【研究目的】全腦放射治療(whole-brain radiation therapy, WBRT)為癌症腦轉移患者之重要治療方式之一，過去研究已證實其可能損傷心智功能和記憶力功能。在心智功能方面，許多研究使用簡短心智狀態檢查表(Mini-Mental Status Examination, MMSE)評估但結果不一致，且少有研究探討治療短期內的功能變化，以及各認知功能向度分析。而在記憶力功能方面，研究顯示記憶為接受WBRT腦轉移患者最常見之缺損，且可能與內側顳葉(Medial Temporal Lobe, MTL)系統損傷有關，此結構目前也已有研究證實與工作記憶損傷有關。又過去研究大多僅使用語文記憶測驗，故本研究欲以MMSE與語文和非語文記憶測驗，探討接受WBRT腦轉移患者於療程中及其後續追蹤之心智功能和記憶力功能變化。
【研究方法】研究樣本病人組立意取樣於南部某教學醫院，經病理診斷為癌症且轉移至腦部需要接受全腦放射治療之病患；社區組為人口學變項配對之一般健康受試者。收案病人組25人，社區組67人。以簡短心智狀態檢查表—台灣版(Mini-Mental Status Examination-Chinese, MMSE-C)、魏式成人智力量表第三版(WAIS-III)中文版之記憶廣度測驗(Digit Span Test, DST)、以及廣泛性非語文記憶力測驗組(comprehensive non-verbal memory test battery, CNMT)於病人接受治療前(T0)、治療開始第3~4天(T1)、結束治療後1週內(T2)、以及結束治療3個月後的追蹤(T3)。
【結果】(1) MMSE僅於T0和T2時病人組顯著低於社區組，其他比較皆未達統計顯著。病人組於T0至T1呈現上升趨勢，但於T1至T2呈下降趨勢，且持續下降至T3。在心智功能各向度的分析也未有顯著差異，然而「定向感」和「登錄與記憶」於T2至T3呈現下降趨勢。(2) DST測驗結果顯示，病人組於T0至 T2時逆序背誦呈現顯著進步，而總分未達顯著但呈上升趨勢，於T2至T3時，各分測驗皆未達顯著但呈現下降趨勢。CNMT於T0至T2之測驗結果，病人組於學習記憶、順序提取、空間提取、以及記憶再認階段的各指標皆未有顯著差異，但呈現進步趨勢。
【結論】本研究在心智功能方面，結果雖未達統計顯著，但仍能觀察到接受WBRT腦轉移患者心智功能於治療中期即可能開始受到WBRT的影響，並持續呈現退步至治療結束後3個月。而在記憶功能方面，本研究得出接受WBRT腦轉移患者於療程期間語文工作記憶呈現顯著進步，另外雖無統計顯著，但仍觀察到3個月後衰退之趨勢。另外，本研究也得出接受WBRT腦轉移患者於療程期間非語文記憶並未受到WBRT影響而產生顯著變化，然而是否會如語文記憶在治療3個月後才會開始受影響呈現衰退的可能，未來還待其他研究進行更長期的追蹤以驗證。

This research wishes to explore the changes in mental and memory functions for cancer patients of brain metastasis undergoing WBRT during treatment and follow-up.There are a total of 25 subjects in the patient group and 67 subjects in the community group. MMSE-C, WAIS-III DST and CNMT were conducted before the patients undergoing treatment, during the treatment, the completion of treatment, and for the follow-up 3 months after the completion of treatment. The changes of mental functions for the patient group displayed a descending trend during the later stage of treatment, then continued descending during the 3 months of follow-up, though the above changes did not render significant differences. Regarding the memory functions for the patient group, the verbal working memory during the treatment has displayed statistical significant improvement, and rendered a descending trend during the 3 months of follow-up, though such descending trend did not display significant differences. Furthermore, the non-verbal memory did not display significant change during the treatment.

王筱雯. (2015). 癌症腦轉移患者接受全腦放射治療前後之心智功能與注意力功能探討. 成功大學行為醫學研究所學位論文, 1–96.
郭乃文、劉秀枝、王珮芳、廖光淦、甄瑞興、林恭平、陳祖裕、徐道昌. (1988). 「簡短式智能評估」之中文施測與常模建立. 中華民國復健醫學會雜誌, 16.
郭乃文、鄭中平. (2005). 非語文注意力與記憶力測驗之修訂與應用. 台北.
