Cognitive disruption by gliomas can be similar for tumors in quite different brain regions, suggesting that network dysfunction may be caused by more than just the structural nuance of the tumor mass.

The pathophysiological mechanisms underlying network disturbances and the resulting deficits in neurocognitive function (NCF) of patients have thus far not been clarified fully. EF is an emergent property of a widespread brain network rather than a product of regional specialization, and is therefore vulnerable to the glioma’s effects. 7, 8 EF encompasses a set of higher-order neurocognitive processes that allow people to make choices and engage in goal-directed and future-oriented behavior.

6 EF is particularly likely to be impaired in glioma patients. Consequently, cognitive dysfunction in glioma patients can be more generalized than might be expected based solely on tumor location and size when coordination has been disrupted. Cognition in particular relies on successful coordination between regions of specialized function. The brain maintains a complex network of interactions between local and distant areas to synthesize regional specialization with global integration. These cognitive impairments have a marked impact on quality of life, both for patients and their caretakers. 1–4 The most common domains affected are Executive Functioning (EF), Psychomotor Speed, and Memory. About one-third of patients with diffuse glioma (WHO grade II-IV) suffer from a deficit in 1 or more cognitive domains.

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