Überwachung der Kognition in der neurologischen Rehabilitation: Durchführbarkeit und Validität eines neuen Screening Tests (BLTT ®) in einer größeren Gruppe von Patienten mit Hirnschädigung

Objective: To evaluate the feasibility and validity of the Brain Lesion Tracking Test (BLTT), a neuropsychological screening tool for the assessment and outcome control of older patients with acquired brain lesions undergoing neurological rehabilitation.

Methods: A consecutive cohort of 376 patients was screened with the BLTT at the beginning and after 4-17 weeks of rehabilitation. The test is standardized for repeated assessment and addresses episodic, semantic memory and executive functions bypassing visual or hand functions. The BLTT was complemented by a figural recognition test, the Extended Barthel Index (EBI) and the Singer scale, an ICF (International Classification of Functioning, Disability, and Health) oriented rating tool.

Results: Application of the BLTT was possible in majority of the patients (82%). Mild aphasia, hemineglect, hemiplegia, psychomotor slowing or visual impairments including hemianopsia did not exclude testing. With 30 minutes, testing took longer than in controls. 88% showed baseline an impaired total scale, 38% to 71% subscale deficits. Singer and EBI indicated 96% and 48% impaired. Cognitive improvement was evident in 31-37%, EBI and Singer improved in 27% and 49%. Cognitive worsening was seen in 11-17% (mostly memory), in the EBI and Singer in 2% and 0%. BLTT, figural memory, EBI and Singer correlated at baseline at best with r = 0.39, whereas pre- to post changes did not correlate. Different outcomes dependent on lesion type and side, presence of epilepsy, a previous hit, gender, education and duration of rehabilitation proved the clinical validity of the assessments.

Conclusion: The BLTT, a time-efficient screening tool appears suitable and valid in patients with acquired brain injury of various etiologies. In light of these findings, the test is highly appropriate for repetitive neurocognitive monitoring of neurosurgical patients in both perioperative and postoperative settings. Its application is currently underway.