Feasibility and utility of a tablet-based digital neurocognitive assessment following radiosurgery for brain metastases

Neurocognitive decline (NCD) is a significant concern for patients with brain metastases, yet traditional paper-based assessments are often burdensome. This prospective cohort study evaluated the feasibility and outcomes of a tablet-based digital neurocognitive battery in patients with prior stereotactic radiosurgery (SRS). Data were analyzed from an institutional prospective registry (NCT05504681) including 41 adults with prior SRS. Patients were stratified into a high-risk group (undergoing repeat SRS for progression) and a low-risk group (surveillance only). Neurocognitive function was assessed using the “Cognition” tablet-based platform. NCD was defined as significant deterioration in at least 1 test at 3 months using the Reliable Change Index. The median age was 66 years, and 46% of assessments were conducted in Spanish. Learning and memory were the most frequently affected domains (32%). At 3 months, NCD rates were significantly higher in the high-risk cohort (76%) compared to the low-risk cohort (40%; p = 0.019). On multivariable analysis, risk group status was the only independent predictor of NCD (p = 0.030). Patient feedback indicated high satisfaction and usability. Digital neurocognitive assessment is a feasible and sensitive tool for monitoring patients with brain metastases. The platform effectively differentiated between patients undergoing repeat SRS and those under surveillance, underscoring the importance of routine cognitive monitoring.