Tilburg University
In reply to the letter to the editor regarding 'Cognitive outcomes in meningioma
patients undergoing surgery: Individual changes over time and predictors of late
cognitive functioning'
Rijnen, Sophie; De Baene, Wouter; Rutten, Geert-Jan; Gehring, Karin; Sitskoorn, Margriet
Published in:
Neuro-Oncology
DOI:
10.1093/neuonc/noaa020
Publication date:
2020
Document Version
Publisher's PDF, also known as Version of record
Link to publication in Tilburg University Research Portal
Citation for published version (APA):
Rijnen, S., De Baene, W., Rutten, G-J., Gehring, K., & Sitskoorn, M. (2020). In reply to the letter to the editor
regarding 'Cognitive outcomes in meningioma patients undergoing surgery: Individual changes over time and
predictors of late cognitive functioning'. Neuro-Oncology, 22(4), 582-583.
https://doi.org/10.1093/neuonc/noaa020
General rights
Copyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights. • Users may download and print one copy of any publication from the public portal for the purpose of private study or research. • You may not further distribute the material or use it for any profit-making activity or commercial gain
• You may freely distribute the URL identifying the publication in the public portal
Take down policy
If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim.
1
Neuro-Oncology
XX(XX), 1–2, 2020 | doi:10.1093/neuonc/noaa020 | Advance Access date 30 January 2020
© The Author(s) 2020. Published by Oxford University Press on behalf of the Society for Neuro-Oncology.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
Reply to Letter to the Editor
applyparastyle "fig//caption/p[1]" parastyle "FigCapt"
applyparastyle "fig" parastyle "Figure"
In reply to the letter to the
editor regarding “Cognitive
outcomes in meningioma
patients undergoing surgery:
individual changes over
time and predictors of late
cognitive functioning”
We appreciate the thoughtful comments by Prof Dr de Vries1 regarding our published article,2 as well as the invitation to reply to these comments.
De Vries raised two methodological comments about medi-cation use and the validity of the presurgical neuropsycho-logical measurement.
First, the author1 suggests that the study protocol states that patients had to be free of medications that interfere with cog-nitive functioning to be included in the study. Yet, the protocol states that “subjects for the control group (recruited from the general population) (. . .) should (. . .) be free of medication use that interfere with cognitive function.” 3 This does, however, not apply to the patients, for whom the exclusion criteria as de-scribed in our published manuscript correspond to the criteria as described in the study protocol.2,3 Therefore, patients who used medications that are known to affect cognitive function were included in the analyses.
Additionally, the author raises the question as to why all drugs were combined into one category, regardless of the various effects of different substances on cognition. Our manuscript concerns one of the few studies examining cog-nitive functioning in a large sample of patients with men-ingioma, individual as well as group changes in performance over time, and is to our knowledge the first study that exam-ines a plethora of possible predictors of cognitive func-tioning after surgery.2 It was beyond the scope of this study to examine the effects of the types and timing of medication in detail as well. Yet, we agree on the importance of moni-toring the effects of different types and timing of medication on cognitive performance in more detail in future studies, as we recognize the various effects that substances can have on cognition.
Furthermore, a clarification was requested with regard to the percentage of patients (ie, 43%) who were non-users of psychotropic drugs on the day prior to surgery, since
dexamethasone is usually initiated before meningioma sur-gery. The neuropsychological screening (NPS) was taken on the day before surgery in all patients; however, the NPS was scheduled either in the morning (ie, before hos-pital admission) or in the afternoon (ie, after admission to the neurosurgical department). Therefore, dexamethasone was not yet started in all meningioma patients at the time of presurgical NPS.
As a second methodological comment, the author brings up the validity of the presurgical NPS, as psychological stress of patients on the day before meningioma surgery might have affected neuropsychological test outcomes. In the present study, we did not investigate the link between symptoms of anxiety and depression and cognition. Yet, in our former study in meningioma patients we found nega-tive correlations between depression and cogninega-tive per-formance (but not for anxiety) prior to surgery, and negative correlations between depression as well as anxiety and per-formance after surgery.4,5 Although this suggests that psy-chological stress may indeed affect test outcomes, levels of symptoms of anxiety and depression in our sample are very comparable between pre and postsurgery (ie, with negligible changes in mean scores over time, see Table 2 of the manu-script).2 Taken together, we do not rule out the effects of psy-chological distress on cognitive performance in meningioma patients, however, such effects may play a role throughout the pre and postoperative trajectory.
Funding and conflict of interest
Nothing to declare.Sophie J. M. Rijnen, Wouter De Baene,
Geert-Jan M. Rutten, Karin Gehring, and
Margriet M. Sitskoorn
Department of Cognitive Neuropsychology, Tilburg University, Tilburg, the Netherlands (S.J.M.R., W.D.B., K.G., M.M.S.); Department of Neurosurgery, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands (G.J.M.R., K.G.)
Corresponding Author: S.J.M. Rijnen, Tilburg University – Department
of Cognitive Neuropsychology, Warandelaan 2, 5000 LE Tilburg, Noord-Brabant, The Netherlands, Room 202, P.O. Box 90153 (s.j.m.rijnen@uvt.nl).
Reply to Letter to the Editor
2
References
1. De Vries F. Letter regarding “Cognitive outcomes in meningioma pa-tients undergoing surgery: individual changes over time and predictors of late cognitive functioning.” Neuro Oncol. 2020. Epub ahead of print. doi:10.1093/neuonc/noz247.
2. Rijnen SJM, Meskal I, Bakker M, De Baene W, Rutten GJM, Gehring K, Sitskoorn MM. Cognitive outcomes in meningioma patients undergoing surgery: individual changes over time and predictors of late cognitive func-tioning. Neuro Oncol. 2019;21(7):911–922.
3. Cognitive deficits in brain tumor patients after neurosurgery: incidence, severity and predictionof outcome. ZonMw
pro-ject number 842003007. Medical Ethical Committee protocol ID NL41351.008.12. https://www.trialregister.nl/trial/5063, accessed on 8 January 2020.
4. Meskal I, Gehring K, van der Linden SD, Rutten GJ, Sitskoorn MM. Cognitive improvement in meningioma patients after sur-gery: clinical relevance of computerized testing. J Neurooncol. 2015;121(3):617–625.
5. Meskal I, Gehring K, Rutten GJ, Sitskoorn MM. Cognitive func-tioning in meningioma patients: a systematic review. J Neurooncol. 2016;128(2):195–205.
