Ac a Neu ochi u gica (2022) 164:2021–2034
Vol.:(0123456789)
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h ps://doi.o g/10.1007/s00701-022-05162-5
ORIGINAL ARTICLE - BRAIN TUMORS
Assessmen o neu opsychological unc ion inb ain umo ea men :
acompa ison o  adi ional neu opsychological assessmen
wi happ‑based cogni i e sc eening
Ra aelRome o‑Ga cia1,2 · Mallo yOwen1· AlexaMcDonald3· EmmaWoodbe y3· Moa azAssem4·
Ped oCoelho5· RobC.Mo is6· S ephenJ.P ice6· TomSan a ius6,7· JohnSuckling1,8,9· TomManly9· Yaa aE ez4,10·
MichaelG.Ha 1
Recei ed: 9 Augus 2021 / Accep ed: 16 Feb ua y 2022
© The Au ho (s) 2022
Abs ac
Backg ound Gliomas a e ypically conside ed o cause ela i ely ew neu ological impai men s. Howe e , cogni i e di icul-
ies can a ise, o example du ing ea men , wi h po en ial de imen al e ec s on quali y o li e. Accu a e, ep oducible, and
accessible cogni i e assessmen is he e o e i al in unde s anding he e ec s o bo h umo and ea men s. Ou aim is o
compa e adi ional neu opsychological assessmen wi h an app-based cogni i e sc eening ool in pa ien s wi h glioma be o e
and a e su gical esec ion. Ou hypo heses we e ha cogni i e impai men s would be appa en , e en in a young and high
unc ioning coho , and ha app-based cogni i e sc eening would complemen adi ional neu opsychological assessmen .
Me hods Se en een pa ien s wi h di use gliomas comple ed a adi ional neu opsychological assessmen and an app-based
ouchsc een able assessmen p e- and pos -ope a i ely. The app assessmen was also conduc ed a 3- and 12-mon h ollow-
up. Impai men a es, mean pe o mance, and p e- and pos -ope a i e changes we e compa ed using s anda dized Z-sco es.
Resul s App oxima ely 2–3h o adi ional assessmen indica ed an a e age o 2.88 cogni i e impai men s pe pa ien , while
he 30-min sc een indica ed 1.18. As migh be expec ed, adi ional assessmen using mul iple i ems ac oss he di icul y
ange p o ed mo e sensi i e han b ie sc eening measu es in a eas such as memo y and a en ion. Howe e , he capac-
i y o he sc eening app o cap u e eac ion imes enhanced i s sensi i i y, ela i e o adi ional assessmen , in he a ea o
non- e bal unc ion. Whe e he e was o e lap be ween he wo assessmen s, o example digi span asks, he esul s we e
b oadly equi alen .
Conclusions Cogni i e impai men s we e common in his sample and app-based sc eening complemen ed adi ional neu-
opsychological assessmen . Implica ions o clinical assessmen and ollow-up a e discussed.
Keywo ds Glioma· Neu opsychology· Neu opsychia y· Neu osu ge y· Cogni i e unc ion
In oduc ion
Pa ien s wi h di use glioma can de elop impai men s in
mul iple cogni i e domains be o e o a e su ge y ha can
ha e a p o ound e ec on unc ion and quali y o li e [9,
25]. The ype o impai men can be in luenced by umo
mo phology, ex en o esec ion and pos -su gical ea men ,
umo ecu ence, age, and concu en psychological dis ess
[1, 8, 13, 15, 16, 19, 30, 34, 35]. Howe e , in any gi en case,
i is di icul o make p ecise p edic ions abou cogni i e
ou come due o, e.g., indi idual di e ences and long- anging
e ec s o di use gliomas on ne wo ks h oughou he b ain
[11, 12, 27, 31]. Assessmen o cogni i e unc ion is he e-
o e i al in in o ming managemen and in moni o ing he
long- e m e ec s o umo s and in e en ions.
Despi e ecogni ion o his impo ance, se e al issues
emain wi h cu en di use glioma neu ocogni i e es ing. In
a adi ional cogni i e assessmen , a neu opsychologis wo ks
h ough a ange o in-dep h assessmen s wi h he pa ien ,
Ra ael Rome o-Ga cia and Mallo y Owen con ibu ed equally o
his wo k.
This a icle is pa o he Topical Collec ion on B ain Tumo s
* Ra ael Rome o-Ga cia
[email p o ec ed]
Ex ended au ho in o ma ion a ailable on he las page o he a icle
Published online: 1 Ma ch 2022
/
Ac a Neu ochi u gica (2022) 164:2021–2034
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w i ing down he esponses hen manually sco ing and w i ing
a epo . The ange o es s e lec s he ac iona ion o he cog-
ni i e sys em, ha is dis inc unc ions ha can be selec i ely
impai ed. Fo example, in he a ea o memo y, a neu opsy-
chologis may apply di e en es s o e bal and non- e bal
memo y, ecogni ion memo y s. ecall, au obiog aphical
memo y, p ospec i e memo y, wo king memo y, and so on.
These es s ypically p esen many i ems, g aded in di icul y,
such ha he es s a e sensi i e o indi idual di e ences in he
gene al popula ion as well as simply de ec ing “impai men .”
