Different profiles of neurocognitive functioning in patients with brain metastases prior to brain radiotherapy

Author:

van Grinsven Eva E.1ORCID,Cialdella Fia23,Verhoeff Joost J. C.2,Philippens Marielle E. P.2,van Zandvoort Martine J. E.14

Affiliation:

1. Department of Neurology & Neurosurgery University Medical Center Utrecht Brain Center Utrecht University Utrecht The Netherlands

2. Department of Radiation Oncology University Medical Center Utrecht Utrecht The Netherlands

3. Department of Medical Oncology University Medical Center Utrecht Utrecht The Netherlands

4. Department of Experimental Psychology and Helmholtz Institute Utrecht University Utrecht The Netherlands

Abstract

AbstractObjectivePatients with brain metastases (BrMs) are a heterogeneous population, with almost 50% experiencing cognitive impairment before brain radiotherapy. Defining pre‐radiotherapy cognitive profiles will aid in understanding of the cognitive vulnerabilities and offer valuable insight and guidance for tailoring interventions.MethodsThe study population consisted of 58 adult patients with BrMs referred for radiotherapy. A semi‐structured interview and comprehensive battery including 10 neuropsychological tests were used to assess subjective and objective cognitive performance prior to radiotherapy.ResultsA majority (69%) of patients report decline in cognitive performance compared to their premorbid level (i.e. pre‐cancer). Objective testing revealed memory (52%), processing speed (33%) and emotion recognition (29%) deficits were most frequent. 21% of patients had no cognitive deficits while 55% had deficits (−1.5SD) in at least two cognitive domains. Hierarchical cluster analysis based on patient deficit profiles identified four clusters: (I) no or limited cognitive deficits selectively restricted to processing speed or executive function, (II) psychomotor speed deficits, (III) memory deficits and (IV) extensive cognitive deficits including memory. No patient or clinical‐related (e.g. age, number of BrMs, previous treatment) differences were found between clusters.ConclusionsPatterns of cognitive performance in patients with BrMs are heterogeneous, with most experiencing at least some degree of neurocognitive dysfunction. We identified four meaningful cognitive clusters. Stability of these clusters over time and in different samples should be assessed to advance understanding of the cognitive vulnerability of this patient population.

Funder

KWF Kankerbestrijding

Publisher

Wiley

Subject

Psychiatry and Mental health,Oncology,Experimental and Cognitive Psychology

Reference38 articles.

1. Epidemiology of brain metastases and leptomingeal disease;Lambda N;Neuro Oncol,2021

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