Neurocognitive Dysfunction in Patients with Brain Metastases Prior to Radiotherapy

Eva Grinsven, University Medical Center, Utrecht, Netherlands
Joost Verhoeff, University Medical Center, Utrecht, Netherlands
Marielle Phillipens, University Medical Center, Utrecht, Netherlands
Martine Zandvoort, Neuropsychology, Utrecht University, Utrecht, Netherlands

Brain metastases (BMs) occur in ten to thirty percent of the adult population and thereby are the most common complication of cancer. Before starting treatment, approximately one out of every two patients experience cognitive impairment. Pre-treatment cognitive functioning and the factors determining pre-treatment cognitive functioning should be established first in order to fully understand and predict changes in cognitive performance after treatment.
Participants and Methods:

The study population consists of adult patients (≥18 years) with either radiographic and/or histologic proof of metastatic brain disease that were referred to the radiotherapy department of the UMC Utrecht for cranial radiation therapy for BMs. An elaborate battery of neuropsychological tests was used to assess cognitive performance prior to radiotherapy. Cognitive impairment was defined as a z-score ≤-1.5. Analyses were performed on 1) Group level (one-sample t-tests) 2) Individual-level (percentage patients impaired per domain and tasks, and 3) exploratory cluster analysis: with a data-driven approach patients were clustered based on similarities in deficits at the domain-level using Ward’s linkage with squared Euclidean distance.



58 BMs patients were included for the current analysis. On the group-level, one-sample t-tests indicated the BMs patients scored lower than the normative population for tests on memory, processing speed, psychomotor speed, executive functioning and emotion recognition. On the individual level, 20.7% of patients did not have any cognitive deficits while 55.1% had deficits in at least two cognitive domains. Most patients (25-35%) had deficits regarding memory, processing speed and emotion recognition. Cluster analysis based on cognitive performance identified three groups: (1) patients with no or limited cognitive deficits, (2) patients with memory deficits and (3) patients with mainly speed deficits. The memory group had most cognitive deficits. No patient or treatment-related differences were found between the groups.


To further understand the differences between cognitive clusters, future analysis will include self-reported cognitive deficits and multivariate analysis will be performed to identify risk factors for worse cognitive performance.

Prior to radiotherapy patients with BMs already pose a vulnerable population with cognitive deficits spanning multiple cognitive domains, from memory and processing speed to emotion recognition.

Category: Cancer

Keyword 1: cancer
Keyword 2: psychometrics
Keyword 3: brain tumor