This app oach has g ea s eng hs bu also impo an limi-
a ions. In-dep h assessmen o an indi idual can ake se e al
hou s, in addi ion o sco ing and epo w i ing ime. A long
assessmen may be highly sensi i e in he gene al popula ion
bu be o e ly in luenced by a igue, pain, o o he ac o s in
clinical g oups [30]. The e is such a wide ange o special-
ized es s a ailable ha he e may be li le o e lap be ween
hose used in one cen e and ano he , making compa ison
o ou comes complex [22, 26, 28]. Many es s ha e s ong
o unknown p ac ice e ec s, limi ing hei use o epea ed
assessmen s.
Compu e ized cogni i e assessmen s o e po en ial ad an-
ages including highly s anda dized adminis a ion, he capac-
i y o measu e eac ion imes wi h millisecond p ecision, and
ins an sco ing/ epo ing. In his way, indica ions o possi-
ble impai men in language, memo y, o ien a ion, a en ion,
nume ical cogni ion, spa ial bias, and abili y o imi a e ges-
u es can be de i ed in a ound 10min, helping o in o m man-
agemen in se ings whe e pa ien s may be in ole an o longe
assessmen s (e.g., acu e s oke). The ad en o he ouchsc een
able added po abili y and sui abili y o bedside use, g ea e
hygiene, a mo e in ui i e means o in e ac ion, and u he
educed cos s. OCS-BRIDGE is a ecen ly de eloped able
app ha is a hyb id be ween e y b ie sc eening and mo e
in-dep h assessmen (h ps:// ocs- b idge. com/) [6, 18].
To da e, he e a e no epo s o he use o app-based cog-
ni i e assessmen in di use glioma. He e 17 pa ien s we e
gi en a adi ional neu opsychological assessmen and OCS-
BRIDGE assessmen be o e and a e su ge y. In addi ion,
OCS-BRIDGE was e-adminis e ed a 3- and 12-mon h
ollow-up. Ou in e es was whe he OCS-BRIDGE o e ed
ad an ages in e ms o ease o adminis a ion and e iciency
o epea ed es ing in longi udinal s udies, whe he i s esul s
acco ded well wi h adi ional in-dep h assessmen , and
whe he aspec s o he wo app oaches may be complemen a y.
Ma e ials andme hods
Pa icipan s
This s udy is a single-cen e p ospec i e coho design
app o ed by he Camb idge Cen al Resea ch E hics
Commi ee (p o ocol numbe 16/EE/0151). All p ocedu es
con ibu ing o his wo k comply wi h he e hical s anda ds
o he ele an na ional and ins i u ional commi ees on
human expe imen a ion and wi h he Helsinki Decla a ion o
1975, as e ised in 2008. All pa ien s ga e w i en in o med
consen . Pa ien s deemed o ha e ypical appea ances o a
di use glioma we e iden i ied a adul neu o-oncology mul i-
disciplina y eam (MDT) mee ings a Addenb ooke’s Hospi-
al (Camb idge, UK), and a consul an neu osu geon di ec ly
in ol ed in he s udy iden i ied po en ial pa ien s based on
he ou come o he MDT discussion. Pa ien s (n = 17) we e
ec ui ed be ween 2017 and 2019 and ollowed up un il
2020. Inclusion c i e ia included he ollowing: (i) pa ici-
pan is willing and able o gi e in o med consen o pa ici-
pa ion in he s udy, (ii) imaging is e alua ed by he MDT and
judged o ha e ypical appea ances o a di use glioma, (iii)
s eal h MRI is ob ained ( ou ine neu ona iga ion MRI scan
pe o med p io o su ge y), (i ) Wo ld Heal h O ganiza-
ion (WHO) pe o mance s a us 0 o 1, ( ) age be ween 18
and 80yea s, ( i) umo loca ed in o nea eloquen a eas
o he b ain hough o be impo an o speech and execu-
i e unc ions, and ( ii) pa ien unde going awake su gical
esec ion o a di use glioma. This las inclusion c i e ion
was adop ed o collec addi ional in aope a i e elec oco -
icog aphy da a ha will be epo ed sepa a ely [10]. Pa -
icipan s we e excluded i any o he ollowing applied: (i)
concomi an an i-cance he apy, (ii) concomi an ea men
wi h s e oids, (iii) his o y o p e ious malignancy (excep
o adequa ely ea ed basal and squamous cell ca cinoma
o ca cinoma insi u o he skin) wi hin 5yea s, and (i )
p e ious se e e head inju y. See Table1 o demog aphic
and clinical cha ac e is ics.
Cogni i e assessmen
Cogni i e assessmen was ca ied ou using wo dis inc
me hods a a ious ime poin s be o e and a e su ge y.
