Detection of specific executive deficits using an “ecological” battery in frontal low grade gliomas

MARÍA ROCA; TERESA TORRALVA; LUCIANA VITA; AGUSTINA LACROZE; MARÍA DE LUJÁN CALCAGNO; FACUNDO MANES; DIEZ B

Edinburgo

Encuentro; World Federation of Neuro-Oncology Second Quadrennial Meeting, Sixth Meeting of the European Association for Neuro-Oncology; 2005

World Federation of Neuro-Oncology, European Association for Neuro-Oncology

The most common cognitive symptoms of frontal lesions are impaired executive functions, social interaction, and personal regulation. However, this form of mental impairment is sometimes so subtle in daily activities and unsusceptible to testing that these patients seem intellectually intact. Deficits are not found in standard tests because they do not address the component of real life decision-making and social cognition. Therefore, the objective of this investigation was to detect specific executive deficits in patients with frontal low-grade gliomas (FG), using an “ecological” executive battery, that consists in real-life tests shown to be sensitive to damage to the prefrontal cortex (PFC). Patients with FG (n = 5) were compared with a group of normal controls (n = 5). All patients underwent a standard neuropsychological examination and the “ecological” executive battery. The “ecological” executive battery used in this study consists of five tests. (1) Frontal Assessment Battery (FAB): This consists in 6 subscales exploring frontal lobe functions. (2) IOWA Gambling Task (IGT): This test simulates personal real life decision-making activities. (3) Faux Pas Test: The subject is shown ten faux pas stories and ten stories without a faux pas; the subject is asked if something was said inappropriately and why. (4) The Hotel Task: It comprised six distinct activities that would plausibly need to be completed in the course of running a hotel. (5) MET–Hv: The purpose of this test, undertaken in the hospital and its surroundings, is to carry out 12 subtasks in a “real life” situation. Significant differences were found between FG and normal controls in both Trail Making Tests (P = 0.14 and P = 0.27), Faux Pas (P = 0.007), and total scores of the IGT (P = 0.034). In addition, tendencies were noted in the Met –hv total error score, which were not statistically significant, probably because of the limited size of the sample. These patients with low-grade gliomas in the frontal cortex did not exhibit the most typical disinhibited and socially inappropriate behavior, usually seen after frontal injury. However, the deficits in social interactions and decision making were captured by this new ecological executive battery. The present study has implications for the clinical assessment of the real-life problems faced by these patients, both within the family and whenever they might return to work.