Brain tumors are associated with cognitive dysfunction that can impact treatment adherence, symptom management, emotional well-being and quality of life. Cognitive symptom screening, neuropsychological assessment and management strategies are not routinely available for neuro-oncology patients. The Amsterdam Cognition Scan (ACS) is an online battery of ten cognitive tests that can be completed without supervision and has been validated in Dutch speaking healthy adults and patients treated for non-central nervous system cancer. The battery is based on well-established neuropsychological tests measuring attention, memory, processing speed, executive functions, and motor dexterity. The aim of our study was to evaluate the feasibility, acceptability, and validity of the ACS in English speaking brain tumor patients. Here we present preliminary findings from our prospective mixed-method study.

Adults with primary brain tumors who were referred for a clinical neuropsychological assessment completed the ACS and corresponding traditional neuropsychological tests within two weeks of one another. We defined feasibility as 75% of patient participants being able to complete the ACS independently at home. Acceptability was evaluated through a satisfaction questionnaire and a brief semi-structured interview. Preliminary estimates of concurrent validity were evaluated using Pearson correlation coefficients evaluating the consistency between the ACS and traditional tests. Correlations of ≥.40 indicated acceptable validity.

Twelve English speaking participants completed the study so far (M_age=32.17 years, range 19-57, SD=11.04; 50% male). Eleven (91.6%) completed the ACS at home without assistance; one participant required technical assistance on one of the ten tests. In terms of acceptability, most (91.6-100%) participants rated the ACS as at least “very good” in terms of capturing experienced cognitive problems, the time required to complete it, and ease of use. From interviews, participant-identified strengths of the ACS included convenience, ease of use, time efficiency, and less feelings of intimidation because no one was in the room observing responses. However, several drawbacks were noted by participants, including not having a person to interact with to provide structure and limit distractions, and not being able to ask questions to ensure that test instructions were correctly understood. Correlations between the ACS and traditional test scores ranged from -0.18 to 0.93, with acceptable (≥.4) concurrent validity on tests of memory (ACS word list learning and CVLT-II: total recall, r=0.85, p<.01; delayed recall, r=.93, p<.01; recognition, r=.93, p<.01), attention (ACS box tapping and WMS-IV spatial span, r=0.73, p<.01; ACS Digit sequence I and WAIS-IV digits forwards, r=.44, p=.14), executive functions (ACS connect the dots II and trailmaking test B, r=.48, p=.11) and motor dexterity (ACS fill-the-grid and grooved pegboard, r=.62, p=.03).

These early preliminary findings suggest that the ACS may be a feasible, acceptable, and valid way to screen for neurocognitive dysfunction in English speaking brain tumor patients. The study is ongoing and will provide the larger sample necessary to confirm whether these results hold. If they do, the ACS may aid in improving access to neurocognitive assessments and facilitating efficient gathering of neurocognitive data in this population.