T adi ional neu opsychological assessmen
The neu opsychological ba e y comp ised 26 independ-
en measu es o cogni i e unc ion ac oss eigh domains:
e bal memo y, non e bal memo y, e bal skills, non-
e bal skills, a en ion, execu i e unc ion, and mood
dis u bance using a a ie y o p e iously alida ed es s
[20, 24, 33]. The ba e y included elemen s o bo h he
Weschle Adul In elligence Scale IV, which has p e i-
ously been used o assess cogni i e unc ioning in glioma
pa ien s [37], and he B ain Inju y Rehabili a ion T us
Memo y and In o ma ion P ocessing Ba e y, which was
speci ically designed o pa ien s wi h neu ological inju-
ies [5]. Tes ing ook app oxima ely 2–3h o comple e and
was adminis e ed by a egis e ed neu opsychologis in a
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Ac a Neu ochi u gica (2022) 164:2021–2034
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clinical se ing. A ull lis o he es s included on bo h he
OCS-BRIDGE and he neu opsychological assessmen s
can be ound in TableS1.
OCS‑BRIDGE assessmen
This no el app-based sc eening ool, adminis e ed ia ouch-
sc een able , consis s o 3 pa s. The i s pa is based on
he Ox o d Cogni i e Sc een (OCS) and consis s o a b ie
sc eening o language, o ien a ion, a en ion, pe cep ion,
memo y, p axis, and nume acy skills, based on a pape -
and-pencil measu e ex ensi ely alida ed in s oke [6, 18].
The second pa o OCS-BRIDGE p o ides mo e sensi i e
measu es, adap ed om well-es ablished es pa adigms,
o pa ien s able o ole a e a sligh ly longe assessmen o
25–40min. I includes measu es o eac ion ime, wo k-
ing memo y, and isual pe cep ion. Sc eening included 6
memo y asks: ee e bal memo y, o e all e bal memo y,
episodic memo y, o ien a ion (spa ial memo y), o wa d
and backwa d digi span ( e bal sho e m and wo king
memo y) [32, 36]. Because pe o mance bene i s om
p e ious exposu e o he asks (p ac ice e ec ) end o be
less ma ked on such measu es, hey also lend hemsel es o
epea assessmen in longi udinal ollow-up. The inal pa o
OCS-BRIDGE consis s o he widely used mood measu es
PHQ-9 and GAD-7 [14, 29]. OCS-BRIDGE was adminis-
e ed p e-ope a i ely, pos -ope a i ely p io o discha ge,
as well as a 3-mon h and 12-mon h ollow-up, and ook
be ween 20 and 35min o comple e.
Cogni i e impai men quan i ica ion
An impai men in ei he assessmen echnique was de ined
by con en ion as pe o mance wo s anda d de ia ions below
he mean o a e e ence con ol popula ion on any pa icu-
la es o es componen . OCS-BRIDGE o e s a second
ca ego y o “possibly impai ed” o sco es ha all app oxi-
ma ely be ween he 5 h and he 10 h pe cen ile. The o al
impai men s in each domain we e de ined as he numbe o
indi idual es s wi hin ha domain on which a pa icipan
demons a ed an impai men .
Indi idual domains om he neu opsychological ba e y
and he OCS-BRIDGE assessmen we e combined in o ou
gene alized unc ional domains o he pu poses o di ec
compa ison: a en ion, memo y, e bal skills, and non e -
bal skills (TableS2). The neu opsychological ba e y also
included wo es s o execu i e unc ion ha p o ided ou
independen measu es, as well as wo assessmen s o mood.
These we e included in he analysis as hei own domains.
Neu opsychological and OCS-BRIDGE alues we e
z-sco ed by sub ac ing he mean and di iding by he s and-
a d de ia ion de i ed om no ma i e heal hy pa icipan s.
No ma i e da a o neu opsychological assessmen s we e
ob ained om pa icipan s aged 16 o 89. OCS-BRIDGE e -
e ence sco es we e de i ed om 268 heal hy con ols (mean
age, 51.44, SD age 19.86). These samples we e ep esen a-
i e o he gene al dis ibu ion in e ms o age, gende , and
educa ional le el. Neu ological/heal h condi ions ha we e
likely o impac on sco es (e.g., s oke, epilepsy, medica-
ions, unco ec ed hea ing loss) we e an exclusion c i e ion.
Table 1 Demog aphic in o ma ion. SFG, supe io on al gy us; MFG, middle on al gy us; IFG, in e io on al gy us; ITG, in e io empo al
gy us; MTG, middle empo al gy us; SMA, supplemen a y mo o a ea. Ages ha e been ounded o o o anonymi y
Pa ien Age Gende Handedness P esen a ion Hemisphe e Loca ion Tumo g ade/pa hology
1 40 Female Le Seizu es Le F on al G ade II oligodend oglioma
2 30 Male Righ Seizu es Righ Insula G ade II as ocy oma
3 30 Male Righ Seizu es Le Tempo al/insula G ade IV glioblas oma
4 50 Female Righ Inciden al Righ Insula G ade II oligodend oglioma
5 60 Female Righ Recu ence Le F on al/SFG/ on al pole G ade II oligodend oglioma
6 20 Female Le Seizu es Righ F on al/IFG G ade I ganglioglioma
7 30 Male Righ Seizu es Righ F on al/SFG and MFG G ade III as ocy oma
8 30 Male Righ Seizu es Righ F on al/MFG G ade III as ocy oma
9 50 Male Le Seizu es Le Tempo al/ITG G ade IV glioblas oma
10 40 Female Righ Seizu es Righ F on al/MFG G ade II oligodend oglioma
11 30 Male Righ Seizu es Le F on al/SFG/ on al pole G ade II as ocy oma
12 30 Female Righ Headaches Le Tempo al/MTG G ade III as ocy oma
13 30 Female Righ Seizu es Le Supe io empo al gy us G ade I ganglioglioma
14 60 Female Righ Seizu es Le Supe io empo al gy us G ade II as ocy oma
15 30 Male Righ Seizu es Le Supe io empo al gy us G ade III as ocy oma
16 30 Male Righ Seizu es Le SFG/SMA and p e-cen al G ade IV glioblas oma
17 30 Male Righ Seizu es Le In e io on al G ade III as ocy oma
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Fu he de ails on he no ma i e da a can be ound in each
indi idual es manual.
