Assessment of cognitive, emotional, and motor domains in patients with diffuse gliomas utilizing the NIH Toolbox battery

Abstract Objective Brain tumor patients are known to have deficits in cognitive, motor, and emotional domains. Comprehensive evaluation of the brain tumor patient includes taking into account all these domains at baseline and throughout treatment. However, standard neuropsychological assessment methods are lengthy, expensive, and are often variable. The authors appraised the feasibility of using a brief, inexpensive, comprehensive and standardized neuropsychological battery, the NIH Toolbox, to assess these domains in patients with diffuse glioma. Methods Eighteen patients were recruited and completed the NIH toolbox Cognitive Battery, two motor tests (Grip Strength and Grooved Pegboard) and the NIH toolbox Emotional Battery. Fully corrected T-scores are reported, as well as composite scores of fluid and crystallized cognition. Follow-up cognitive (n=13) and motor assessment (n=12) were performed at one-month post-surgery. Results The total time to complete the battery was approximately 60 minutes. 78% of patients demonstrated significant impairment on one or more cognitive test, while 37% had impaired fluid cognition. Crystallized and overall composite cognitive scores were relatively intact, with 16% of patients showing significant impairment. 22% of patients had impaired strength in the left hand, and 22% had impaired dexterity in both hands. 50% of patients showed impairment in one or more emotional domain. At one-month post-surgery, a significant decrease in crystallized cognition was observed. Conclusions The NIH Toolbox represents a feasible alternative to current neuropsychological batteries in the assessment of neurosurgical patients. It can be administered quickly, inexpensively, and will give the neurosurgical community a common currency when reporting neuropsychological results.