陳榮華、陳心怡. (2002). 魏氏成人智力量表第三版(中文版) 指導手冊. 台北: 中國行為科學社.
A, O. R., &Michael, M. (2010). Selection Bias Introduced by Neuropsychological Assessments Prostate Centre View project Increasing evidence based prescription of radiotherapy for bone metastases View project.
Abayomi, O. K. (1996). Pathogenesis of Irradiation-Induced Cognitive Dysfunction. Acta Oncologica, 35(6), 659–663.
Ahles, T. A., Silberfarb, P. M., Herndon, J., Maurer, L. H., Kornblith, A. B., Aisner, J., …Holland, J. C. (1998). Psychologic and neuropsychologic functioning of patients with limited small-cell lung cancer treated with chemotherapy and radiation therapy with or without warfarin: a study by the Cancer and Leukemia Group B. Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology, 16(5), 1954–1960.
Andrews, D. W., Scott, C. B., Sperduto, P. W., Flanders, A. E., Gaspar, L. E., Schell, M. C., …Curran, W. J. (2004). Whole brain radiation therapy with or without stereotactic radiosurgery boost for patients with one to three brain metastases: phase III results of the RTOG 9508 randomised trial. The Lancet, 363(9422), 1665–1672.
Anthony, J. C., LeResche, L., Niaz, U., VonKorff, M. R., &Folstein, M. F. (1982). Limits of the ‘Mini-Mental State’ as a screening test for dementia and delirium among hospital patients. Psychological Medicine, 12(02), 397.
Aoyama, H., Shirato, H., Tago, M., Nakagawa, K., Toyoda, T., Hatano, K., …Kobashi, G. (2006). Stereotactic Radiosurgery Plus Whole-Brain Radiation Therapy vs Stereotactic Radiosurgery Alone for Treatment of Brain Metastases. JAMA, 295(21), 2483.
Aoyama, H., Tago, M., Kato, N., Toyoda, T., Kenjyo, M., Hirota, S., …Shirato, H. (2007). Neurocognitive Function of Patients with Brain Metastasis Who Received Either Whole Brain Radiotherapy Plus Stereotactic Radiosurgery or Radiosurgery Alone. International Journal of Radiation Oncology*Biology*Physics, 68(5), 1388–1395.
Aoyama, H., Tago, M., &Shirato, H. (2015). Stereotactic Radiosurgery With or Without Whole-Brain Radiotherapy for Brain Metastases. JAMA Oncology, 1(4), 457.
Baddeley, A. (2000). The episodic buffer: a new component of working memory? Trends in Cognitive Sciences, 4(11), 417–423.
Baddeley, A. (2012). Working Memory: Theories, Models, and Controversies. Annual Review of Psychology, 63(1), 1–29.
Baddeley, A. D., &Warrington, E. K. (1970). Amnesia and the distinction between long- and short-term memory. Journal of Verbal Learning and Verbal Behavior, 9(2), 176–189.
Beaumont, T. L., Kupsky, W. J., Barger, G. R., &Sloan, A. E. (2007). Gliosarcoma with multiple extracranial metastases: Case report and review of the literature. Journal of Neuro-Oncology, 83(1), 39–46.
Benedict, R. H. B., Schretlen, D., Groninger, L., &Brandt, J. (1998). Hopkins Verbal Learning Test – Revised: Normative Data and Analysis of Inter-Form and Test-Retest Reliability. The Clinical Neuropsychologist, 12(1), 43–55.
Brown, P. D., Jaeckle, K., Ballman, K.V., Farace, E., Cerhan, J. H., Anderson, S. K., …Asher, A. L. (2016). Effect of Radiosurgery Alone vs Radiosurgery With Whole Brain Radiation Therapy on Cognitive Function in Patients With 1 to 3 Brain Metastases. JAMA, 316(4), 401.
Brown, P. D., Pugh, S., Laack, N. N., Wefel, J. S., Khuntia, D., Meyers, C., …Watkins-Bruner, D. (2013). Memantine for the prevention of cognitive dysfunction in patients receiving whole-brain radiotherapy: a randomized, double-blind, placebo-controlled trial. Neuro-Oncology, 15(10), 1429–1437.
Cagney, D. N., Martin, A. M., Catalano, P. J., Redig, A. J., Lin, N. U., Lee, E. Q., …Aizer, A. A. (2017). Incidence and prognosis of patients with brain metastases at diagnosis of systemic malignancy: a population-based study. Neuro-Oncology, 19(11), 1511–1521.