S a is ical analysis
All s a is ical analyses we e ca ied ou in R (R Co e Team,
2014) and Ma lab R2021b. The Z-sco e o a gi en domain
was calcula ed as he median Z-sco e o all he i ems belong-
ing o ha domain. We addi ionally calcula ed he a io o
cogni i e de ici s o each pa ien as he numbe o asks
showing a de ici (pe o mance below h eshold) di ided
by he o al numbe o asks. The - alue and P- alue we e
calcula ed using an unpai ed - es be ween assessmen s
ac oss pa ien s. The numbe o asks ha con ibu ed o each
domain di e ed and ull de ails a e a ailable in TableS1.
Al hough he numbe o pa icipan s in he cu en
s udy is low o o mal analysis, o illus a ion, unsupe -
ised clus e ing analysis was ca ied ou using he K-means
algo i hm. Indi idual es s ha did no show any a ia ion
in sco e be ween pa icipan s we e omi ed om he clus-
e ing analysis, excluding 14/39 OCS-BRIDGE, and 1/28
neu opsychological measu es. Clus e ing was pe o med on
alues ha had been cen e ed o a mean alue o 0 wi h a
s anda d de ia ion o 1. K-means clus e ing was done wi h
a k alue o 4 based on he wi hin-g oups sum o squa es.
Analysis was pe o med using he k-means unc ion in R
e sion 3.6.1. Clus e s we e isualized by pe o ming a
p incipal componen s analysis using he iz unc ion in he
ac oex a package and plo ing he indi idual cogni i e es s
agains he i s and second p incipal componen s.
Resul s
Demog aphics andda a comple eness
No signi ican di e ence was ound in o al impai men s
epo ed p eope a i ely be ween igh - and le -handed
pa icipan s ( = 0.547, P = 0.6183), male and emale
( = 01.175, P = 0.258), o igh - and le -sided umo s
( = 0.845, P = 0.411). The co ela ion be ween age and
impai men equency did no each s a is ical signi icance
( = − 0.22, P = 0.39).
All pa icipan s comple ed p e-ope a i e adi ional neu-
opsychology and OCS-BRIDGE assessmen s. Fou een
pa icipan s comple ed adi ional neu opsychology be ween
2 and 5weeks a e su ge y, and eigh comple ed pos ope a-
i e OCS-BRIDGE assessmen s wi hin 72h. Ele en pa ici-
pan s comple ed an OCS-BRIDGE assessmen a 3-mon h
ollow-up and a 12-mon h ollow-up. Six een o se en een
pa icipan s had a leas one OCS-BRIDGE assessmen a e
su ge y (see TableS3).
Neu opsychia ic unc ion
In his sample, anxie y was a a ela i ely low le el wi h
jus 3/17 pa icipan s p e-ope a i ely sco ing wi hin he
mild ange on he Beck Anxie y Index (BAI) and 2/17
in he mode a e ange. The e was no associa ion be ween
mood s a us and equency o cogni i e impai men in his
sample (BAI s a us– o al cogni i e impai men s = 1.2789,
P = 0.22; BDI s a us– o al cogni i e impai men s = 0.87,
P = 0.4).
T adi ional neu opsychological assessmen
On adi ional neu opsychological assessmen , p e-su gi-
cally, 79% (14/17) o pa icipan s had an impai men in a
leas one domain, wi h a mean o 2.88 (SD = 2.47) impai -
men s pe pa icipan . Th ee pa icipan s pe o med abo e
cu o in all domains. Impai men s we e obse ed in he
domains o a en ion (7), e bal memo y (7), e bal skills
(6), non e bal memo y (4), and execu i e unc ion (3). O
he 26 cogni i e measu es in he ba e y, 16 de ec ed a leas
one impai ed le el o pe o mance among he pa icipan s
while 10 e u ned no impai ed sco es o any pa icipan .
A e su ge y, all bu one pa icipan had an impai men
in a leas one domain, wi h a mean o 4.50 impai men s pe
pa icipan (SD = 3.40). Compa ed wi h es ing be o e su -
ge y, he o al numbe o cogni i e impai men s appa en ly
educed in 43% (6/14) pa icipan s, emained unchanged in
7% (1/14), and inc eased by 50% (7/14) (Fig.1). O he 7
pa icipan s wi h mo e impai men s, he a e age inc ease
was 4.14 (SD 3.18). Th ee domains ( e bal memo y, non-
e bal memo y, and e bal skills) demons a ed an inc ease
in impai men s a e su ge y, wo domains (non e bal skills
and a en ion) emained unchanged, and one (execu i e unc-
ion) imp o ed. No pa icipan s demons a ed an impai men
in non e bal skills a any poin .
