EPID-07. RELATIONSHIP BETWEEN COGNITION, SPEED OF PRESENTATION AND SEMANTIC VERBAL FLUENCY TEST IN PATIENTS WITH NEW INTRA-CEREBRAL TUMORS

Abstract

Patients with brain tumors often have subtle cognitive change, which may go unnoticed by patient and family doctor. This may result in delays in diagnosis. We studied the relationship between first and subsequent symptoms and semantic verbal fluency test (SVFT), a quick cognitive screening test. (Normal median SVFT for 60-79 age range who have 12 years of education = 17 animals; 10th percentile is 12 animals). Patients with new intrinsic brain tumors had structured patient interviews to determine first and subsequent symptoms. Patients were specifically asked about cognition. A cognitive screening test (SVFT - how many animals can you think of in a minute) was performed in patients as part of the Addenbrookes Cognitive Exam on admission. Symptoms were categorized into focal, non-focal, episodic attack or headache. 127 patients with cerebral brain tumors were assessed- glioma (n=94 HGG=79;LGG=15); metastasis (n= 28); primary CNS lymphoma (n=5). Mean age, 56.2, (SD 13.1): 55% male. 16 patients presented with a solitary symptom (episodic (9); focal (4); headache (3); non-focal (0)). As symptoms accumulated time to diagnosis increased “1 symptom” (med 23 days); “2 symptoms” (med 42 days) “>=3 symptoms” (med 44 days). Mean SVFT was lowest in HGG (mean 10.9) vs LGG (mean 15.7). Patient awareness of cognitive problems did not correlate with SVFT score (aware (n=50) mean 11.9 v unaware (n=77) mean 11.7)) Presentation with an isolated cognitive complaint is uncommon in cerebral brain tumors. Diagnosis becomes apparent when combined with headache or focal symptoms. Diagnosis becomes easier when multiple symptoms accumulate, but there are increasing delays. Many patients with headache also have asymptomatic cognitive problems on SVFT. Where there is a suspicion of cerebral problem e.g. headache suspicious of cancer, it is insufficient just to ask patients whether they have cognitive problems. SVFT may be a helpful red flag.