**Author details**

**8. Rehabilitation**

254 Neurooncology - Newer Developments

verbal memory [130].

**8.2. Cognition rehabilitation program**

Patients with brain tumors face the challenge of cognitive impairment due to the tumor itself or treatments. Cognitive deficits in processing speed, memory, attention, and executive functions interfere with patients' relationships, occupational activities and daily life activities.

Methylphenidate (MPH) is a CNS stimulant that increases synaptic concentration of dopa‐ mine and noradrenaline in the brain [127]. De-Long et al. [128] conducted a pilot study on children with ALL or brain tumor, they found that approximately 75% of those patients had

Meyers et al. [129] reported significant improvements in processing speed, memory, mental flexibility, and even mood, in adult patients with brain tumors and receiving MPH. Conklin et al. showed encouraging results in the use of psychostimulant medication. On 122 survi‐ vors of childhood brain tumors or ALL who were enrolled in a double-blinded, cross-over trial

Donepezil is acetylcholinesterase inhibitor and has efficacy in the treatment of cognitive functions impairment; uses of donepezil in adult patients with brain tumors treated with RT demonstrate improvements in cognition impairment such as attention, concentration, and

However, stimulant medication is short-acting and is not expected to result in long-term improvement in academic achievement and neurocognitive functioning once it is discontin‐ ued; on the other hand, newer pscyhostimulant medications have been widely used in children with attention-deficit hyperactivity disorder (ADHD) and have proven to have fewer side effects and a longer half-life than MPH, for these reasons further studies are needed [131].

Cognitive rehabilitation program has proven to be effective in in-patients with primary brain tumors. The program consists of psychoeducation, teaching of strategies to compensate for

Cognitive remediation program (CRP) highly structured and individualized regimen, included traditional massed practice rehabilitation, instruction in metacognitive strategies, and cognitive-behavioral psychotherapy focused primarily on improving resistance to distraction. Butler and Copeland tested the effectiveness of CRP. Thirty-one subjects who had been treated from CNS tumors included in the study, and they were suffering from cogni‐ tive impairment such as attention deficits documented by continuous performance test (CPT). Cognitive behavioral psychotherapy was used. Significant improvement in focused atten‐ tion and attention/concentration was observed in those who underwent the CRP, but no significant benefit was measured with regard to arithmetic computation. The authors concluded that the intervention produced improved neurocognitive functioning on meas‐

response to treatment with MPH regarding neuropsychological dysfunction.

comparing the acute efficacy and adverse effects of MPH and placebo.

problems in attention, memory, and executive functioning in daily life.

**8.1. Pharmacologic treatment of neurocognitive impairment**

Mohammad Abu-Hegazy1,3\* and Hend Ahmed El-Hadaad2

\*Address all correspondence to: mhegazy@mans.edu.eg

1 Neurology Department, Mansoura University, Mansoura, Egypt

2 Clinical Oncology and Nuclear Medicine Department, Mansoura University, Mansoura, Egypt

3 Faculty of Medicine, Mansoura University, Mansoura, Egypt