OCS‑BRIDGE es ing
As expec ed, OCS-b idge assessmen equi ed conside -
ably less adminis a ion ime (mean = 30.5min, SD = 7.4)
han adi ional assessmen (2–3h). Be o e su ge y, 59%
(10/17) o pa icipan s had an impai men in a leas one
OCS-BRIDGE domain, wi h a mean o 0.94 impai men s
(SD = 1.08) pe pa icipan . Impai men s be o e su ge y
occu ed in he domains o nume ical cogni ion (4), pe cep-
ion (3), a en ion (3), language (1), p axis (1), and e bal
wo king memo y (1). No pa icipan s showed an impai men
in memo y o p ospec i e memo y be o e su ge y. O he
39 indi idual cogni i e es s included in he OCS-BRIDGE
ba e y, 26 (66%) de ec ed a leas 1 impai ed pe o mance
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Ac a Neu ochi u gica (2022) 164:2021–2034
1 3
while pe o mance on he emaining 13 was uni o mly
wi hin he no mal ange.
OCS‑BRIDGE longi udinal changes
OCS-BRIDGE’s ela i e b e i y and ease o adminis a ion
len i sel o longi udinal assessmen as pa o ollow-up
clinics. The a ia ion o pos ope a i e impai men s de ec ed
is shown in Fig.2. The g ea es numbe was seen in a en ion
and non- e bal skills. O he 16 pa icipan s who had a leas
one pos -ope a i e assessmen , 44% (7/16) had a educed
numbe o impai men s by hei las assessmen , 25% (4/16)
had he same, and 31% (5/16) showed an inc ease. Fou pa -
icipan s who had mul iple ollow-ups showed a pa e n o
inc eased impai men s on ei he pos -ope a i e o 3-mon h
es ing which esol ed by hei las ollow-up da e. Th ee o
hese ou pa icipan s showed a ansien inc ease o a leas
one impai men in pe cep ion, and wo showed a ansien
inc ease in memo y impai men s. Ten o he six een pa ici-
pan s who had a leas one ollow-up OCS-BRIDGE assess-
men ended he s udy wi h no impai men on o mal es ing.
Compa ison o OCS‑BRIDGE wi h adi ional
neu opsychological es ing
As discussed, a p opo ion o he OCS-BRIDGE es s a e
ex emely b ie sc eening measu es— he au ho s, he e o e,
applied a conse a i e s a egy o a oid a high, and hence
unin o ma i e, le el o alse posi i es. I would he e o e
be p edic ed ha OCS-BRIDGE would be less sensi i e o
impai men s han in-dep h adi ional neu opsychological
assessmen s. Figu e3A shows he o al numbe o p eop-
e a i e impai men s de ec ed in di e en domains using he
wo me hods (Fig.3A). The es s in he wo ba e ies a y
qui e widely bu one a ea o commonali y is in he o wa d
and backwa d digi span es s. As shown in Fig.3B, he es s
e u ned simila indings wi h no s a is ically signi ican di -
e ences on he o wa d ( adi ional mean = 6.29, SD = 1.40
s. OCS-BRIDGE mean 6.76, SD = 0.90; = − 1.367,
P = 0.1905) o backwa d es s ( adi ional mean = 4.47,
SD = 1.28 s. OCS-BRIDGE mean = 4.82, SD = 1.55;
= − 0.972, P = 0.3456).
O e all, adi ional neu opsychological es s de ec ed
44 p eope a i e impai men s among he 17 pa icipan s in
he ou combined domains o a en ion, memo y, e bal
skills, and non- e bal skills. OCS-BRIDGE de ec ed 13
impai men s and 28 possible impai men s p e-ope a i ely
(Fig.3C). The a e age a io o de ec ed de ici s was signi i-
can ly highe o he neu opsychological assessmen s han
o OCS-BRIDGE in he a en ion (p eope a i e, = 3.35,
P = 0.002; pos ope a i e, = 2.64, P = 0.016) and memo y
(p eope a i e, = 3.24, P = 0.003; pos ope a i e, = 1.79,
P = 0.088) domains. On he con a y, OCS-BRIDGE
e ealed a highe a io o non- e bal skills de ici s han
Fig. 1 Change in he o al num-
be o de ici s o each pa ien
be ween p e- and pos ope a i e
adi ional neu opsychology
es ing
2025

Ac a Neu ochi u gica (2022) 164:2021–2034
1 3
neu opsychological assessmen s (p eope a i e, = − 3.11,
P = 0.004; pos ope a i e, = − 3.16, P = 0.005) (see Table2
o he a e age a io o de ici s pe assessmen and TableS4
o he o al numbe o de ici s).
