Assessment of neuropsychological function in brain tumor treatment: a comparison of traditional neuropsychological assessment with app-based cognitive screening

[Background] Gliomas are typically considered to cause relatively few neurological impairments. However, cognitive difficulties can arise, for example during treatment, with potential detrimental effects on quality of life. Accurate, reproducible, and accessible cognitive assessment is therefore vital in understanding the effects of both tumor and treatments. Our aim is to compare traditional neuropsychological assessment with an app-based cognitive screening tool in patients with glioma before and after surgical resection. Our hypotheses were that cognitive impairments would be apparent, even in a young and high functioning cohort, and that app-based cognitive screening would complement traditional neuropsychological assessment.
[Methods] Seventeen patients with diffuse gliomas completed a traditional neuropsychological assessment and an app-based touchscreen tablet assessment pre- and post-operatively. The app assessment was also conducted at 3- and 12-month follow-up. Impairment rates, mean performance, and pre- and post-operative changes were compared using standardized Z-scores.
[Results] Approximately 2–3 h of traditional assessment indicated an average of 2.88 cognitive impairments per patient, while the 30-min screen indicated 1.18. As might be expected, traditional assessment using multiple items across the difficulty range proved more sensitive than brief screening measures in areas such as memory and attention. However, the capacity of the screening app to capture reaction times enhanced its sensitivity, relative to traditional assessment, in the area of non-verbal function. Where there was overlap between the two assessments, for example digit span tasks, the results were broadly equivalent.
[Conclusions] Cognitive impairments were common in this sample and app-based screening complemented traditional neuropsychological assessment. Implications for clinical assessment and follow-up are discussed.
RRG is funded by a Guarantors of Brain Post-Doctoral Fellowship award, by a Cancer Research UK Cambridge Centre RG86786 (CRUK grant ref: A25117) grant, and by the EMERGIA Junta de Andalucía program. Y. E. is funded by a Royal Society Dorothy Hodgkin Research Fellowship. M. A. is funded by the Cambridge Trust–Yousef Jameel Scholarship. S. J. P. is supported by the National Institute for Health Career Development Fellowship (CDF-2018-11-ST2-003). This report is an independent research supported by the National Institute of Research (NIHR Career Development Fellowship, Mr. Stephen Price, CDF-2018-11-ST2-003). M. G. H. received an award from The Brain Tumour Charity (ref: RG86218) to fund this work.