35 Cognitive Impact of SRS vs. WBRT: Systematic Review & Meta-analysis studies assessing short-term cognitive performance found no change in cognition compared to baseline.25,30 For example, it was reported that 78-100% of the patients (N = 19) had stable performance regarding the different cognitive constructs, where the small percentage of patients that showed declined cognitive performance on the different tests (3-8%) was balanced by those that improved (3-17%).30 At both mid-term (5-8 months) and long-term follow-up (9-12 months) all studies reported either stable or slightly improved cognitive performance compared to baseline performance.25,29–32,44,45 To illustrate, the percentage of patients with declined performance on L&M decreased at both mid- and long-term follow-up compared to short-term.44 Additionally, the mean decline reduced to 2-5% at long-term followup compared to 10-14% at short-term, suggesting that both the number of patients as well as the severity of the cognitive decline decreased. Forest plots of the incidence of patients with cognitive decline for each construct at each time point are presented in the Supplementary Materials. There was no significant heterogeneity between studies for any cognitive construct at any time point for the SRS studies. The meta-analysis suggests a relatively constant number of patients experiencing cognitive decline over time after SRS, albeit with large confidence intervals (Figure 2b). 2
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