83 Individual Cognitive Trajectories Post-Radiotherapy for Brain Metastases Neurocognitive assessment A comprehensive NCA was used to assess objective cognitive performance. All tests are internationally widely used standardized psychometric instruments designed to assess neurocognitive deficits in the major neurocognitive domains. This battery encompasses all tests advised by the International Cancer and Cognition Task Force (ICCTF)26 and supplemented with additional neuropsychological tests (Supplementary Table 1). At repeated testing, alternate forms were used to minimize practice effects. Whilst neuropsychological tests often evaluate more than one neurocognitive domain, tests were classified into different neurocognitive domains based on available literature and clinical experience. All NCAs were performed in-person by trained psychologists and were planned to be completed within approximately 90 minutes. To assess neurocognitive impairment, 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. Neurocognitive impairment in each domain was defined as a Z-score ≤-1.5 on any of the administered tests within the domain. Individual change in neurocognitive performance was assessed using the RCI as formulated by Jacobson and Truax.21,22 Using the uncorrected scores, this RCI accounts for the test-retest reliability of the task based on published normative data (Supplementary Table 2). RCI values of ≥1.645 indicate improvement, ≤-1.645 decline, and values within ±1.645 indicate stable cognitive performance.27 Change in neurocognitive performance per domain was defined as improved or declined if at least one task within that domain showed improvement or decline, respectively, as mixed if at least one task indicated improvement and one task indicated decline and as stable when all tasks within that domain demonstrated stable performance. Patient characteristics Patient characteristics were obtained from the semi-structured interview and from the hospital’s electronic healthrecord (HiX, Chipsoft, The Netherlands). This data included sex, age at inclusion, level of education according to the Verhage criteria28, handedness, Karnofsky Performance Status (KPS)6, primary tumor origin, presence of extracranial metastases, time since BMs diagnosis, previous anti-tumor therapy, dexamethasone dose 1-5 days prior to radiotherapy, and symptoms at BMs diagnosis. As part of standard medical care, the pre-radiotherapy MRI scans of each patient were evaluated to determine the number of BMs, hemisphere, and lobe 4
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