NEUROCOGNITIVE functioning declines across central nervous system cancers, shaped by tumor location and interacting treatment effects.
Neurocognitive Functioning in CNS Cancer
This narrative review synthesizes evidence that neurocognitive deficits are common in central nervous system cancer. Impairments frequently involve memory, attention, processing speed, and executive function. The profile and severity of decline vary with tumor biology and anatomic location. Involvement of the frontal and temporal lobes is linked to more prominent disruption of higher order skills that support daily independence and complex medical decision making. The review emphasizes that neurocognitive functioning reflects combined effects from disease and therapy, which requires clinicians to integrate cognitive outcomes into routine oncologic care.
Tumor and Treatment Influences
Patterns differ across gliomas, primary central nervous system lymphoma, meningioma, and brain metastases. Surgery, radiotherapy, chemotherapy, targeted therapy, and immunotherapy can each influence neurocognitive functioning. Radiotherapy exerts cumulative effects that may progress over time. Adjunctive treatments such as corticosteroids and antiepileptic medicines may both relieve symptoms and contribute potential adverse cognitive effects, which calls for careful dosing and ongoing review. The authors note that tumor location strongly shapes the domain profile, with disruption of networks supporting episodic memory and processing speed when temporal and subcortical regions are affected.
Modifiers and Clinical Assessment
Outcomes are modified by individual brain resilience, neuroplasticity, and psychological distress. Standardized neuropsychological assessment helps characterize baseline status and change over time. The review discusses commonly used measures and highlights the need for longitudinal follow up that captures domain specific trajectories. Demographic factors and treatment intensity should be considered when interpreting scores. Attention to neurocognitive functioning supports shared decision making and helps align therapy with patient goals.
Implications for Care and Rehabilitation
Neurocognitive impairment in central nervous system cancer arises from both tumor biology and treatment exposure. Understanding these mechanisms supports tailored strategies that include cognitive rehabilitation, optimization of treatment planning, and incorporation of neuroprotective approaches. Early identification of decline can prompt timely referral to rehabilitation services and counseling. Integration of psychological support may lessen distress and improve engagement with therapy. A comprehensive approach that prioritizes neurocognitive functioning can enhance health related quality of life and support long term survivorship planning.
Reference: Klein M et al. Neurocognitive functioning in patients with Cancer involving the central nervous system. J Clin Exp Neuropsychol. 2025:1-17. doi: 10.1080/13803395.2025.2577949.
