Verbal Fluency Test In Patients With A New Brain Tumour

Abstract Aims: To evaluate the frequency of impairment on semantic verbal fluency (SVF) test in patients with a new brain tumour prior to neurosurgery and to examine scores across symptom presentations. Methods: This is a secondary analysis of clinical, cognitive and capacity data from a prospective study of consent in patients with newly diagnosed brain tumours. Addenbrooke’s Cognitive Examination-Revised version, which includes within it the Mini-Mental State Examination (MMSE), was tested prior to surgery. Patient’s presenting symptoms were categorised into five groups according to a pre-defined criteria. SVF score was converted to a z-score to identify frequency of impairment and raw scores for SVF were compared across symptom presentations. Results: A total of 97 patients (51% female; mean age 53.8 years; 53% high-grade tumours; 11% metastases) were assessed. Forty-one percent had headache only or headache “plus”, 26% had focal deficit only; 21% had seizures only, and 13% had cognitive deficits. SVF was impaired in 40% of patients. Adjusted SVF performance was worse for patients with headache symptoms and cognitive deficits than those with focal neurology only or seizures. SVF and MMSE had a positive moderate-strong correlation (r=0.59, p<0.0001). Conclusion: Decreased cognitive performance as identified by SVF is common in patients with a new brain tumour, especially those with headache or cognitive deficits. A low SVF may be a useful rapid additional “red flag” for patients with a suspicious headache, when referral to secondary care is considered. Further work needs to be done around the cut-off values for SVF in helping primary care clinicians select patients for early referral.