ERodriguez_HW1

ERodriguez_HW1

by Eduardo Rodriguez Almaraz -

Topic

Integrating new technologies to improve cognitive function in patients with primary malignant neoplasms of the brain.

Background

Cognitive function is an important predictor of response to treatment and it also has been shown to be an important survival predictor in patients with primary malignant brain tumors1. Measurement and consideration of performance status is, therefore, vital when counseling patients regarding their expected survival or evaluating the results of clinical trials. Unfortunately, measures of patient function in clinical trials have remained quite crude1.

Furthermore, cognitive dysfunction is common among patients with intracranial tumors. Most cognitive deficits are subtle, lack specificity, may mimic depression or other neurological disorders and may be recognized in retrospect by the physician2.

In recent years, the body of evidence has increased in favor of computer-based applications for “brain training” with the aim of improving central areas of cognition such as executive functions, working memory, and processing speed in young adults3. Moreover, with the emergency of these technologies, treating physicians are able to track progress and communicate with patients in real time, at the same time that other important determinants such as physical activities are tracked for posterior analysis.

Gap

Currently the use of such applications is not used regularly for a number of reasons such as lack of consistency among the software, variation in the level of technological literacy among patients, access to devices enabled to use this software, among others.

 

Implementation

Lumosity is one of the most widely used and researched mobile applications that have shown to be beneficial to patients at a low financial cost. With the implementation of this mobile application as part of routine clinical practice, the treating oncologists would be able to assess more accurately the physical and cognitive level of patients, which are important factors in determining clinical status of the patient and subsequent therapy. Most importantly, patients will delay their cognitive decline improving substantially their prognosis and quality of life4.  

References

 

1.      Johnson DR, Wefel JS. Relationship between cognitive function and prognosis in glioblastoma. CNS Oncol. 2013;2(2):195-201. doi:10.2217/cns.13.5.

2.      Ali FS, Hussain MR, Gutiérrez C, et al. Cognitive disability in adult patients with brain tumors. Cancer Treat Rev. 2018;65:33-40. doi:10.1016/j.ctrv.2018.02.007.

3.      Nouchi R, Taki Y, Takeuchi H, et al. Brain Training Game Boosts Executive Functions, Working Memory and Processing Speed in the Young Adults: A Randomized Controlled Trial. Kline AE, ed. PLoS ONE. 2013;8(2):e55518. doi:10.1371/journal.pone.0055518.

4.      Ballesteros S, Mayas J, Prieto A, Ruiz-Marquez E, Toril P, Reales JM. Effects of Video Game Training on Measures of Selective Attention and Working Memory in Older Adults: Results from a Randomized Controlled Trial. Frontiers in Aging Neuroscience. 2017;9:354. doi:10.3389/fnagi.2017.00354.


Re: ERodriguez_HW1

by Tene -

How exciting to think that this type of software might be able to improve outcome for brain tumor patients. Are there any restrictions that patients may come up against based on physical deficits associated with their tumor? If so, would that make implementation or repeated measures challenging? Can patients with metastatic tumors to the brain also benefit from this device?  I look forward to hearing more about how patients and providers are trained to use this software.

Re: ERodriguez_HW1

by Eduardo Rodriguez Almaraz -

Those are very good and valid questions. I think it is still in its early stages but there are other groups (mainly in Europe) that are developing software specifically oriented to brain tumor patients. Here in the US some Neurology practices (not limited to neurooncology) use this type of software to improve cognitive function in other neurological disorders, therefore, it makes sense and it looks promising to use these kind of applications to, at minimum, delay the cognitive decline in patients with brain tumors. 

I am not familiar with the work done (if any) with brain metastases. Although, it is a very important question since metastasis are actually more frequent than primary brain tumors. 

Re: ERodriguez_HW1

by Iris Otani -
Hi - That is interesting that there aren't great measures of cognitive function despite cognitive function being a predictor of treatment response and survival. I'm curious to know more about the specific efficacy of Luminosity! It would be helpful to have a sentence like "Luminosity has been shown to boost x, y, and z", similar to the sentence you have in your background about brain training apps as a group.


You mentioned some reasons why your 'gap' exists. Would using Luminosity address those reasons? For example, wouldn't patients still have variation in level of technological literacy and access to devices that would prevent them from using Luminosity? 


Also, it seems like there are 2 specific gaps that you could focus on? One is the gap of inadequate measures of cognitive function at time of diagnosis to help predict treatment response and survival (which you are hoping to address by using Luminosity). Another is the gap of inadequate measures to track cognitive function and prevent cognitive decline during treatment / clinical trials (which you can also address by using Luminosity). Thanks!



Re: ERodriguez_HW1

by Eduardo Rodriguez Almaraz -

Hi - Thank you for your comments. They make me think further regarding this "gap". 

You are correct in the "alternative" gap that exists regarding the measurement of cognitive function. Actually, that was my first thought when I was "developing" this idea. However, there are tools that, even not so accurate, are used routinely in the clinical setting to try to establish cognitive and physical function, an example used in our clinic is Karnofsky Performance status. I think you are right, developing a more sensitive and specific tool to measure cognitive function is greatly important, but it would need to be validated and tested first and then it could be implemented in routine care. 

Re: ERodriguez_HW1

by Odmara Barreto Chang -

Jesus, 

This is a very interesting topic, my research is actually related to cognitive function. Do you know what are the specific cognitive domains affected in your patients? Does Lumosity cover those domains? Do researchers know when is best to start "training the brain" or if there are specific periods of higher susceptibility?

Looking forward to hearing more about your topic.


Best, Odmara


Re: ERodriguez_HW1

by Eduardo Rodriguez Almaraz -

Hi Odmara,

I was just reading a comment from a class mate that pointed out the importance of developing a tool that is sensitive and specific to assess cognitive function, maybe you are undertaking this huge task. 

Regarding your questions, I know that Lumosity has shown to improve working memory and attention primarily in older adults. 

Your question regarding the knowledge of when to start or periods of higher susceptibility are not yet clear, but I believe it is being explored. I think in primary brain tumors is a little difficult to establish this time-points since the speed of cognitive decline varies depending of a number of factors (type of tumor, location of tumor, size of tumor, age, therapy, symptoms at diagnosis, initial cognitive function, etc), but it I think it is worth to explore this area to be more accurate when recommending this type of intervention.

Re: ERodriguez_HW1

by Andrew -

Hi Eduardo, 

Very interesting topic! 

1.) Utilizing Luminosity is a wonderful idea. What specific cognitive aspects would you be assessing for and for how long? Are you utilizing the basic cognitive tasks already created by Luminosity or are you interested in partnering to create a "Luminosity-Healthcare Provider" specialized cognitive tasks? 

2.) As you mentioned, the power of technology is immeasurably useful however considerable variations and inconsistencies exist. What are some of these issues and how do you plan to overcome some of them? 

Great work! Looking forward to hearing more about your project in session.

Sincerely,

Andrew