Z-sco es we e calcula ed om bo h he neu opsychologi-
cal es ing and he OCS-BRIDGE da a o each indi idual
es (Table3). The only signi ican di e ences be o e and
a e su ge y a i em le el (OCS-BRIDGE ex inc ion. o al-
Co ec and boa .lineHeigh ; Neu opsychology AIMPB
S o y Immedia e Recall and BMIPB Wo d lis A6) did no
su i e co ec ion o mul iple compa isons. I em Z-sco es
we e a e aged o e each domain, e ealing a a ie y o
shape dis ibu ions wi h a p edominance o no mal (neu-
opsychology e bal skills) and nega i ely skewed (memo y,
non- e bal skills, execu i e unc ion) o ms (Fig.S1). No
ou lie s we e obse ed ha may ha e o e ly in luenced
s a is ical es ing. To al and memo y p eope a i e Z-sco e
o neu opsychological es ing we e weakly co ela ed
wi h OCS-BRIDGE Z-sco e ac oss pa ien s bu signi i-
cance did no su i e mul iple co ec ion (To al, R = 0.49,
Punco ec ed = 0.045; A en ion, R = 0.27, Punco ec ed = 0.29;
Memo y, R = 0.50, Punco ec ed = 0.041; Non- e bal skills,
R = 0.06, Punco ec ed = 0.82; Fig.4). A he g oup le el,
only a en ion p eope a i e sco es we e signi ican ly di -
e en be ween neu opsychology and OCS-BRIDGE
(Pco ec ed = 0.04. Table4). To explo e his u he , unsupe -
ised clus e ing was ca ied ou o assess whe he indi idual
es s clus e ed in o g oups ha we e di e en om he o igi-
nal domains (Fig.5). Clus e s we e named o hei dominan
es ype. Clus e 1 included 10 es s, p edominan ly memo y
es s om he adi ional ba e y, and included all bu one
es om AMIPB and BMIPB. Clus e 2 included 10 es s,
8 om he adi ional ba e y and 2 om OCS-BRIDGE,
and was mos ly composed o A en ion and Ve bal Skills
es s. Clus e 3 included only 4 es s, 3 o which we e om
he SALT a en ion ask wi hin he OCS-BRIDGE ba e y.
Finally, clus e 4 was he la ges clus e , wi h 29 o he o al
es s, and included all bu one o he es s o non- e bal
skills, as well as 10 ou o 14 o he OCS-BRIDGE a en-
ion es s. Tasks which included se e al indi idual es s,
such as he OCS-BRIDGE Hea s and SALT asks, clus-
e ed oge he , in clus e 4 and clus e 3 espec i ely. The
Beck Dep ession In en o y ell in o clus e 1, while he Beck
Anxie y In en o y ell in o clus e 4.
Discussion
Di use glioma can cause cogni i e impai men s and iden i-
ying hese is impo an in in o ming pa ien s and amilies,
in imp o ing managemen , and in e alua ing ou comes. T a-
di ional neu opsychological es ing is esou ce-in ensi e,
making i di icul o pe o m a mul iple ime poin s du ing
he pa ien jou ney [30]. Table -based assessmen s ools such
Fig. 2 Numbe o cogni i e
de ici s o e ime based on
OCS-BRIDGE assessmen p e-
ope a i ely, pos ope a i ely and
a 3- and 12-mon h ollow-ups
2026
Ac a Neu ochi u gica (2022) 164:2021–2034
1 3
as OCS-BRIDGE p o ide apid, easy- o-use al e na i es o
adi ional pen-and-pape es ing, ye li le wo k has been
done o demons a e he alidi y o hese es s in his popu-
la ion, o o assess hei ela i e s eng hs and weaknesses
when compa ed wi h adi ional ba e ies. This pape p e-
sen s ea ly da a om a coho o 17 pa icipan s wi h di -
use glioma who unde wen adi ional and OCS-BRIDGE
assessmen , bo h be o e and a e su ge y, and a se e al
ollow-ups. The esul s show ha bo h me hods de ec ed
cogni i e impai men s in pa icipan s who did no p ima -
ily p esen wi h sel - epo ed cogni i e p oblems.
Resul s e ealed ha , when compa ed wi h a 2–3-h adi-
ional assessmen , a 30-min OCS-BRIDGE assessmen sig-
ni ican ly de ec ed ewe impai men s in he a eas o a en-
ion and memo y. Howe e , OCS-BRIDGE signi ican ly
de ec ed mo e impai men s in non- e bal skills. Memo y
and a en ion sc eening using only a ew i ems canno make
he kind o ine dis inc ions possible wi h a longe es , and
Fig. 3 A Cogni i e de ici s
by domain om p eope a i e
neu opsychological es ing and
OCS-BRIDGE assessmen s. B
Compa ison o digi span analy-
sis be ween neu opsychological
es ing and OCS-BRIDGE.
C To al p eope a i e de ici s
shown by neu opsychological
es ing and OCS-BRIDGE
Table 2 A e age a io and
s anda d de ia ion o cogni i e
de ici s ac oss pa ien s o
each domain and assessmen .
