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. 2023 Jul 22:42:100664.
doi: 10.1016/j.ctro.2023.100664. eCollection 2023 Sep.

Clinical implementation of standardized neurocognitive assessment before and after radiation to the brain

C M L Zegers  1 , C Offermann  1 , J Dijkstra  2 , I Compter  1 , F J P Hoebers  1 , D de Ruysscher  1 , M M Anten  3 , M P G Broen  3 , A A Postma  4 , A Hoeben  5 , K E Hovinga  6 , W Van Elmpt  1 , D B P Eekers  1
Affiliations

Clinical implementation of standardized neurocognitive assessment before and after radiation to the brain

C M L Zegers et al. Clin Transl Radiat Oncol. .

Abstract

Background: Radiotherapy induced impairment of cognitive function can lead to a reduced quality of life. The aim of this study was to describe the implementation and compliance of standardized neurocognitive assessment. In addition, the first results of cognitive changes for patients receiving a radiation dose to the brain are described.

Materials and methods: Patients that received radiation dose to the brain (neuro, head and neck and prophylactic cranial irradiation between April-2019 and Dec-2021 were included. Three neuro cognitive tests were performed a verbal learning and memory test, the Hopkins Verbal Learning Test; a verbal fluency test, the Controlled Oral Word Association Test and a speed and cognitive flexibility test, the Trail Making Test A&B. Tests were performed before the start of radiation, 6 months (6 m) and 1 year (1y) after irradiation. The Reliable Change Index (RCI) between baseline and follow-up was calculated using reference data from literature.

Results: 644 patients performed the neurocognitive tests at baseline, 346 at 6 months and 205 at 1y after RT, with compliance rates of 90.4%, 85.6%, and 75.3%, respectively. Reasons for non-compliance were: 1. Patient did not attend appointment (49%), 2. Patient was unable to perform the test due to illness (12%), 3. Patient refused the test (8 %), 4. Various causes, (31%). A semi-automated analysis was developed to evaluate the test results. In total, 26% of patients showed a significant decline in at least one of variables at 1y and 11% on at least 2 variables at 1y. However, an increase in cognitive performance was observed in 49% (≥1 variable) and 22% (≥2 variables).

Conclusion: Standardized neurocognitive testing within the radiotherapy clinic was successfully implemented, with a high patient compliance. A semi-automatic method to evaluate cognitive changes after treatment was defined. Data collection is ongoing, long term follow-up (up to 5 years after treatment) and dose-effect analysis will be performed.

Keywords: Attention; Brain; Cognition; Implementation; Memory; Radiotherapy.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Visualization of the compliance to the neurocognitive assessment at baseline, 6 months and 1 year after radiotherapy.
Fig. 2
Fig. 2
Number of patients with a significant change on the five selected variables per sub-type (head and neck; HN, Neurological (neuro), prophylactic cranial irradiation (PCI) computed in the compound score. Where −5 represents a significant decline on all variables, 5 a significant improvement on all variables. A decline in one variable is compensated for improvement on another variable. The bottom row shows the proportion of patients with a significant decline as a proportion of the total number of patients.
Fig. 3
Fig. 3
Reliable Change index at 1 year versus baseline, for the 5 variables on the cognitive tests; Immediate recall, delayed recall, verbal fluency, processing speed and cognitive flexibility. Results are shown for the total group (N = 201) and the subgroups of Neuro, Head and Neck (HN) and patients treated with Prophylactic cranial irradaitin (PCI). The black line represents the mean +/- SD.
Fig. 4
Fig. 4
Linear regression between the reliable change index at 6 months and 1 year for the individual test variables. Reported are the R-squared and p-value.
See this image and copyright information in PMC

References

    1. Palmer S.L., Reddick W.E., Gajjar A. Understanding the cognitive impact on children who are treated for medulloblastoma. J Pediatr Psychol. 2007;32(9):1040–1049. doi: 10.1093/jpepsy/jsl056. - DOI - PubMed
    1. Greene-Schloesser D., Robbins M.E. Radiation-induced cognitive impairment-from bench to bedside. Neuro Oncol. 2012;14(suppl 4):iv37–iv44. - PMC - PubMed
    1. Makale M.T., McDonald C.R., Hattangadi-Gluth J.A., Kesari S. Mechanisms of radiotherapy-associated cognitive disability in patients with brain tumours. Nat Rev Neurol. 2017;13(1):52–64. doi: 10.1038/nrneurol.2016.185. - DOI - PMC - PubMed
    1. “Brain dosimetry from locally advanced head and neck cancer radiotherapy: implications for neurocognitive outcomes research - PubMed.” https://pubmed-ncbi-nlm-nih-gov.ezproxy.ub.unimaas.nl/30141706/ (accessed Dec. 24, 2022). - PubMed
    1. Welsh L.C., Dunlop A.W., McGovern T., McQuaid D., Dean J.A., Gulliford S.L., et al. Neurocognitive function after (chemo)-radiotherapy for head and neck cancer. Clin Oncol. 2014;26(12):765–775. - PubMed