Longitudinal Analysis of Depression and Anxiety Symptoms as Independent Predictors of Neurocognitive Function in Primary Brain Tumor Patients.

ABSTRACT Background Primary brain tumor patients are vulnerable to depression and anxiety symptoms, which may affect their neurocognitive functioning. We performed a prospective longitudinal analysis to examine the association between depression and anxiety symptoms and domain-specific neurocognitive functioning in primary brain tumor patients receiving radiation therapy [RT]. Methods On a prospective trial, 54 primary brain tumor patients receiving RT underwent comprehensive neurocognitive evaluation at baseline (pre-RT), and 3, 6, and 12 months post-RT. Neurocognitive assessments measured attention/processing speed, verbal and visuospatial memory, and executive functioning, including Delis-Kaplan Executive Function System Trail-Making Test [DKEFS-TMT], DKEFS Verbal Fluency [DKEFS-VF], and Brief Visuospatial Memory Test-Revised [BVMT-R]. Depression and anxiety symptoms were also assessed at each time point with Beck Depression and Anxiety Inventories [BDI-II, BAI], respectively. Higher scores reflect more numerous or severe depression/anxiety symptoms. Univariable and multivariable linear mixed-effects models assessed associations between BDI-II and BAI scores and domain-specific neurocognitive scores over time, controlling for pre-existing depression/anxiety disorders and other patient, tumor, and treatment characteristics. Results Higher BAI scores were associated with worse attention/processing speed in univariable analyses: DKEFS-TMT Visual Scanning (p=0.003), Number Sequencing (p=0.011), and Letter Sequencing (p Conclusions Among primary brain tumor patients receiving RT, increased depression and anxiety were independently associated with worsened neurocognition, particularly in attention/processing speed. Depression and anxiety symptoms should be controlled for in prospective clinical trials and managed in the clinical setting to optimize neurocognitive functioning.