Caine, C., Deshmukh, S., Gondi, V., Mehta, M., Tomé, W., Corn, B. W., …Kachnic, L. (2016). CogState computerized memory tests in patients with brain metastases: secondary endpoint results of NRG Oncology RTOG 0933. Journal of Neuro-Oncology, 126(2), 327–336.
Chang, E. L., Wefel, J. S., Hess, K. R., Allen, P. K., Lang, F. F., Kornguth, D. G., …Meyers, C. A. (2009). Neurocognition in patients with brain metastases treated with radiosurgery or radiosurgery plus whole-brain irradiation: a randomised controlled trial. The Lancet Oncology, 10(11), 1037–1044.
Chapman, C. H., Nagesh, V., Sundgren, P. C., Buchtel, H., Chenevert, T. L., Junck, L., …Cao, Y. (2012). Diffusion Tensor Imaging of Normal-Appearing White Matter as Biomarker for Radiation-Induced Late Delayed Cognitive Decline. International Journal of Radiation Oncology*Biology*Physics, 82(5), 2033–2040.
Cheng, H., Chen, H., Lv, Y., Chen, Z., &Li, C.-S. R. (2018). Prospective memory impairment following whole brain radiotherapy in patients with metastatic brain cancer. Cancer Medicine, 7(10), 5315–5321.
Cohen, J. (1992). A power primer. Psychological Bulletin, 112(1), 155–159.
Corn, B. W., Moughan, J., Knisely, J. P. S., Fox, S. W., Chakravarti, A., Yung, W. K. A., …Movsas, B. (2008). Prospective Evaluation of Quality of Life and Neurocognitive Effects in Patients With Multiple Brain Metastases Receiving Whole-Brain Radiotherapy With or Without Thalidomide on Radiation Therapy Oncology Group (RTOG) Trial 0118. International Journal of Radiation Oncology*Biology*Physics, 71(1), 71–78.
Correa, D. D. (2010). Neurocognitive Function in Brain Tumors. Current Neurology and Neuroscience Reports, 10(3), 232–239.
Delattre, J. Y., Krol, G., Thaler, H. T., &Posner, J. B. (1988). Distribution of Brain Metastases. Archives of Neurology, 45(7), 741–744.
Drachman, D. A., &Arbit, J. (1966). Memory and the Hippocampal Complex. Archives of Neurology, 15(1), 52.
Eichenbaum, H. (2009). The Cognitive Neuroscience of Memory: An Introduction. The Cognitive Neuroscience of Memory: An Introduction. Oxford University Press.
Eichenbaum, H., &Lipton, P. A. (2008). Towards a functional organization of the medial temporal lobe memory system: Role of the parahippocampal and medial entorhinal cortical areas. Hippocampus, 18(12), 1314–1324.
Folstein, M. F., Folstein, S. E., &McHugh, P. R. (1975). “Mini-mental state”: A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12(3), 189–198.
Glantz, M. J., &Batten, J. (2008). Seizures and Anti-Epileptic Drugs in Neuro-Oncology. In Cancer Neurology In Clinical Practice (pp. 33–46). Totowa, NJ: Humana Press.
Gondi, V., Pugh, S. L., Tome, W. A., Caine, C., Corn, B., Kanner, A., …Mehta, M. P. (2014). Preservation of memory with conformal avoidance of the hippocampal neural stem-cell compartment during whole-brain radiotherapy for brain metastases (RTOG 0933): a phase II multi-institutional trial. Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology, 32(34), 3810–3816.
Gondi, V., Tomé, W. A., &Mehta, M. P. (2010). Why avoid the hippocampus? A comprehensive review. Radiotherapy and Oncology, 97(3), 370–376.
Grattan-Smith, P. J., Morris, J. G. L., Shores, E. A., Batchelor, J., &Sparks, R. S. (1992). Neuropsychological abnormalities in patients with pituitary tumours. Acta Neurologica Scandinavica, 86(6), 626–631.
Greene-Schloesser, D., Robbins, M. E., Peiffer, A. M., Shaw, E. G., Wheeler, K. T., &Chan, M. D. (2012). Radiation-induced brain injury: A review. Frontiers in Oncology, 2, 73.
Groen, H. J. M., Dingemans, A.-M. C., Belderbos, J., Tissing-Tan, C., Herder, G., Haitjema, T., …DeRuysscher, D. (2017). Prophylactic cranial irradiation (PCI) versus observation in radically treated stage III non-small cell lung cancer (NSCLC): A randomized phase III NVALT11 study. Journal of Clinical Oncology, 35(15_suppl), 8502–8502.
