NCOG-05. Peri-operative Cognitive Function Assessment Of Brain Tumor Patients In Resource-Limited Settings: Challenges And Report Of An Ongoing Initiative

Abstract INTRODUCTION Pre- and post-operative neuropsychological assessment of patients with brain lesions is essential for evaluating the cognitive impact of both the tumor and its treatment. These cognitive outcomes are strongly associated with daily functioning and overall quality of life. However, in resource-limited settings such as Pakistan, a lack trained neuropsychologists limits the ability to systematically assess these outcomes. Consequently, the effectiveness of interventions aimed at improving surgical and treatment outcomes remains difficult to measure METHODS A multidisciplinary team from a tertiary hospital in Pakistan collaborated with experts from the U.S. to create a locally feasible neuropsychological test battery. The battery was formulated based on feasibility, patient tolerance, and diagnostic value, and trialed and refined over time based on patient compliance, language barriers, and feasibility. Individuals from the local team were trained in test administration by international and local psychologists. RESULTS The primary challenges included patient fatigue and reluctance due to the length of the assessments, making it essential to prioritize tests that were brief yet informative. Additionally, patients with any form of aphasia were ineligible for many standard cognitive tests, limiting inclusivity. Poor follow-up rates also posed a major barrier, often due to the significant travel required for healthcare access in Pakistan. To mitigate these issues, we selected a set of core tests with minimal administration time, trained specific individuals under the guidance of the international neuropsychologist and the local clinical psychologist, and offered post-treatment assessments at 3 and 6 months via telemedicine. Although several follow-up assessments were successfully completed online, loss to follow-up remains a significant limitation. CONCLUSIONS Neuropsychological assessment in resource-limited settings is feasible with strategic adaptations, interdisciplinary collaboration, and remote follow-up. Despite challenges, such protocols can provide valuable insight into cognitive outcomes and improve post-treatment care planning in brain tumor patients.