PURPOSE: Gliomas are the most common primary brain tumors, with a yearly incidence in the Netherlands of 5 to 7 per 100,000. In addition to seizures, increased intracranial pressure and neurological deficit, the majority of these patients exhibit objective cognitive impairment and/or self- reported neuropsychological symptoms. These cognitive problems may be caused by the tumor itself, by tumor-related epilepsy, by the treatment (surgery with or without radiotherapy), by psychological distress, or a combination of these factors. Although the disease is ultimately fatal, glioma patients, and particularly those with low-grade tumors, may live for years without disease progression. For these patients, cognitive deficits can have a sustained, negative impact on daily functioning and quality of life. Recently, cognitive rehabilitation programs have been shown to be effective in patients with brain injury and partial epilepsy. Given that partial epilepsy is by far the most common clinical manifestation of low-grade gliomas as well as in a favorable subgroup of anaplastic gliomas (present in up to 90% of cases), and that epilepsy is known to be related significantly to cognitive impairment, it is hypothesized that cognitive rehabilitation will also be effective in this patient population. The proposed study will evaluate the efficacy of a structured cognitive rehabilitation program in improving the cognitive functioning, as measured by both objective neuropsychological tests and patients' self-reported symptoms. Additionally, the possible carry-over effect of the training on patients' self-reported quality of life will be assessed. PLAN OF INVESTIGATION: The proposed study will employ a prospective, randomized, control group design. Adult low-grade glioma patients, either histologically proven, or suspected (1), as well as adult anaplastic glioma patients with favorable prognostic factors (2) (N = 150), who are clinically stable for at least 6 months following primary diagnosis and/or treatment will be recruited from 7 hospitals in the Netherlands. Only patients with both self-reported cognitive symptoms and objective cognitive deficits (as determined by a battery of standardized neuropsychological tests) will be included. Consenting patients will be randomized to either the cognitive rehabilitation program or a 'waiting-list' control group. The cognitive rehabilitation program will be tailored to the specific needs of the individual patient. This will optimize the effect of training and result in generalization to everyday life. Upon completion of the study, those patients assigned to the control group will be given the opportunity to undergo the cognitive rehabilitation. The cognitive rehabilitation program incorporates both retraining and compensation strategies; the former focuses on retraining of impaired cognitive functions, while the latter focuses on compensatory strategies, taking neuronal loss for granted. Rehabilitation will be directed primarily towards attention deficits, but is expected to have indirect benefit for memory and executive functioning as well. The intervention will consist of 6 weekly, individual, 2-hour sessions plus two hours of homework. To evaluate the efficacy of the rehabilitation program, objective neuropsychological functioning, self-reported cognitive symptoms and health-related quality of life will be assessed before rehabilitation, directly following rehabilitation, and at 6-month follow-up. Normative data from age- and gender-matched healthy controls will also be available for interpreting the patients' neuropsychological test results. POSSIBLE RESULTS: If demonstrated to be effective, the availability of a structured cognitive rehabilitation program will be a welcome addition to the program of treatment and care offered to patients with a low-grade glioma. It is anticipated that such a program will not only have direct benefit in terms of patients' cognitive functioning, but also will have an indirect, salutary effect on their quality of life.