Abstracts

Rationale: Patients frequently report symptoms of cognitive dysfunction after temporal lobectomy for treatment of refractory epilepsy. It has been previously shown that patient reports of symptom severity correlates better with mood than objective measures of cognitive dysfunction. Conversely, spouses and close relatives (proxies) of patients who have undergone a temporal lobectomy are cognitively normal and may be better observers of a patient’s cognitive ability. The aim of this study was to compare subjective reports of cognitive dysfunction by patients with reports of their proxies and to objective neuropsychological variables. Methods: We administered an original questionnaire to 43 patients with a history of prior right or left temporal lobectomy to assess patients’ impressions of their own cognitive deficits. We concurrently administered a parallel questionnaire to the proxy of the patient and asked them to judge the level of cognitive deficit of the patient. The questionnaire consisted of 20 questions scaled 0 to 5 which addressed five distinct realms of cognitive function: language, memory, executive function/judgment, emotional control, and social perception. In addition, we included a satisfaction with life scale (SWL). We compared the patient reports with proxy reports. In addition, we compared patients and proxy reports to objective measures of neuropsychological functioning using correlation analysis. Results: A correlation between patient and proxy responses was observed after left sided resections in memory and social perception (r=0.41 for both, p=0.05), and for executive function (r=0.57, p=0.05). No correlation was present for patient and proxy responses for language and emotional control for left sided resections; no correlations were observed for any domains following a right temporal resection. No significant correlation was observed between self-reported language deficits and BNT scores or self-reported memory scores and long delay CVLT scores after either right or left temporal resection. A correlation was observed for proxy report of language deficit and patient BNT scores (left side r=0.58, right side r=0.66) and proxy report of memory deficit and CVLT scores (left side r=0.51, right side r=0.81). A correlation was observed between patient reports of cognitive function and SWL score (r=0.57, p=0.05) while no correlation was observed for proxy reports of cognitive function and SWL score. Conclusions: These data suggest that the proxies of patients who have undergone a temporal lobectomy may be more accurate at estimating the level of postoperative cognitive disturbance than the patients themselves. In addition, patient responses correlate more strongly with their satisfaction with life scores than the proxies. The key finding is that proxy reports may be better estimates of some aspects of cognitive function than patient reports, which are probably overly influenced by mood.