Holdstock, J. S., Gutnikov, S. A., Gaffan, D., &Mayes, A. R. (2000). Perceptual and Mnemonic Matching-To-Sample in Humans: Contributions of The Hippocampus, Perirhinal and Other Medial Temporal Lobe Cortices. Cortex, 36(3), 301–322.
Holzer, C. E., Tischler, G. L., Leaf, P. J., &Myers, J. K. (1984). No TitleAn epidemiologic assessment of cognitive impairment in a community population. Research in Community & Mental Health, 4, 3–32.
Jeneson, A., Mauldin, K. N., Hopkins, R. O., &Squire, L. R. (2011). The role of the hippocampus in retaining relational information across short delays: the importance of memory load. Learning & Memory (Cold Spring Harbor, N.Y.), 18(5), 301–305.
Jeneson, A., &Squire, L. R. (2012). Working memory, long-term memory, and medial temporal lobe function. Learning & Memory (Cold Spring Harbor, N.Y.), 19(1), 15–25.
Just, M. A., &Carpenter, P. A. (1992). A capacity theory of comprehension: individual differences in working memory. Psychological Review, 99(1).
Kaufman, A. S., &Lichtenberger, E. O. (1999). Essentials of WAIS-III assessment. John Wiley & Sons Inc.
Knight, J. A., &Kaplan, E. (2003). The handbook of Rey–Osterrieth complex figure usage: Clinical and research applications. Lutz, FL: Psychological Assessment Resources.
Kocher, M., Soffietti, R., Abacioglu, U., Villà, S., Fauchon, F., Baumert, B. G., …Mueller, R.-P. (2011). Adjuvant whole-brain radiotherapy versus observation after radiosurgery or surgical resection of one to three cerebral metastases: results of the EORTC 22952-26001 study. Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology, 29(2), 134–141.
Kondziolka, D., Niranjan, A., Flickinger, J. C., &Lunsford, L. D. (2005). Radiosurgery with or without whole-brain radiotherapy for brain metastases: The patients’ perspective regarding complications. American Journal of Clinical Oncology: Cancer Clinical Trials, 28(2), 173–179.
Lee, P. W., Hung, B. K., Woo, E. K., Tai, P. T., &Choi, D. T. (1989). Effects of radiation therapy on neuropsychological functioning in patients with nasopharyngeal carcinoma. Journal of Neurology, Neurosurgery, and Psychiatry, 52(4), 488–492.
Li, J., Bentzen, S. M., Li, J., Renschler, M., &Mehta, M. P. (2008). Relationship Between Neurocognitive Function and Quality of Life After Whole-Brain Radiotherapy in Patients With Brain Metastasis. International Journal of Radiation Oncology*Biology*Physics, 71(1), 64–70.
Li, J., Bentzen, S. M., Renschler, M., &Mehta, M. P. (2007). Regression after whole brain radiation for brain metastases correlates with survival and improved cognitive function Regression After Whole-Brain Radiation Therapy for Brain Metastases Correlates With Survival and Improved Neurocognitive Function. Article in Journal of Clinical Oncology, 25, 1260–1266.
Loganadane, G., Hendriks, L., LePéchoux, C., &Levy, A. (2017). The Current Role of Whole Brain Radiation Therapy in Non–Small Cell Lung Cancer Patients. Journal of Thoracic Oncology, 12(10), 1467–1477.
Malloy, P. F., Cummings, J. L., Coffey, C. E., Duffy, J., Fink, M., Lauterbach, E. C., …Salloway, S. (1997). Cognitive screening instruments in neuropsychiatry: a report of the Committee on Research of the American Neuropsychiatric Association. The Journal of Neuropsychiatry and Clinical Neurosciences, 9(2), 189–197.
McDuff, S. G. R., Taich, Z. J., Lawson, J. D., Sanghvi, P., Wong, E. T., Barker, F. G., …Chen, C. C. (2013). Neurocognitive assessment following whole brain radiation therapy and radiosurgery for patients with cerebral metastases. Journal of Neurology, Neurosurgery & Psychiatry, 84(12), 1384–1391.
McFaline-Figueroa, J. R., &Lee, E. Q. (2018). Brain Tumors. The American Journal of Medicine, 131(8), 874–882. https://doi.org/10.1016/J.AMJMED.2017.12.039
McTyre, E., Scott, J., &Chinnaiyan, P. (2013). Whole brain radiotherapy for brain metastasis. Surgical Neurology International, 4(Suppl 4), S236-44.
