91 Individual Cognitive Trajectories Post-Radiotherapy for Brain Metastases Short-term post-radiotherapy Three months after radiotherapy, a cognitive impairment (Z ≤ -1.5) in ≥1 domain was observed for nearly all patients 35/36 (97%), whereby more than half of all patients (68%) showed impaired performance in at least 2 domains. Memory was most often impaired (78%), followed by psychomotor speed (39%) and attention (31%; Supplementary Materials). Using the RCI, decline in cognitive performance was observed across all domains, but most frequently for memory (47%) and processing speed (35%; Figure 3a). Improvements were most often observed for executive function and visuospatial functioning (both 31%) and processing and psychomotor speed (both 28%). Mixed cognitive changes across the tests within a cognitive domain were seen for all domains, except visuospatial functioning and social cognition. Memory showed the highest frequency of mixed responses (28%). Stable cognitive performance was most often observed for social cognition (82%) and for visuospatial functioning (61%). Overall, none of the patients showed stable performance across all domains, with most 29/36 (81%) showing both improvement and decline in different cognitive domains (Figure 3c). Solely declined performance was observed in 6/36 (17%). Age, KPS at baseline, number of BMs, synchronous BMs diagnosis, primary tumor, extracranial metastases, symptomatic BMs, intracranial progression and number of cognitive domain impairments at baseline did not differ between the four categories from baseline to 3 months after radiotherapy (Supplementary Table 5). Long-term post-radiotherapy At least 11 months after radiotherapy, a cognitive impairment (Z ≤ -1.5) in at least 1 domain was found for 11/14 (79%) of patients, whereby more than half of the patients (71%) showed impaired performance in ≥2 domains. Memory was most often impaired (71%), followed by social cognition (43%), and psychomotor speed (39%; Supplementary Materials). The RCI indicated decline in cognitive performance across all domains except social cognition (Figure 3b). Declines were most frequently observed for processing speed (54%) and psychomotor speed (39%). Improvements were most often observed regarding memory (57%) and executive function (36%). Mixed responses across the tests within a cognitive domain were seen for all domains, except visuospatial functioning and social cognition, and was most common for memory (29%). Stable cognitive performance was most often observed for social cognition (89%) and 4
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