Cognitive Dysfunction in Non-CNS Metastatic Cancer: Comparing Brain Metastasis, Non-CNS Metastasis, and Healthy Controls

Abstract

AbstractObjectiveCognitive impairment in primary and metastatic brain cancers has been well-documented. However, there is a lack of research comparing the cognitive profiles of people with non-central nervous system (CNS) metastatic cancer versus metastatic brain cancer.MethodsThis cross-sectional study consisted of 40 non-CNS metastasis, 61 brain metastasis, and 37 healthy control (HC) participants completing the same neuropsychological test battery.ResultsBoth clinical groups had reduced processing speed, verbal learning/memory, and executive functioning. Non-CNS metastasis participants performed below HC participants on processing speed and executive functioning, while brain metastasis participants demonstrated lower performance across all neuropsychological tests. Semantic verbal fluency differentiated the two clinical groups (non-CNS metastasis>brain metastasis). Twenty-five percent of non-CNS metastasis participants and 57% of brain metastasis participants had ≥3 impaired scores (i.e., ≤5th%ile).ConclusionOne-quarter of non-CNS metastasis participants were cognitively impaired on at least three neuropsychological tests, and over half of brain metastasis participants demonstrated the same level of cognitive impairment. The elevated rate of cognitive dysfunction in the non-CNS metastasis participants is possibly attributable to systemic illness and treatment effects, while the cognitive deficits among brain metastasis participants may be associated with the more significant neurologic disease burden posed by brain metastases in conjunction with treatment effects.