Mehta, M. P., Rodrigus, P., Terhaard, C. H. J., Rao, A., Suh, J., Roa, W., …Renschler, M. F. (2003). Survival and neurologic outcomes in a randomized trial of motexafin gadolinium and whole-brain radiation therapy in brain metastases. Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology, 21(13), 2529–2536.
Meyers, C. A., &Brown, P. D. (2006). Role and relevance of neurocognitive assessment in clinical trials of patients with CNS tumors. Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology, 24(8), 1305–1309.
Meyers, C. A., Geara, F., Wong, P.-F., &Morrison, W. H. (2000). Neurocognitive effects of therapeutic irradiation for base of skull tumors. International Journal of Radiation Oncology*Biology*Physics, 46(1), 51–55.
Meyers, C. A., Rock, E. P., &Fine, H. A. (2012). Refining endpoints in brain tumor clinical trials. Journal of Neuro-Oncology, 108(2), 227–230.
Meyers, C. A., Smith, J. A., Bezjak, A., Mehta, M. P., Liebmann, J., Illidge, T., …Renschler, M. F. (2004). Neurocognitive function and progression in patients with brain metastases treated with whole-brain radiation and motexafin gadolinium: results of a randomized phase III trial. Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology, 22(1), 157–165.
Mulvenna, P., Nankivell, M., Barton, R., Faivre-Finn, C., Wilson, P., Mccoll, E., …Langley, R. E. (2016). Dexamethasone and supportive care with or without whole brain radiotherapy in treating patients with non-small cell lung cancer with brain metastases unsuitable for resection or stereotactic radiotherapy (QUARTZ): results from a phase 3, non-inferiority,. The Lancet, 388, 2004–2014.
Murray, K. J., Scott, C., Zachariah, B., Michalski, J. M., Demas, W., Vora, N. L., …Movsas, B. (2000). Importance of the mini-mental status examination in the treatment of patients with brain metastases: a report from the radiation therapy oncology group protocol 91-04. International Journal of Radiation Oncology*Biology*Physics, 48(1), 59–64.
Nasreddine, Z. S., Phillips, N. A., Bédirian, V., Charbonneau, S., Whitehead, V., Collin, I., …Chertkow, H. (2005). The Montreal Cognitive Assessment, MoCA: A Brief Screening Tool For Mild Cognitive Impairment. Journal of the American Geriatrics Society, 53(4), 695–699.
Nayak, L., Lee, E. Q., &Wen, P. Y. (2012). Epidemiology of Brain Metastases. Current Oncology Reports, 14(1), 48–54. https://doi.org/10.1007/s11912-011-0203-y
Nussbaum, E. S., Djalilian, H. R., Cho, K. H., &Hall, W. A. (1996). Brain metastases: Histology, multiplicity, surgery, and survival. Cancer, 78(8), 1781–1788.
Olson, I. R., Moore, K. S., Stark, M., &Chatterjee, A. (2006). Visual Working Memory Is Impaired when the Medial Temporal Lobe Is Damaged. Journal of Cognitive Neuroscience, 18(7), 1087–1097.
Olson, R. A., Iverson, G., Parkinson, M., Carolan, H., &M, A. E. (2009). Investigation of cognitive screening measures in patients with brain tumors: Diagnostic accuracy and correlation with quality of life. Ournal of Clinical Oncology, 27(15_suppl), e13000.
Olson, R., Tyldesley, S., Carolan, H., Parkinson, M., Chhanabhai, T., &McKenzie, M. (2011). Prospective comparison of the prognostic utility of the Mini Mental State Examination and the Montreal Cognitive Assessment in patients with brain metastases. Supportive Care in Cancer, 19(11), 1849–1855.
Olson, Robert Anton, Chhanabhai, T., &McKenzie, M. (2008). Feasibility study of the Montreal Cognitive Assessment (MoCA) in patients with brain metastases. Supportive Care in Cancer, 16(11), 1273–1278.
Onodera, S., Aoyama, H., Tha, K. K., Hashimoto, N., Toyomaki, A., Terae, S., &Shirato, H. (2014). The value of 4-month neurocognitive function as an endpoint in brain metastases trials. Journal of Neuro-Oncology, 120(2), 311–319.
