Although it has been used widely, a weak point of the MMSE is that it is designed to evaluate global cognitive function rather than learning and memory. It also has a ceiling effect . Sun et al. published the results of their secondary analysis of the RTOG 0214 trial evaluating the effect of prophylactic WBRT for advanced NSCLC : the rate of decline in individual TR scores of the HVLT was significantly higher in the prophylactic WBRT arm at 3, 6, and 12 months, whereas the rate of decline in individual MMSE scores was higher in the intervention arm only at three months. The ability of the HVLT-R to detect subtle changes in learning and memory supports its routine use in trials evaluating cranial radiation therapy for BM.