A posi i e T alue indica es a
highe a io o de ici s de ec ed
by adi ional neu opsychology
compa ed wi h OCS-BRIDGE
Neu opsychology
a e age a io (SD)
OCS-BRIDGE
a e age a io (SD)
T alue P alue
A en ion P eope a i e 0.255 (0.28) 0.025 (0.56) 3.35 0.002
Pos ope a i e 0.262 (0.23) 0.036 (0.76) 2.64 0.016
Memo y P eope a i e 0.078 (0.10) 0 (0) 3.24 0.003
Pos ope a i e 0.131 (0.14) 0.031 (0.09) 1.79 0.088
Non- e bal skills P eope a i e 0 (0) 0.034 (0.04) − 3.11 0.004
Pos ope a i e 0 (0) 0.080 (0.10) − 3.16 0.005
2027
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Table 3 Raw, s anda d de ia ion (SD), and Z-sco ed pe o mance o each i em included in adi ional neu opsychology and OCS-BRIDGE.
T- alues and P- alues esul om a pai ed - es s compa ing sco es be o e (p eop) and a e (pos op) su ge y
I em name Rawp eop (SD) Zp eop Rawpos op (SD) Zpos op - alue P- alue
OCS-BRIDGE
A en ion hea s.o e allSco e 29.31 (− 1.08) 0.34 28.63 (− 1.41) − 0.06 1.33 0.20
hea s.spaceAsymme y − 0.002 (− 0.03) 0.03 0 (− 0.07) 0.10 − 0.19 0.85
hea s.objec Asymme y 0.12 (− 0.6) 0.11 0.38 (− 0.74) 0.55 − 0.93 0.36
hea s.pe se e a i eResponsesTo al 0 (0) 0.06 0 (0) 0.06 0.00 1.00
hea s.o ganisa ionIndex − 2.64 (− 0.76) 0.16 − 2.13 (− 0.63) 0.70 − 1.64 0.11
sal .o e allFlashSco e 3.53 (− 0.72) − 0.02 3.43 (− 0.79) − 0.16 0.30 0.76
sal .numbe AllTa ge sDe ec ed 35.71 (− 0.69) 0.18 35.29 (− 1.5) − 0.28 0.96 0.35
sal .RTCoe icien − 0.15 (− 0.06) 0.81 − 0.15 (− 0.03) 0.90 − 0.26 0.80
sal . a ge Bias 0 (− 0.02) − 0.06 0 (− 0.01) 0.22 − 0.66 0.52
sal .RTBias 0.01 (− 0.04) 0.17 0.04 (− 0.04) 0.68 − 1.21 0.24
Pe cep ion ex inc ion. o alCo ec 17.94 (− 0.24) 0.12 17.43 (− 0.79) − 1.30 2.48 0.02
ex inc ion. ieldP oblem 0 (0) − 0.02 − 0.14 (− 0.38) − 0.61 1.61 0.12
ex inc ion.le Ex inc ion 0 (0) − 0.07 0 (0) − 0.07 0.00 1.00
ex inc ion. igh Ex inc ion 0 (0) − 0.08 0.14 (− 0.9) 0.34 − 0.68 0.51
boa .lineHeigh − 0.99 (− 0.23) − 0.78 − 1.26 (− 0.23) − 2.21 2.70 0.01
boa .meanDe ia ion − 0.56 (− 2.29) − 0.11 − 0.4 (− 1.4) − 0.05 − 0.18 0.86
ps l.o e allSco e 6 (0) 0.13 6 (0) 0.13 0.00 1.00
Memo y memo y. e balF eeRecall 3.06 (− 0.97) − 0.18 3 (− 1.51) − 0.25 0.12 0.91
memo y. e balO e allRecall 3.88 (− 0.33) 0.02 3.75 (− 0.46) − 0.34 0.82 0.42
memo y.episodicMemo ySco e 4 (0) 0.18 4 (0) 0.18 0.00 1.00
o ien a ion.o e allSco e 4 (0) 0.17 3.88 (− 0.35) − 0.61 1.49 0.15
ins. o wa dDigi Span 6.76 (− 0.9) − 0.20 6.14 (− 1.07) − 0.66 1.46 0.16
ins.backwa dDigi Span 4.82 (− 1.55) − 0.39 4.43 (− 1.4) − 0.65 0.58 0.57
ps p.p ospec i eSco e 4 (0) 0.71 4 (0) 0.71 0.00 1.00
ps p. e ospec i eSco e 4 (0) 0.68 4 (0) 0.68 0.00 1.00
Language Naming.o e allSco e 4 (0) 0.32 4 (0) 0.32 0.00 1.00
seman ics.o e allSco e 3 (0) 0.06 3 (0) 0.06 0.00 1.00
eading.o e allSco e 15 (0) 0.34 15 (0) 0.34 0.00 1.00
P axis imi a ion.handSco e 5.88 (− 0.49) 0.00 5.88 (− 0.35) − 0.02 0.04 0.97
imi a ion. inge Sco e 6 (0) 0.20 6 (0) 0.20 0.00 1.00
imi a ion.o e allSco e 11.88 (− 0.49) 0.12 11.88 (− 0.35) 0.11 0.04 0.97
Numbe nume ical.o e allA i hme icSco e 3.47 (− 0.94) − 0.87 3.63 (− 0.52) − 0.50 − 0.43 0.67
