89 Individual Cognitive Trajectories Post-Radiotherapy for Brain Metastases reported across all domains, but most common for attention, thinking, memory and language (all four domains: 14/36, 39%). Post-radiotherapy changes On the domain-level, subjective declines in cognitive performance were reported across all domains 3 months post-radiotherapy (Figure 2a). Declines were most frequently reported for attention (22%) and thinking (19%). For most domains, the percentage of patients that reported a decline were balanced out by the percentage of patients that reported an improvement (11-22%). Improvements were most often reported for attention (22%) and memory (22%). A stable score was reported across domains by 56-78% of patients. Stable scores were most often reported for processing speed (78%), language (72%), and thinking (69%). From 3 to ≥11 months after radiotherapy, (further) subjective declines in cognitive performance were reported for memory (29%), perception (21%), attention (14%), and thinking (7%; Figure 2b). No declines were reported for processing speed or language. Improvements were also reported across all domains, but most frequently for attention (21%) and perception (21%). Stable scores were again most often observed for processing speed (93%) and language (86%). Overall, 3 months post-radiotherapy 39% of patients reported a decline, 31% an improvement, 11% mixed performance and 19% stable subjective cognitive performance (Figure 2c). In the time period from 3 to ≥11 months after radiotherapy similar results were observed, with decline, improvement and stable performance in 29% of patients and mixed in 14%. More patients with intracranial progression showed decline across all cognitive domains 3 months post-radiotherapy compared to patients without intracranial progression (X2(3) = 8.896, p = .031). Age, KPS at baseline, number of BMs, synchronous BMs diagnosis, primary tumor, extracranial metastases, symptomatic BMs and number of cognitive domain impairments at baseline did not significantly differ between the four categories from baseline to 3 months after radiotherapy (Supplementary Table 3). Objective neurocognitive functioning Pre-radiotherapy An elaborate evaluation of pre-radiotherapy cognitive performance in a larger sample of this subset has been reported previously.23 For the currently included sample, 29/36 (81%) showed impairments (Z ≤ -1.5) in at least one cognitive domain and 18/36 (50%) with impairments in at least two domains. Memory was most 4
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