METHODS: A systematic literature search of brain tumours in the context of fMRI methods applied to pre-operative mapping for language functional areas was conducted using PubMed/MEDLINE and Scopus electronic database following PRISMA guidelines. The article search was conducted between the earliest record and March 1, 2019. References and citations were checked in Google Scholar database.
RESULTS: Twenty-nine independent studies were identified, comprising 1031 adult participants with 976 patients characterised with different types and sizes of brain tumours, and the remaining 55 being healthy controls. These studies evaluated functional language areas in patients with brain tumours prior to surgical interventions using language-based fMRI. Results demonstrated that 86% of the studies used a Word Generation Task (WGT) to evoke functional language areas during pre-operative mapping. Fifty-seven percent of the studies that used language-based paradigms in conjunction with fMRI as a pre-operative mapping tool were in agreement with intra-operative results of language localization.
CONCLUSIONS: WGT was most commonly utilised and is proposed as a suitable and useful technique for a language-based paradigm fMRI for pre-operative mapping. However, based on available evidence, WGT alone is not sufficient. We propose a combination and convergence paradigms for a more sensitive and specific map of language function for pre-operative mapping. A standard guideline for clinical applications should be established.
DESIGN: An analysis of the English Longitudinal Study of Ageing (ELSA) cohort.
SETTING: United Kingdom community-based.
PARTICIPANTS: 5197 community-dwelling older adults recruited to a prospective longitudinal cohort study.
MEASUREMENTS: Data on the occurrence of falls and number of falls, which occurred during a 12-month follow-up period, were assessed against the specific cognitive domains of memory, numeracy skills, and executive function. Binomial logistic regression was performed to evaluate the association between each cognitive domain and the dichotomous outcome of falls in the preceding 12 months using unadjusted and adjusted models.
RESULTS: Of the 5197 participants included in the analysis, 1308 (25%) reported a fall in the preceding 12 months. There was no significant association between the occurrence of a fall and specific forms of cognitive dysfunction after adjusting for self-reported hearing, self-reported eyesight, and functional performance. After adjustment, only orientation (odds ratio [OR]: 0.80; 95% confidence intervals [CI]: 0.65-0.98, p = 0.03) and verbal fluency (adjusted OR: 0.98; 95% CI: 0.96-1.00; p = 0.05) remained significant for predicting recurrent falls.
CONCLUSIONS: The cognitive phenotype rather than cognitive impairment per se may predict future falls in those presenting with more than one fall.