting a functional reorganisation. Mixed-effects modelling demonstrated the resilience of the functional MD system to infiltration and resection, while the early post-operative period was critical for effective neurorehabilitation. Graph analyses revealed increased perioperative modularity can distinguish patients with long-term cognitive improvements at one-year follow-up. Finally, NIBS within two weeks post-craniotomy had a 90% (n=31/34) recruitment rate into the trial. There were no seizures or serious complications due to NIBS in this patient population. Transient headaches and tingling were reported in a minority of patients. CONCLUSION For the first time, we elucidate long-term cognitive and network trajectories following LGG surgery while establishing a positive safety-profile for NIBS in the acute post-operative period. We argue that “mesoscale” brain mapping serves as a robust biomarker for intervention-related plasticity for future clinical trials. While we performed these experiments in the context of neurosurgery, connectomics and NIBS could be adopted across diverse neuro-oncological care pathways (i.e. chemotherapy/radiation).

scholarly journals NCMP-05. THE INCIDENCE AND IMPACT OF POST-OPERATIVE STROKE IN SURGERY FOR LGG

2019 ◽  
Vol 21 (Supplement_6) ◽  
pp. vi180-vi180
Author(s):  
Asaf Berger ◽  
Garry Tzarfati ◽  
Mathias Costa ◽  
Marga Serafimova ◽  
Akiva Korn ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Performance Status ◽  
Tumor Resection ◽  
Neurological Deficits ◽  
Functional Improvement ◽  
Motor Deficit ◽  
Low Grade ◽  
Post Surgery ◽  
One Year

Abstract BACKGROUND Postoperative neurological deficits may outweigh the benefit conferred by maximal resection of gliomas. We evaluated the incidence of ischemic events in patients undergoing surgery for low-grade gliomas (LGG) and the long-term neurological and cognitive sequelae. METHODS Between 2013–2017, 168 patients underwent surgical resection or biopsy for LGG at our center. A full dataset, including pre- and postoperative magnetic resonance imaging (MRI) and long-term clinical evaluation findings, was available for 82 patients (study group). Ischemic complications, overall and progression-free survival, and functional and neurocognitive outcomes were evaluated. RESULTS The immediate postoperative MRI revealed an acute ischemic stroke adjacent to the tumor resection cavity in 19 patients (23%), 13 of whom developed new neurological deficits due to the ischemic event. Infarcts were more common in patients with recurrent tumors, especially those involving the Sylvian fissure (p< 0.05). Surgery for insular gliomas had the strongest association with postoperative infarcts. Survival of patients w/wo a postoperative infarct was the same. The median Karnofsky-Performance Status was lower for the infarct group vs. the non-infarct group at 3 months post-surgery (p=0.016), with a gradual significant improvement for the former over one year (p=0.04). Immediately after surgery, 27% of the patients without infarcts and 58% of those with infarcts experienced a new motor deficit (p=0.037), decreasing to 16% (p=0.028) and 37% (p=0.001), respectively, at one year. Neurocognitive analysis findings before and 3 months after surgery were unchanged, but patients with an infarct had a significant decrease in naming (p=0.04). Confusion during awake craniotomy was a strong predictor of an ischemic stroke. CONCLUSIONS Intraoperative strokes are more prevalent among patients who undergo recurrent surgeries, especially in the insula. Although they do not affect survival, these strokes negatively impact the patients’ activity and performance status, especially during the first 3 postoperative months, with gradual functional improvement over one year.

scholarly journals Neuroplastic Changes Induced by Cognitive Rehabilitation in Traumatic Brain Injury: A Review

2017 ◽  
Vol 31 (9) ◽  
pp. 800-813 ◽  
Author(s):  
Valentina Galetto ◽  
Katiuscia Sacco
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Cognitive Training ◽  
Cognitive Deficits ◽  
Cognitive Rehabilitation ◽  
Cerebral Activation ◽  
Rehabilitation Programs ◽  
Brain Changes ◽  
The Impact

Background. Cognitive deficits are among the most disabling consequences of traumatic brain injury (TBI), leading to long-term outcomes and interfering with the individual’s recovery. One of the most effective ways to reduce the impact of cognitive disturbance in everyday life is cognitive rehabilitation, which is based on the principles of brain neuroplasticity and restoration. Although there are many studies in the literature focusing on the effectiveness of cognitive interventions in reducing cognitive deficits following TBI, only a few of them focus on neural modifications induced by cognitive treatment. The use of neuroimaging or neurophysiological measures to evaluate brain changes induced by cognitive rehabilitation may have relevant clinical implications, since they could add individualized elements to cognitive assessment. Nevertheless, there are no review studies in the literature investigating neuroplastic changes induced by cognitive training in TBI individuals. Objective. Due to lack of data, the goal of this article is to review what is currently known on the cerebral modifications following rehabilitation programs in chronic TBI. Methods. Studies investigating both the functional and structural neural modifications induced by cognitive training in TBI subjects were identified from the results of database searches. Forty-five published articles were initially selected. Of these, 34 were excluded because they did not meet the inclusion criteria. Results. Eleven studies were found that focused solely on the functional and neurophysiological changes induced by cognitive rehabilitation. Conclusions. Outcomes showed that cerebral activation may be significantly modified by cognitive rehabilitation, in spite of the severity of the injury.

