The Stability of Cognitive Profiles in Patients with Brain Metastases Undergoing Radiotherapy

Abstract

Half to eighty percent of patients with brain metastases (BMs) show cognitive impairment before receiving radiotherapy. The cognitive performance of this population has been clustered into cognitive profiles. This study aims to replicate that cluster analysis using two different impairment thresholds, to see whether the cognitive profiles change after radiotherapy and to investigate if profiles before radiotherapy predict profiles after radiotherapy.

Forty-eight patients with BMs referred to the University Medical Centre Utrecht (UMCU) completed a neurocognitive assessment before and three months after radiotherapy. Using cluster analysis, patients were clustered into cognitive profiles. Profiles before radiotherapy were used to predict profiles after radiotherapy.

Depending on the impairment threshold used, 44% to 81% of patients with brain metastases showed cognitive impairment before starting radiotherapy. This number slightly increased after radiotherapy. Cognitive performance before radiotherapy could be classified into cognitive profiles, that remained relatively stable after radiotherapy. Most profiles before radiotherapy were predictors for profiles after radiotherapy.

The validity of these cognitive profiles, as well as their predictive value, should be tested in different and larger patient populations. In future research and in clinical practice, a sensitive impairment threshold (z-value ≤-1.5 on at least one test within a cognitive domain) should be used together with a measure of subjective cognitive problems.