Patchell, R. A., Tibbs, P. A., Regine, W. F., Dempsey, R. J., Mohiuddin, M., Kryscio, R. J., …Young, B. (1998). Postoperative Radiotherapy in the Treatment of Single Metastases to the Brain. JAMA, 280(17), 1485–1489.
Raber, J., Rola, R., LeFevour, A., Morhardt, D., Curley, J., Mizumatsu, S., …Fike, J. R. (2004). Radiation-Induced Cognitive Impairments are Associated with Changes in Indicators of Hippocampal Neurogenesis. Radiation Research, 162(1), 39–47.
Rapp, S. R., Case, L. D., Peiffer, A., Naughton, M. M., Chan, M. D., Stieber, V. W., …Shaw, E. G. (2015). Donepezil for Irradiated Brain Tumor Survivors: A Phase III Randomized Placebo-Controlled Clinical Trial. Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology, 33(15), 1653–1659.
Rostami, R., Mittal, S., Rostami, P., Tavassoli, F., &Jabbari, B. (2016). Brain metastasis in breast cancer: a comprehensive literature review. Journal of Neuro-Oncology, 127(3), 407–414.
Squire, L. R., &Wixted, J. T. (2011). The Cognitive Neuroscience of Human Memory Since H.M. Annual Review of Neuroscience, 34(1), 259–288.
Strauss, E., Sherman, E. M., &Spreen, O. (2006). A compendium of neuropsychological tests: Administration, norms, and commentary. American Chemical Society.
Suh, J. H., Stea, B., Nabid, A., Kresl, J. J., Fortin, A., Mercier, J.-P., …Shaw, E. (2006). Phase III study of efaproxiral as an adjunct to whole-brain radiation therapy for brain metastases. Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology, 24(1), 106–114.
Sun, A., Bae, K., Gore, E. M., Movsas, B., Wong, S. J., Meyers, C. A., …Choy, H. (2011). Phase III trial of prophylactic cranial irradiation compared with observation in patients with locally advanced non-small-cell lung cancer: neurocognitive and quality-of-life analysis. Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology, 29(3), 279–286.
Taillibert, S., &Delattre, J.-Y. (2005). Palliative care in patients with brain metastases. Current Opinion in Oncology, 17(6), 588–592.
Tallet, A.V, Azria, D., Barlesi, F., Spano, J.-P., Carpentier, A. F., Gonçalves, A., &Metellus, P. (2012). Neurocognitive function impairment after whole brain radiotherapy for brain metastases: actual assessment. Radiation Oncology, 7(1), 77.
Tofilon, P. J., &Fike, J. R. (2000). The Radioresponse of the Central Nervous System: A Dynamic Process. Https://Doi.Org/10.1667/0033-7587(2000)153[0357:TROTCN]2.0.CO;2, 153(4), 357–370.
Tombaugh, T. N., &McIntyre, N. J. (1992). The Mini-Mental State Examination: A Comprehensive Review. Journal of the American Geriatrics Society, 40(9), 922–935.
Tsao, M. N., Rades, D., Wirth, A., Lo, S. S., Danielson, B. L., Gaspar, L. E., …Chang, E. L. (2012). Radiotherapeutic and surgical management for newly diagnosed brain metastasis(es): An American Society for Radiation Oncology evidence-based guideline. Practical Radiation Oncology, 2(3), 210–225.
Tsao, M., Xu, W., &Sahgal, A. (2012). A meta-analysis evaluating stereotactic radiosurgery, whole-brain radiotherapy, or both for patients presenting with a limited number of brain metastases. Cancer, 118(9), 2486–2493.
Welzel, G., Fleckenstein, K., Schaefer, J., Hermann, B., Kraus-Tiefenbacher, U., Mai, S. K., &Wenz, F. (2008). Memory Function Before and After Whole Brain Radiotherapy in Patients With and Without Brain Metastases. International Journal of Radiation Oncology*Biology*Physics, 72(5), 1311–1318.
Wu, X., Gu, M., Zhou, G., Xu, X., Wu, M., &Huang, H. (2014). Cognitive and neuropsychiatric impairment in cerebral radionecrosis patients after radiotherapy of nasopharyngeal carcinoma. BMC Neurology, 14(1), 10.
Zhou, M., Zou, L., Chen, Q. Q., Tian, Y., &Lian, Y. X. (2016). The Assessment of Cognitive Function in Lung Cancer Patients With Brain Metastases Before and After Whole-Brain Radiation Therapy. International Journal of Radiation Oncology*Biology*Physics, 96(2), E68–E69.