Long-term Impact of Cognitive Deficits and Epilepsy on Quality of Life in Patients With Low-Grade Meningiomas

Neurosurgery ◽  
2011 ◽  
Vol 69 (1) ◽  
pp. 72-79 ◽  
Author(s):  
Martin L Waagemans ◽  
David van Nieuwenhuizen ◽  
Monica Dijkstra ◽  
Miriam Wumkes ◽  
Clemens M F Dirven ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cognitive Deficits ◽  
Low Grade ◽  
Long Term Impact

scholarly journals Cognitive Rehabilitation Reduces Cognitive Impairment and Normalizes Hippocampal CA1 Architecture in a Rat Model of Vascular Dementia

2013 ◽  
Vol 33 (6) ◽  
pp. 872-879 ◽  
Author(s):  
Kristopher D Langdon ◽  
Shirley Granter-Button ◽  
Carolyn W Harley ◽  
Frances Moody-Corbett ◽  
James Peeling ◽  
...  
Keyword(s):  
Vascular Dementia ◽  
Learning And Memory ◽  
Cognitive Deficits ◽  
Rat Model ◽  
Cognitive Rehabilitation ◽  
Cognitive Activity ◽  
Western Society ◽  
Sprague Dawley ◽  
Post Surgery ◽  
Hippocampal Ca1

Dementia is a major cause of morbidity in the western society. Pharmacological therapies to delay the progression of cognitive impairments are modestly successful. Consequently, new therapies are urgently required to improve cognitive deficits associated with dementia. We evaluated the effects of physical and cognitive activity on learning and memory in a rat model of vascular dementia (VasD). Male Sprague-Dawley rats (6 months old) were exposed to either regular chow or a diet rich in saturated fats and sucrose and chronic bilateral common carotid artery occlusion or sham surgery. First, this model of VasD was validated using a 2 × 2 experimental design (surgery × diet) and standard cognitive outcomes. Next, using identical surgical procedures, we exposed animals to a paradigm of cognitive rehabilitation or a sedentary condition. At 16 weeks post surgery, VasD animals demonstrated significant learning and memory deficits in the Morris water maze, independent of diet. Rehabilitation significantly attenuated these cognitive deficits at this time point as well as at 24 weeks. Further, rehabilitation normalized hippocampal CA1 soma size (area and volume) to that of control animals, independent of cell number. Importantly, these findings demonstrate beneficial neuroplasticity in early middle-aged rats that promoted cognitive recovery, an area rarely explored in preclinical studies.

Efficient Co-Harvesting of Solar Energy and Low-Grade Heat by Molecular Photoswitches for High Energy Density, Long-Term Stable Solar Thermal Battery

2019 ◽  
Author(s):  
Zhao-Yang Zhang ◽  
Tao LI
Keyword(s):  
Energy Density ◽  
Solar Energy ◽  
High Performance ◽  
High Energy ◽  
Solar Thermal ◽  
High Energy Density ◽  
Low Grade ◽  
Thermal Battery ◽  
Low Grade Heat

Solar energy and ambient heat are two inexhaustible energy sources for addressing the global challenge of energy and sustainability. Solar thermal battery based on molecular switches that can store solar energy and release it as heat has recently attracted great interest, but its development is severely limited by both low energy density and short storage stability. On the other hand, the efficient recovery and upgrading of low-grade heat, especially that of the ambient heat, has been a great challenge. Here we report that solar energy and ambient heat can be simultaneously harvested and stored, which is enabled by room-temperature photochemical crystal-to-liquid transitions of small-molecule photoswitches. The two forms of energy are released together to produce high-temperature heat during the reverse photochemical phase change. This strategy, combined with molecular design, provides high energy density of 320-370 J/g and long-term storage stability (half-life of about 3 months). On this basis, we fabricate high-performance, flexible film devices of solar thermal battery, which can be readily recharged at room temperature with good cycling ability, show fast rate of heat release, and produce high-temperature heat that is >20<sup> o</sup>C higher than the ambient temperature. Our work opens up a new avenue to harvest ambient heat, and demonstrate a feasible strategy to develop high-performance solar thermal battery.

Efficient Co-Harvesting of Solar Energy and Low-Grade Heat by Molecular Photoswitches for High Energy Density, Long-Term Stable Solar Thermal Battery

2019 ◽  
Author(s):  
Zhao-Yang Zhang ◽  
Tao LI
Keyword(s):  
Energy Density ◽  
Solar Energy ◽  
High Performance ◽  
High Energy ◽  
Solar Thermal ◽  
High Energy Density ◽  
Low Grade ◽  
Thermal Battery ◽  
Low Grade Heat

Solar energy and ambient heat are two inexhaustible energy sources for addressing the global challenge of energy and sustainability. Solar thermal battery based on molecular switches that can store solar energy and release it as heat has recently attracted great interest, but its development is severely limited by both low energy density and short storage stability. On the other hand, the efficient recovery and upgrading of low-grade heat, especially that of the ambient heat, has been a great challenge. Here we report that solar energy and ambient heat can be simultaneously harvested and stored, which is enabled by room-temperature photochemical crystal-to-liquid transitions of small-molecule photoswitches. The two forms of energy are released together to produce high-temperature heat during the reverse photochemical phase change. This strategy, combined with molecular design, provides high energy density of 320-370 J/g and long-term storage stability (half-life of about 3 months). On this basis, we fabricate high-performance, flexible film devices of solar thermal battery, which can be readily recharged at room temperature with good cycling ability, show fast rate of heat release, and produce high-temperature heat that is >20<sup> o</sup>C higher than the ambient temperature. Our work opens up a new avenue to harvest ambient heat, and demonstrate a feasible strategy to develop high-performance solar thermal battery.

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