nume ical.o e allW i ingSco e 2.88 (− 0.49) − 1.00 2.88 (− 0.35) − 1.07 0.04 0.97
Neu opsychological Assessmen s
A en ion WAIS-IV.Digi .Span.Fo wa d 9.88 (− 2.5) − 0.04 9.5 (− 2.24) − 0.17 0.44 0.66
WAIS-IV.Digi .Span.Backwa d 8.12 (− 2.2) − 0.63 7.21 (− 1.85) − 0.93 1.22 0.23
WAIS-IV.Digi .Symbol 66.29 (− 13.85) − 0.18 66.07 (− 15.43) − 0.19 0.04 0.97
Non- e bal skills BMIPB.Complex.Figu e.copy 79.12 (− 1.17) 0.30 79.38 (− 0.87) 0.40 − 0.69 0.50
VOSP.Objec .Decision 18.29 (− 1.16) − 0.19 19 (− 1.22) 0.25 − 1.61 0.12
VOSP.Numbe .Loca ion 9.41 (− 0.87) 0.01 9.38 (− 0.65) − 0.01 0.09 0.93
VOSP.Cube.Analysis 9.76 (− 0.56) 0.39 9.77 (− 0.44) 0.39 − 0.02 0.98
2028
Ac a Neu ochi u gica (2022) 164:2021–2034
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as a consequence can ha e a mo e conse a i e h eshold
o impai men . In con as , OCS-BRIDGE measu es wi h
eac ion ime assessmen s can make e y ine indi idual di -
e ence dis inc ions. The esul s sugges ha a combined
app oach, using adi ional assessmen in hose a eas whe e
b ie sc eening, may be less sensi i e, and OCS-BRIDGE
s yle measu es o eac ion ime and pe cep ual asks may
be mos e ec i e.
Table 3 (con inued)
I em name Rawp eop (SD) Zp eop Rawpos op (SD) Zpos op - alue P- alue
Memo y AMIPB.S o y-Immedia e.Recall 34.71 (− 8.99) 0.17 27 (− 9.04) − 0.59 2.37 0.02
AMIPB.S o y-Delayed.Recall 32.82 (− 11.14) 0.18 27.54 (− 11.4) − 0.32 1.28 0.21
BMIPB.Wo d.Lis .A1-A15 54.59 (− 9.1) − 0.22 50.14 (− 9.36) − 0.84 1.34 0.19
BMIPB.Wo d.Lis .A6 12.82 (− 2.53) 0.29 10.5 (− 2.95) − 0.64 2.36 0.03
BMIPB.Wo d.Lis
Wo d.Recogni ion
28.71 (− 0.99) 0.08 27.64 (− 2.47) − 0.74 1.63 0.11
BMIPB.Wo d.Lis
Lis .Recogni ion
28.94 (− 1.56) − 0.04 27.5 (− 3.61) − 1.00 1.49 0.15
BMIPB.Complex.Figu e
Immedia e.Recall
65.47 (− 7.8) 0.02 61.36 (− 13) − 0.39 1.09 0.28
BMIPB.Complex.Figu e
Delayed.Recall
63.24 (− 8.21) 0.11 59.57 (− 13.36) − 0.23 0.94 0.36
BMIPB.Design.Lea ning-A1-A15 37.35 (− 6.19) − 0.01 35.14 (− 7.22) − 0.38 0.92 0.37
BMIPB.Design.Lea ning-A6 8.29 (− 1.16) 0.07 8.14 (− 1.61) − 0.04 0.30 0.76
BMIPB.Design.Lea ning
Recogni ion
39.41 (− 1.18) 0.32 38.43 (− 2.59) − 0.12 1.40 0.17
BMIPB.Design.Lea ning
Iden i ica ion
9.59 (− 1) 0.13 9 (− 1.62) − 0.27 1.24 0.22
Language Le e .Fluency 37.82 (− 14.55) − 0.25 30.71 (− 15.04) − 0.91 1.33 0.19
Seman ic.Fluency 20.71 (− 5.92) 0.22 16.5 (− 5.68) − 0.79 2.00 0.05
G aded.Naming.Tes 19.65 (− 3.87) − 0.66 19.57 (− 5) − 0.68 0.05 0.96
Syn ac ic.Speech.Comp ehension 24.88 (− 0.93) − 0.08 24.57 (− 1.99) − 0.29 0.57 0.57
Execu i e unc ioning Hayling.Ini ia ion.( ime) − 3.88 (− 3.76) − 0.76 − 2.5 (− 1.61) − 0.13 − 1.28 0.21
Hayling.Inhibi ion.( ime) − 21.24 (− 16.06) − 0.36 − 23 (− 21.01) − 0.49 0.27 0.79
Hayling.Inhibi ion.(sco e) 10.94 (− 3.23) − 0.04 10.86 (− 3.72) − 0.07 0.07 0.95
B ix on − 10.94 (− 4.49) 0.89 − 10.92 (− 7.1) 0.89 − 0.01 0.99
Fig. 4 Associa ion be ween Z-sco es de i ed om OCS-BRIDGE and neu opsychological es ing. Plo s o o e lapping domains (A en ion,
Memo y, and Non- e bal skills) and o he o al a e age ac oss domains (To al)
2029