Prediction of Verbal Memory Loss in Individuals After Anterior Temporal Lobectomy

Authors

  • Keith G. Davies,

    Corresponding author
    1. Epi-Care Center, Baptist Memorial Hospital, Memphis
    2. Semmes-Murphey Clinic, Memphis
    3. Departments of Neurosurgery, University of Tennessee, Memphis, Tennessee
      Address correspondence and reprint requests to Dr. K. G. Davies at Epi-Care Center, Suite 700, 930 Madison Ave., Memphis TN 38103, U.S.A.
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  • Brian D. Bell,

    1. Epi-Care Center, Baptist Memorial Hospital, Memphis
    2. Semmes-Murphey Clinic, Memphis
    3. Departments of Psychiatry, University of Tennessee, Memphis, Tennessee
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  • Andrew J. Bush,

    1. Departments of Preventive Medicine, University of Tennessee, Memphis, Tennessee
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  • Allen R. Wyler

    1. Epilepsy Center, Swedish Medical Center, Seattle, Washington, U.S.A.
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Address correspondence and reprint requests to Dr. K. G. Davies at Epi-Care Center, Suite 700, 930 Madison Ave., Memphis TN 38103, U.S.A.

Abstract

Summary: Purpose: Decreased memory function represents the area of greatest neuropsychological morbidity after anterior temporal lobectomy (ATL), particularly for left ATL candidates. We wished to identify easily derived demographic and neuropsychological predictors of risk of pre-to postoperative memory decline using only information available preoperatively.

Methods: We assessed decline in memory as measured by the California Verbal Learning Test (CVLT) by deriving multiple regression equations using the following measures as independent variables: age at onset, chronological age at time of surgery, sex, Full Scale IQ (FSIQ), level of education, and preoperative memory scores. In all, 203 patients (93 males, 110 females), undergoing ATL (107 left, 96 right) with preoperative and 6-month postoperative testing, were examined.

Results: The combination of age, FSIQ, sex, side of surgery and preoperative score was highly predictive (p-values <0.0001) of postoperative memory scores. Higher postoperative scores were associated with higher preoperative score, younger chronological age, higher FSIQ, female sex, and right side of resection. Reliable change index (RCI) values were used to estimate meaningful decline on the total score across five trials. Logistic regression analysis showed preoperative score and age to be predictors of RCI decline for left-sided resections. Sensitivity of decline (≥90th centile RCI) prediction was 56%, and specificity was 95%. Validation in 30 patients from a separate population of patients undergoing left ATL produced similar figures.

Conclusions: The derived regression equations can accurately predict verbal memory decline on a list-learning task in-50% of individual patients undergoing ATL, and false-positive prediction errors are very rare.

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