61 Pre-Radiotherapy Cognitive Profiles in Patients with Brain Metastases extreme improvement/decline (±>50). Patients indicated their current stress levels using the same VAS-methodology, with higher scores indicating more stress, and lower scores indicating lower stress. Neurocognitive assessment A comprehensive NCA was used to assess objective cognitive performance. All tests are internationally widely used, standardized psychometric instruments for assessing neurocognitive deficits in the major neurocognitive domains. While neuropsychological tests often tap into more than one neurocognitive domain, tests were classified into different neurocognitive domains based on available literature and clinical experience. In our clinical practice, we assess fatigue by repeating the Digit Span Forward twice during the NCA, once halfway and once at the end. The maximum span reached by the patient at the repeated assessments is compared to the initial maximum span. If the maximum span decreased, this is taken as indication of cognitive fatigue. This approach was also used in this study. NCAs were performed by trained personnel and were planned to be completed within approximately 90 minutes. The comprehensive battery was compared to the core battery. The core battery represents tests advised by the International Cancer and Cognition Task Force (ICCTF)18 combined with tests frequently used in previous BMs research9. The comprehensive battery encompasses the core battery complemented by additional neuropsychological tests (Supplementary Table 1). For current analyses the cognitive data acquired prior to radiotherapy from October 2020 to January 2023 was used. Each neuropsychological test was scored according to standardized scoring criteria. The uncorrected scores were transformed into z-scores based on the mean and standard deviation of control populations derived from published norm data and corrected for age and education where appropriate (see Supplementary Table 1 for references of used norm data), with lower z-scores representing worse performance. Overall neurocognitive domain scores were calculated using the mean of the z-scores of the available tests within a domain. Overall neurocognitive domain scores were only calculated if a patient completed at least 50% of the tasks within the domain. Additionally, neurocognitive impairment in each domain was defined as z-score≤-1.5 on any of the administered tests within the domain to ensure both specificity and sensitivity to cognitive difficulties experienced by patients. 3
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