68 Chapter 3 Figure 3. Dendrogram of the cluster analysis performed on the presence/absence of cognitive impairments across all cognitive domains except social cognition. Numbers I-IV indicate the different clusters. The table below shows number and percentage of patients per cluster with a cognitive impairment (-1.5SD) on the different cognitive domains. Clusters with different subscripts showed a statistically significant difference (p < .05). DISCUSSION This prospective study aimed to describe and classify the individual cognitive performance of patients with BMs prior to radiotherapy. Results indicated that impairments in neurocognitive functioning occur frequently; almost 80% of patients had cognitive deficits (Z≤-1.5) in at least one cognitive domain before starting radiotherapy. The most commonly affected cognitive domains included memory, processing speed, psychomotor speed, and social cognition. When applying more stringent thresholds (Z≤-2.0), less than one third of patients were not affected. Thus, nearly all BMs patients referred for radiotherapy experience some degree of neurocognitive dysfunction. Correspondingly, almost 70% of patients experienced a decline in subjective cognitive functioning compared to their indicated premorbid level, with decline in two or more domains reported by 55%. Decline was reported across all domains, but were most often labelled as attention, memory and thinking. Interestingly, the majority reported stable performance, with some (2%) even reporting improved performance. There could have been a positive bias due to dexamethasoneinduced euphoria, which could have led to overall more positive self-reported
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