Developing a screening tool for cognitive deficits in routine neuro-oncology clinical practice: Clinical Feasibility and Cognitive Insight

Background Cognitive impairments are common in brain tumor patients and cause significant impact on quality of life. Early detection is imperative for targeted neurorehabilitation, yet in clinical settings, time and resources constraints limit cognitive assessments. Computerized tools might be advantageous, but there is a lack of standardized, sensitive, and clinically feasible methods. This study aimed to develop time-efficient and sensitive tools for cognitive screening suitable for constrained clinical scenarios and assess their clinical feasibility and efficiency. Method Two cohorts of brain tumor patients completed a computerized tablet assessment (OCS-Bridge) pre-operatively. The first cohort (n = 85) completed the full battery and shorter assessments (15, 10 and 5 minutes) were generated using the most sensitive tests. The abbreviated batteries were then integrated in the neuro-oncology clinic where the second cohort (n = 111) was assessed. Cognitive self-awareness was also evaluated using a set of self-reported questions (Cardiff Questionnaire). Results The abbreviated assessments detected cognitive deficits with a comparable accuracy to the full battery. These integrated efficiently into the service, were well engaged with by the patients, and enabled the generation of cognitive data in as little as 5 minutes, without interrupting an already established clinical routine or requiring specialist administration. Self-reported cognitive concerns showed poor associations with objective performance, highlighting limited cognitive awareness amongst patients. Conclusion We present evidence supporting the integration of pre-operative cognitive assessments in neuro-oncology clinics and propose context-guided OCS-Bridge protocols as a fit standardized approach for cognitive screening in adult with brain tumors undergoing surgery.