***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Purpose The assessment of Health-Related Quality of Life ( HRQoL ) in cancer patients has become increasingly important during the past decades . The aim of this study was to evaluate the HRQoL in patients treated for low- grade glioma ( LGG ) . Methods and Material sForty-three adult patients with LGG were evaluated prospect ively between September 2006 and December 2010 . We assessed HRQoL at baseline ( after surgery before radiotherapy ) , at the end of radiotherapy and during follow-up ( every 3 months for the first 2 years and every 6 months between 2 and 5 years ) , using the European Organization for Research and Treatment of Cancer Quality of Life Question naire 30 ( EORTC-C30 ) , Brain Cancer Module-20 ( BN-20 ) , Mini Mental State Examination ( MMSE ) and  Hospital Anxiety and Depression Scale  ( HADS ) . Results We demonstrated changes in global score ( p = 0.004 ) , and future uncertainty ( p < 0.001 ) , communication deficit ( p = 0.007 ) , headache ( p < 0.001 ) , drowsiness ( p = 0.002 ) and hair loss ( p < 0.001 ) , and recall score ( p = 0.0029 ) during follow-up . All complaints of LGG patients showed improvement , except for the hair loss . Although the baseline cognitive function scores was not significantly different , the third-year cognitive function scores of patients who used antiepileptic drugs had lower when compared to patients who did not use ( p < 0.001 ) . The baseline and follow-up anxiety and depression scores did not differ significantly . Conclusion Our results suggested that there were improvement in HRQoL in LGG patients during follow-up and antiepileptic drugs had negative effect on cognitive functions Patients with brain tumors may suffer from cognitive deficits caused by the disease and /or its treatment . Here , we review recent efforts in the research on prevention or treatment of cognitive deficits in these patients . We conclude that interest in this area is growing , but that method ological difficulties persist . In addition , we describe the recently completed first r and omized controlled trial on the effectiveness of cognitive rehabilitation  that we conducted in patients with brain cancer . By reflecting on the method ological challenges experienced in our trial , we hope to assist others in planning and conducting future studies on both pharmacological treatments and  cognitive rehabilitation programs for cognitive deficits in this patient population . We conclude with suggestions for future research directions PURPOSE To evaluate the effects of cranial radiotherapy ( RT ) on cognitive function in patients with supratentorial low- grade glioma . METHODS AND MATERIAL S Twenty adult patients with supratentorial low- grade glioma were treated with 50.4 Gy ( 10 patients ) or 64.8 Gy ( 10 patients ) localized RT . The patients then were evaluated with an extensive battery of psychometric tests at baseline ( before RT ) and at approximately 18-month intervals for as long as 5 years after completing RT . To allow patients to serve as their own controls , cognitive performance was evaluated as change in scores over time . All patients underwent at least two evaluations . RESULTS Baseline test scores were below average compared with age-specific norms . At the second evaluation , the groups ' mean test scores were higher than their initial performances on all psychometric measures , although the improvement was not statistically significant . No changes in cognitive performance were seen during the evaluation period when test scores were analyzed by age , treatment , tumor location , tumor type , or extent of resection . CONCLUSIONS Cognitive function was stable after RT in these patients evaluated prospect ively during 3 years of follow-up . Slight improvements in some cognitive areas are consistent with practice effects attributable to increased familiarity with test procedures and content OBJECTIVE To describe  patient-reported disability in primary brain tumours using the International Classification of Functioning , Disability and Health ( ICF ) ; and comparison with categories within the core sets for stroke and traumatic brain injury . METHOD A prospect i ve community cross-sectional survey ( n = 106 ) following definitive treatment for primary brain tumours . Problems reported by participants were linked with ICF categories using ' linkage ' rules . Participants rated  ' activities and participation '  and  ' environmental factor '  components of ICF checklist ( using qualifiers ) ; and responses compared with categories within core sets for stroke and traumatic brain injury . RESULTS Participant mean age 51 years , median time since diagnosis 2 years ; over a third had high grade tumours . Participants considered 44 categories in ' activities and participation ' and 16 categories ( barriers ) in ' environmental factors ' as relevant ( ≥ 10 % response ) using checklist . Reported problems included : Mobility , Domestic life , General tasks/ dem and s ; and Human made changes to environment . Although the linked categories for brain tumour survivors were similar to those in the core sets for stroke and traumatic brain injury , there was more commonality with the traumatic brain injury core set . CONCLUSION The existing comprehensive stroke and traumatic brain injury core sets incorporate issues relevant to brain tumour survivors in post-acute setting s. Findings from this report will assist in defining a future core set for brain tumour ; the possibility however , of using a single core set relevant to most long-term neurological conditions needs to be explored Background In patients with low- grade glioma ( LGG ) , the tumor and its treatment with conformal radiation therapy ( RT ) and chemotherapy can disrupt cognitive function . However , the contribution of disease and treatment to long-term cognitive outcome remains to be eluci date d. In this study , we performed longitudinal cognitive follow-up in a subgroup of patients who received RT , chemotherapy , or no treatment .  Methods Twenty-five LGG patients underwent neuropsychological evaluations at study entry , and 6 and 12 months subsequently ; 9 patients had RT ± chemotherapy prior to enrollment and 16 had no treatment .  