Hassler, M.R., Elandt, K., Preusser, M., Lehrner, J., Binder, P., Dieckmann, K., . . . Marosi, C. (2010). Neurocognitive training in patients with high-grade glioma: A pilot study. Journal of Neuro-Oncology, 97, 109–115.

To evaluate the effectiveness of small group neurocognitive training to improve cognitive impairment in patients with brain tumors

Pre- and post-intervention cognitive testing was performed. The 10-week-long intervention consisted of 90-minute weekly group sessions of holistic mnemonic training, which included exercises to train perception, concentration, attention, memory, retentiveness, verbal memory, and creativity.

• A total of 11 patients were enrolled in the study.
• Participants' ages ranged from 23–73 years (median = 50 years).
• The sample was 64% male and 36% female.
• Patients had been diagnosed with glioblastoma multiforme (n = 6) or anaplastic gliomas (n = 5).
• Time since initial diagnosis ranged from 10–42 months (median = 15 months).
• Every participant had received treatment that included surgery, radiation therapy, and adjuvant chemotherapy with temozolomide. One subject also received hydroxyurea and imatinib in addition to temozolomide.
• Three subjects had tumor recurrence 3–28 months prior to study participation; none underwent additional surgery, and further treatment with radiation or chemotherapy was not provided. 
• All subjects were taking antiepileptic medications; however a variety of drugs were used. 
• Subjects varied in professional and educational background, but actual information was not provided.

• Single site
• Outpatient setting
• Vienna, Austria

• Patients were undergoing long-term follow-up.
• The study has applicability for late effects and survivorship.

Pilot study with pre-/post-test design

• Trail Making Test–A (TMT-A)    
• Trail Making Test–B (TMT-B)
• Hopkins Verbal Learning Test (HVLT)
• Controlled Oral Word Association Test (COWAT)

Although comparison of mean group differences found improvement in all neuropsychological tests, separate dependent t-tests revealed statistically significant improvement only in verbal memory total learning (p < 0.05) as measured by the HVLT. Significant improvement was not seen in verbal memory delayed recall (p = 0.11) as measured by the HVLT, psychomotor speed (p = 0.22) as measured by the TMT-A, sustained attention (p = 0.17) as measured by the TMT-B, or verbal fluency (p = 0.29) as measured by the COWAT.

Significant improvement was found in verbal memory (total learning). However, it is not possible to distinguish whether the improvement was a benefit of the intervention or resulted from practice effects associated with the repeated measures occurring 12 weeks from baseline. Additionally, any assumptions regarding effectiveness of the intervention would need to be supported by a larger sample with an appropriate comparison control group.

• The sample was small, with less than 30 participants.
• The lack of a comparison control group or randomization limited the generalizability of results and the feasibility of the intervention.

Although neurocognitive training has been suggested as a potential intervention for cognitive impairment, further studies are needed (including feasibility). Effectiveness of this intervention cannot be established based on this pilot study.