Cognitive functioning in patients with nonfunctioning pituitary adenoma before and after endoscopic endonasal transsphenoidal surgery
Butterbrod,Elke Gehring,Karin Voormolen,Eduard Depauw,Paul Nieuwlaat,Willy-Anne Rutten,Geert-Jan Sitskoorn,Margriet
Butterbrod,Elke
Gehring,Karin
Voormolen,Eduard
Depauw,Paul
Nieuwlaat,Willy-Anne
Rutten,Geert-Jan
Sitskoorn,Margriet
Abstract
Objective Patients with nonfunctioning pituitary adenomas (NFPAs) can suffer from cognitive dysfunction. However, the literature on longitudinal cognitive follow-up of patients undergoing endoscopic endonasal transsphenoidal surgery (EETS) is limited. This study was performed to investigate perioperative cognitive status and course in patients with NFPAs. Methods Patients underwent computerized neuropsychological assessment 1 day before (n = 45) and 3 months after (n = 36) EETS. Performance in 7 domains was measured with a computerized test battery (CNS Vital Signs) and standardized using data from a healthy control group. The authors conducted analyses of cognitive performance at both time points and changes pre- to post-ETSS on a group and an individual level. Linear multiple regression analyses were employed to investigate predictors of cognitive performance. Results On average, patients scored significantly lower in 6 of 7 cognitive domains before and after surgery than controls. Impairment proportions were significantly higher among patients (56% before surgery, 63% after surgery) than among controls. Patients showed no change over time in group-level (mean) performance, but 28% of individual patients exhibited cognitive improvement and 28% exhibited cognitive decline after surgery. Hormonal deficiency showed a positive correlation with verbal memory before surgery. Postoperative performances in all cognitive domains were predicted by preoperative performances. Conclusions Cognitive impairment was present before and after EETS in over half of NFPA patients. Individual patients showed diverse postoperative cognitive courses. Monitoring of cognitive functioning in clinical trajectories and further identification of disease-related and psychological predictors of cognition are warranted.
Description
Funding Information: This study is funded by ZonMw: The Netherlands Organisation for Health Research and Development (project number 842003007).
Date
2020
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Keywords
ABNORMALITIES, ADULT PATIENTS, DYSFUNCTION, EXECUTIVE FUNCTIONS, IMPACT, IMPAIRMENT, MEMORY, PERFORMANCE, RADIOTHERAPY, TUMORS, cognitive functioning, endoscopic endonasal transsphenoidal surgery, nonfunctioning pituitary adenoma, pituitary surgery, reliable change index
Citation
Butterbrod, E, Gehring, K, Voormolen, E, Depauw, P, Nieuwlaat, W-A, Rutten, G-J & Sitskoorn, M 2020, 'Cognitive functioning in patients with nonfunctioning pituitary adenoma before and after endoscopic endonasal transsphenoidal surgery', Journal of Neurosurgery, vol. 133, no. 3, pp. 709-716. https://doi.org/10.3171/2019.5.JNS19595