**3. Brain tumors and cognition**

ment without crossing the threshold for dementia has been termed "mild cognitive impair‐ ment" (MCI) [19]. The MCI syndrome, as an expression of an incipient neurodegenerative disorder that may lead to dementia, is extremely heterogeneous and may coexist with systemic, neurologic, or psychiatric disorders that can cause cognitive deficits [20]. The criteria for MCI encompassed all possible cognitive manifestations of the syndrome and four subgroups have been proposed: deficits only in memory functions; memory deficits plus deficits in another cognitive domain; deficits in a single nonmemory domain; and deficits in more than one

MOCA was used as test of cognition, measure cognitive function, its cognitive domains: visuospatial/ executive function; naming; memory; language; abstraction; and attention.

*2.2.3. Other cognitive domain-specific areas neuropsychological tests: focus on domain-specific areas of*

(1) Hayling Sentence Completion Test, Word Span and Corsi's Test to test working memory [24], verbal and visual memory—Recognition Memory Tests, Words, and Topography [25]. (2) Rey Auditory Verbal Learning Test—RAVLT and logical memory to assess episodic memory, immediate and delayed recall [26], abstract reasoning: nonverbal—Raven's ad‐ vanced progressive matrices [27, 28], verbal—Proverb Interpretation Test [29]. (3) Attention— Digit Span sub-test from the Wechsler Adult Intelligence Scale-III [30], Elevator Counting with Distraction from the Test of Everyday Attention [31], Trail Making test, part A and part B to test simple speed processing and complex attention, respectively, [32]. (4) Visual perception —Incomplete Letters Test from the Visual Object and Space Perception Battery [33], Rey– Osterrieth Complex Figure recall, to test visuospatial long-term memory, Rey–Osterrieth Complex Figure, copy to test visuoconstructional abilities [34]. (5) Phonemic and semantic fluency [35], language—Graded Naming Test [36], Word Comprehension—Synonyms Test [37]. (6) Executive functions—phonemic word fluency [38]. (7) Frontal Assessment Battery—

For neuropsychological measures, age-, gender-, and education-corrected scores and equiva‐ lent scores should be calculated from the raw scores according to normative standards.

nonmemory domain [21].

244 Neurooncology - Newer Developments

*cognition:*

**2.2. Evaluation of cognitive functions**

*2.2.1. The Montreal cognitive assessment (MoCA)*

*2.2.2. Mini Mental State Examination (MMSE)*

FAB to assess frontal functionality [39].

MoCA is scored out of 30 points. A normal score is 26 or above [22].

MMSE is used for global cognitive functioning measurement [23].

Cognitive impairment, a common finding with the brain tumors, may result from the tumor itself or the treatment used surgery, chemotherapy, or RT.

#### **3.1. Cognitive impairment due to tumor**

More than 90% of patients with brain tumors showed impairments in the cognition at least in one area. The reported impairments of executive function were observed in 78%, while impairments of memory and attention were presented in more than 60% of patients [40].

Zucchella et al. [41] reported cognitive impairment in 54.4% of brain tumor patients, (53.75%) presented with multidomain impairment, while (46.25%) of the patients revealed cognitive deficits 16.25% of them limited to language, 13.75% to memory, 8.75% to attention, 6.25% to logical-executive functions, and 1.25% to visuospatial abilities.

Talacchi et al. [5] reported cognitive impairment in glioma patients 79% of patients have cognitive deficit in at least one test, (24, 3, 31, and 21% in one, two, three, four, or more tests, respectively, and this was correlated with edema, tumor grade, and size. Verbal memory, visuospatial memory, and word fluency were the most frequently affected functions.
