gms | German Medical Science

71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

21.06. - 24.06.2020

The find-the-symbol test – a normative study comparing five parallel versions of a modified Bells neglect test designed for clinical monitoring of brain tumour patients

Der Finde-das-Symbol-Test – Normierung eines Neglekttests mit fünf Parallelversionen, entwickelt für die klinische Verlaufsbeobachtung von Hirntumorpatienten

Meeting Abstract

  • presenting/speaker Catharina Schröter - Universitätsklinikum Köln, Allgemeine Neurochirurgie, Köln, Deutschland
  • Anna Wagner - Universitätsklinikum Köln, Allgemeine Neurochirurgie, Köln, Deutschland
  • Sophia Kochs - Universitätsklinikum Köln, Allgemeine Neurochirurgie, Köln, Deutschland
  • Roland H. Goldbrunner - Universitätsklinikum Köln, Allgemeine Neurochirurgie, Köln, Deutschland
  • NOA-19 Studiengruppe - Universitätsklinikum Münster, Neurochirurgie, Münster, Deutschland; Universitätsklinikum Heidelberg, Neurochirurgie, Heidelberg, Deutschland; Universitätsklinikum Würzburg, Neurochirurgie, Würzburg, Deutschland; Universitätsklinikum Mainz, Neurochirurgie, Mainz, Deutschland; Universitätsklinikum Carl Gustav Carus Dresden, Neurochirurgie, Dresden, Deutschland; Klinikum Chemnitz gGmbH, Neurochirurgie, Chemnitz, Deutschland; Universitätsklinikum Schleswig-Holstein, Neurochirurgie, Schleswig-Holstein, Deutschland; Helios Kliniken, Neurochirurgie, Schwerin, Deutschland; Universitätsklinikum Regensburg, Neurochirurgie, Regensburg, Deutschland; Universitätsklinikum Freiburg, Neurochirurgie, Freiburg, Deutschland; Donau Isar Klinikum, Neurochirurgie, Deggendorf, Deutschland
  • Carolin Weiß Lucas - Universitätsklinikum Köln, Allgemeine Neurochirurgie, Köln, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. sine loco [digital], 21.-24.06.2020. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocP198

doi: 10.3205/20dgnc483, urn:nbn:de:0183-20dgnc4834

Published: June 26, 2020

© 2020 Schröter et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at



Objective: The assessment of neurocognitive functions in brain tumour patients suffers from the limited availability of sensitive and validated intruments to detect even slight or moderate impairments. The Bells cancellation test is most widely used for assessing neglect in brain tumour patients but does not offer the option of parallel testings and is rather demanding for the in general cognitively and emotionally affected brain tumour patients. Therefore, a simplified version of the Bells cancellation test titled "Find the symbol!" test (FST) was designed and evaluated in five parallel versions.

Methods: 192 healthy volunteers (96 male, 96 high general education level, median age 54 yrs [18-89 yrs]) were tested with the five parallel versions of the FST and additional standard tests (i.e., Bells cancellation test, Apples test, line bisection test) in pseudo-randomized sequence. Motivation and distress level were assessed prior to testing. test results, duration and subjective difficulty level were assessed for each test. The influence of subjective factors on outcome was assessed using ANOVA., parallel-test reliability between FST versions and the validity of the FST compared to standard tests were analysed.

Results: The FTS test result i.e. the percentage of expected cancellations decreased with high age (F[1,153]=28.4, p<0.001) and was higher in females (F[1,153]=7.5, p<0.01)., test duration depended on age (F[1,153]=111.2, p<0.001) and educational level (F[1,153]=14.1 p<0.001). The subjective difficulty level was slightly influenced by the patients motivation alone (F[1,153]=4.7, p<0.05). The FTS results were well comparable across the five FTS parallel versions (95.5 ± 2.5 % of expected cancellations). Compared to the standard Bells tests, the FTS was had a shorter administration time (70 ± 30 vs. 102 ± 43 s, p< 0.001) and was better accepted as reflected by a subjective difficulty rating of 2.4/10 versus 3.4/10 (p<0.001).

Conclusion: The FTS provides a brief and well-tolerated alternative to the commonly used Bells cancellation test for neglect assessment, offering five parallel versions suited for longitudinal studies.