Cognitive decline in brain metastasis patients  treated with stereotactic radiotherapy.

Brain metastases are the spread of primary cancer elsewhere in the body to the brain, that are typically treated with a technique called stereotactic radiotherapy. Whereas the short-term changes within cognition after stereotactic radiotherapy are widely studied, the long-term effects are still relatively unknown. This longitudinalstudy aimed to assess the late effects of stereotactic radiotherapy on cognitive functioning in patients with brain metastases, emphasizing cognitive decline. In addition, this study compared different methodological approaches to measure cognitive changes and examined possible risk factors of cognitive decline. Forty-two brain metastasis patients completed a validated neuropsychological test battery assessing their cognitive functioning at baseline and nine-months follow-up. The battery yielded ten cognitive outcomes, and we defined cognitive decline as impairment on ≥2 outcomes. We used three approaches to calculate the cognitive decline, namely a...Show moreBrain metastases are the spread of primary cancer elsewhere in the body to the brain, that are typically treated with a technique called stereotactic radiotherapy. Whereas the short-term changes within cognition after stereotactic radiotherapy are widely studied, the long-term effects are still relatively unknown. This longitudinalstudy aimed to assess the late effects of stereotactic radiotherapy on cognitive functioning in patients with brain metastases, emphasizing cognitive decline. In addition, this study compared different methodological approaches to measure cognitive changes and examined possible risk factors of cognitive decline. Forty-two brain metastasis patients completed a validated neuropsychological test battery assessing their cognitive functioning at baseline and nine-months follow-up. The battery yielded ten cognitive outcomes, and we defined cognitive decline as impairment on ≥2 outcomes. We used three approaches to calculate the cognitive decline, namely a Reliable Change Index not correcting for practice effects (RCI), a RCI correcting for practice effects (RCI+PE), change and Z-scores. We tested the three measures of cognitive decline for significant differences, providing insight into the sensitivity of the approaches to measure cognition over time. Lastly, we did determine whether age, the baseline level of cognitive functioning, volume and number of brain metastases were predictive of cognitive decline using a binary logistic regression. Our results revealed a cognitive decline in 31% of brain metastasis patients (p < .001). Most decline was found in verbal memory. In addition, the percentage of patients who showed cognitive decline as measured with the RCI+PE was significantly higher than found with a change in Z-scores (p = .014). No significant predictors of cognitive decline were found (p = .213). In addition to the known immediate cognitive effects (< 6 months after treatment), we demonstrated that a significant proportion of patients with brain metastases still shows cognitive decline nine months after stereotactic radiotherapy. Consequently, clinical decision-making about treatment options and psycho-education should include those late effects. Furthermore, we found that the RCI+PE can significantly detect more cognitive decline than the difference in Z-scores, providing a recommendation for future research to use an RCI+PE as a measure of change in cognition over time.Show less

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Cognitive decline in brain metastasis patients treated with stereotactic radiotherapy.