Results At the initial evaluation , treated patients had impaired performance on motor speed only , but scored 1 st and ard deviation below normative values on tests of executive functions ; untreated patients had no cognitive impairment . Repeated measures analyses of variance showed a significant variation over time ( P = 0.03 ) in nonverbal memory ( delayed recall ) ; treated patients ’ performance improved at the 6-month follow-up to a level comparable to untreated patients , but both groups declined slightly by the 12-month evaluation . In a subset of patients ( N = 16 ) available for an additional cognitive evaluation , significant changes between the 12-month and the long-term follow-up were seen in phonemic verbal fluency , mood and quality of life ; untreated patients seen at short intervals improved slightly while treated patients seen at longer intervals declined . Conclusions Longitudinal follow-up showed that both disease duration and treatment with RT ± chemotherapy contributed to a mild decrement in nonverbal recall and in some aspects of executive functions and quality of life in this group of LGG patients The present prospect i ve study intends to evaluate health-related quality of life ( HRQL ) and cognitive functioning in adult patients with supratentorial World Health Organization ( WHO ) grade II glioma ( LGG ) prior to observation/therapy and to determine possible influences of tumor-related factors on these measures . Adult patients with biopsy-proven supratentorial LGG were considered eligible ( study period 18 months ) . Besides detailed documentation of patient clinical status we evaluated HRQL using the  Short Form-36 ( SF-36 ) Health Survey  and applied the  Beck Depression Inventory .  Furthermore , attention and verbal memory functions were tested . Data from matched healthy control population s served as reference , and T-values were compared using Mann – Whitney U tests . For correlation of scores the Pearson test was utilized . Thirty-three patients with median Karnofsky Performance Status ( KPS ) of 80 were evaluated . Selective and divided attention showed significant impairment ( P < 0.005 ) , while verbal memory functions were unaffected . HRQL evaluated by SF-36 Health Survey was significantly reduced predominantly in the psychological domains ( P < 0.025 to P < 0.0005 ) . Nine patients displayed mild to moderate depression . Duration of symptoms > 20 weeks and presence of seizures negatively affected aspects of HRQL , while cognitive functions were not influenced . KPS < 80 correlated significant only with reduced physical functioning ( P < 0.002 ) and role functioning ( P < 0.01 ) on the SF-36 Health Survey . While displaying good clinical status , patients with LGG showed significant impairment in aspects of attention and affections of HRQL already at time of diagnosis . These results suggest that these impairments originate from the tumor and /or potentially from confrontation with the diagnosis itself OBJECTIVE To evaluate effectiveness of a multidisciplinary rehabilitation program for persons following definitive primary brain tumour treatment in a community cohort . METHODS The brain tumour ( glioma ) survivors ( n = 106 ) were allocated either to the treatment group ( n = 53 ) ( intensive ambulatory multidisciplinary rehabilitation ) , or the waitlist control group ( n = 53 ) . The primary outcome - Functional Independence Measure ( FIM ) , measured ' Activity ' limitation ; secondary measures included Depression , Anxiety Stress Scale , Perceived Impact Problem Profile and Cancer Rehabilitation Evaluation System . Assessment s were at baseline , 3 and 6 months after program completion . RESULTS Participants were predominantly women ( 56 % ) , with mean age 51 years ( st and ard deviation 13.6 ) and median time since diagnosis of 2.1 years . Intention-to-treat analysis showed a significant difference between groups at 3-month in favour of multidisciplinary rehabilitation program in FIM motor subscales : ' self-care ' , ' sphincter ' , ' locomotion ' , ' mobility'(p < 0.01 for all ) ; and FIM ' communication ' ( p < 0.01 ) and ' psychosocial ' subscales ( p < 0.05 ) , with small to moderate effect size ( r = 0.2 - 0.4 ) . At 6-month follow-up , significant improvement in the treatment group was maintained only for FIM ' sphincter ' , ' communication ' and ' cognition ' subscales ( p < 0.01 for all ) . No difference between groups was noted in other subscales . CONCLUSIONS brain tumour survivors can improve function with multidisciplinary rehabilitation , with some gains maintained up to 6 months . Evidence for specific interventions in the ' blackbox ' of rehabilitation is needed PURPOSE To assess the neurocognitive effects of cranial radiotherapy on patients with low- grade gliomas , we analyzed cognitive performance data collected in a prospect i ve , intergroup clinical trial . METHODS Patients included 203 adults with supratentorial low- grade gliomas r and omly assigned to a lower dose ( 50.4 Gy in 28 fractions ) or a higher dose ( 64.8 Gy in 36 fractions ) of localized radiotherapy . Folstein Mini-Mental State Examination ( MMSE ) scores and neurologic function scores ( NFS ) at baseline and key evaluations were analyzed . Median follow-up was 7.4 years in 101 patients still alive . A change of more than three MMSE points was considered clinical ly significant . RESULTS In patients without tumor progression , significant deterioration from baseline occurred at years 1 , 2 , and 5 in 8.2 % , 4.6 % , and 5.3 % of patients , respectively . Most patients with an abnormal baseline MMSE score ( < 27 ) experienced significant increases . Baseline variables such as radiation dose , conformal versus conventional radiotherapy , number of radiation fields , age , sex , tumor size , NFS , seizures , and seizure medications did not predict cognitive function changes . CONCLUSION In this population , most low- grade glioma patients maintained a stable neurocognitive status after focal radiotherapy as measured by the MMSE . Patients with an abnormal baseline MMSE were more likely to have an improvement in cognitive abilities than deterioration after receiving radiotherapy . Only a small percentage of patients had cognitive deterioration after radiotherapy . However , more discriminating neurocognitive assessment tools may identify cognitive decline not apparent with the use of the MMSE 
    Output:
    
Many patients with low- grade glioma experience cognitive dysfunction .
However , there is no consensus on how to assess cognitive functioning in these patients