Prospective comparison of the prognostic utility of the Mini Mental State Examination and the Montreal Cognitive Assessment in patients with brain metastases

Olson, Robert; Tyldesley, Scott; Carolan, Hannah; Parkinson, Maureen; Chhanabhai, Taruna; McKenzie, Michael

doi:10.1007/s00520-010-1028-1

Cited by 52 publications

(32 citation statements)

References 38 publications

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“…In the last decade, the Montreal Cognitive Assessment (MoCA) (11) screening tool has been increasingly favored over the MMSE as it has been shown to have greater sensitivity for detecting cognitive dysfunction. This has been shown in patients with brain tumors (12) and brain metastases (13), as well as in other neurological conditions including stroke (14), sub-arachnoid hemorrhages (SAHs) (15), and silent cerebral infarcts (16). Bernstein et al investigated the psychometric properties of the MoCA in three diverse brain pathologies and concluded that it was reliable in detecting cognitive dysfunction as well as having the benefit of not fatiguing the patient (17).…”

Section: Introductionmentioning

confidence: 92%

Cognitive Screening in Brain Tumors: Short but Sensitive Enough?

2015

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Cognitive deficits in brain tumors are generally thought to be relatively mild and non-specific, although recent evidence challenges this notion. One possibility is that cognitive screening tools are being used to assess cognitive functions but their sensitivity to detect cognitive impairment may be limited. For improved sensitivity to recognize mild and/or focal cognitive deficits in brain tumors, neuropsychological evaluation tailored to detect specific impairments has been thought crucial. This study investigates the sensitivity of a cognitive screening tool, the Montreal Cognitive Assessment (MoCA), compared to a brief but tailored cognitive assessment (CA) for identifying cognitive deficits in an unselected primary brain tumor sample (i.e., low/high-grade gliomas, meningiomas). Performance is compared on broad measures of impairment: (a) number of patients impaired on the global screening measure or in any cognitive domain; and (b) number of cognitive domains impaired and specific analyses of MoCA-Intact and MoCA-Impaired patients on specific cognitive tests. The MoCA-Impaired group obtained lower naming and word fluency scores than the MoCA-Intact group, but otherwise performed comparably on cognitive tests. Overall, based on our results from patients with brain tumor, the MoCA has extremely poor sensitivity for detecting cognitive impairments and a brief but tailored CA is necessary. These findings will be discussed in relation to broader issues for clinical management and planning, as well as specific considerations for neuropsychological assessment of brain tumor patients.

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Section: Introductionmentioning

confidence: 92%

Cognitive Screening in Brain Tumors: Short but Sensitive Enough?

2015

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“…In fact, cognitive impairment in these patients is more common than physical disability, in contrast to other focal neurological disorders such as cerebral vascular accidents [7]. Detection of cognitive impairment in this population is clinically important because it is an independent predictor of survival and disease recurrence [1,2,[8][9][10][11]. In addition, cognitive function may be correlated with quality of life (QoL), and individuals who are cognitively impaired may improve their QoL through rehabilitation.…”

Section: Introductionmentioning

confidence: 98%

Prospective comparison of two cognitive screening tests: diagnostic accuracy and correlation with community integration and quality of life

et al. 2011

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Cognitive screening tests are frequently used in brain tumor clinics. The Mini Mental State Examination (MMSE) is the most commonly used, and the Montreal Cognitive Assessment (MoCA) is an alternative. This study compares the diagnostic accuracy of both screening tests. Fifty-eight patients with brain tumors were prospectively accrued and administered the MMSE and MoCA, 67% of who completed a comprehensive neuropsychological evaluation as a gold standard comparison. Quality of life and community integration were measured with the Functional Assessment of Cancer Therapy-Brain (FACT-Br) and Community Integration Questionnaire (CIQ), respectively. At the pre-defined cut-off scores, the MoCA had superior sensitivity (61.9% vs. 19.0%, P < 0.005) and the MMSE had superior specificity (94.4% vs. 55.6%, P < 0.017). The areas under the ROC curve for the MMSE (0.615, standard error = 0.091) and MoCA (0.606, standard error = 0.092) were poor, indicating that at no single cut-off score is either test both sensitive and specific. Neither the MMSE (ρ = 0.12; P < 0.444) nor MoCA (ρ = 0.24; P < 0.108) were significantly correlated with the FACT-Br. The MoCA was modestly correlated with the CIQ (ρ = 0.35; P < 0.017), but the MMSE was not (ρ = 0.14; P < 0.359). The MMSE has extremely poor sensitivity. Using this test in clinical practice, research, and clinical trials will result in failing to detect cognitive impairment in a substantial percentage of patients. The MoCA has superior sensitivity, and is better correlated with self reported measures of community integration, and therefore should be preferentially chosen in practice and clinical trials.

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“…Traditionally, prognostication for patients with HGGs has been based on factors such as age, performance status, cognitive function, tumor grade, and extent of resection [1,2].…”

Section: Introductionmentioning

confidence: 99%

Prognostic and predictive value of epigenetic silencing of MGMT in patients with high grade gliomas: a systematic review and meta-analysis

2011

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Epigenetic silencing of the O(6)-methylguanine-DNA methyltransferase (MGMT) gene is associated with improved survival in patients with high-grade gliomas (HGG), with varying estimates of magnitude. The objective of this meta-analysis is to determine the prognostic value of MGMT silencing, and assess its predictive value by treatment type. MEDLINE and EMBASE databases were searched for studies relating to gliomas and MGMT. Studies reporting overall survival (OS) by MGMT status in patients with HGG were considered potentially eligible. We excluded studies that did not control for potential confounding variables. A meta-analysis of studies was performed via random-effects modelling. Subgroup meta-analyses by treatment were performed according to a priori hypotheses. Twenty studies were ultimately eligible, including 2,018 patients. In the pooled analysis, MGMT silencing was associated with improved OS (HR = 0.436; 95% CI: 0.333-0.571; P < 0.001). The prognostic utility of MGMT status varies significantly by treatment type (P = 0.001): the HR for OS for MGMT silenced tumors is 0.190 (0.047-0.770), 0.403 (0.282-0.576), 0.743 (0.579-0.954), and 1.070 (0.722-1.585) for studies using surgery plus the addition of either: chemotherapy (CT), chemoradiotherapy (CRT), radiotherapy (RT), and nothing (surgery alone), respectively. Epigenetic silencing of MGMT is associated with markedly improved survival in patients with HGG who receive adjuvant therapy. MGMT silencing serves as a predictive marker, with the largest benefit seen in patients receiving CT as a component of adjuvant treatment, an intermediate benefit in patients receiving adjuvant RT, and no evidence to support benefit in those receiving surgery alone.

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Prospective comparison of the prognostic utility of the Mini Mental State Examination and the Montreal Cognitive Assessment in patients with brain metastases

Abstract: Our results indicate that the MoCA is a superior prognostic indicator than the MMSE. Furthermore, given its superior sensitivity and better correlation with quality of life, the MoCA should be preferentially chosen in clinical practice and trials.

Cited by 52 publications

References 38 publications

Cognitive Screening in Brain Tumors: Short but Sensitive Enough?

Cognitive Screening in Brain Tumors: Short but Sensitive Enough?

Prospective comparison of two cognitive screening tests: diagnostic accuracy and correlation with community integration and quality of life

Prognostic and predictive value of epigenetic silencing of MGMT in patients with high grade gliomas: a systematic review and meta-analysis

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