Skip to main content
SpringerLink
Log in

Sensitivity of the Montreal Cognitive Assessment in screening for cognitive impairment in patients with newly diagnosed high-grade glioma

  • Clinical Study
  • Published:
Journal of Neuro-Oncology Aims and scope Submit manuscript

Abstract

Introduction

Cognitive impairment is frequent in patients with high-grade glioma and requires cognitive follow-up. Cognitive screening tools such as the Montreal Cognitive Assessment (MoCA) have been used to assess cognition in these patients. Here we assessed the sensitivity of the MoCA in screening for cognitive impairment in a cohort of 156 patients with newly-diagnosed high-grade glioma, after surgery and before radiochemotherapy.

Methods

We assessed cognitive performance with the MoCA and a neuropsychological battery. Cognitive scores were analyzed in terms of a previously validated framework designed to control false positives and data for 1003 control participants from the GRECOGVASC study. After comparison of performance on the tests, we used stepwise logistic regression to produce a cognitive summary score from the neuropsychological battery. Then we analyzed sensitivity and specificity of the MoCA with receiver operator characteristic (ROC) curve analysis.

Results

Both raw and adjusted MoCA scores showed only moderate sensitivity. The area under the ROC curve was 0.759 (95% CI 0.703–0.815) for the raw score and 0.788 (95% CI 0.734–0.842) for the adjusted score. Optimal discrimination was obtained with a raw score ≤ 25 (sensitivity: 0.526; specificity: 0.832; positive predictive value: 0.2; negative predictive value: 0.96) and an adjusted score − 0.603 (sensitivity: 0.716; specificity: 0.768; positive predictive value: 0.24; negative predictive value: 0.96).

Conclusion

The moderate sensitivity of MoCA indicates that it is not a suitable screening tool for detecting cognitive impairment in patients with newly-diagnosed high-grade glioma.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Bosma I, Vos MJ, Heimans JJ, Taphoorn MJB, Aaronson NK, Postma TJ et al (2007) The course of neurocognitive functioning in high-grade glioma patients1. Neuro-Oncol 9:53–62. https://doi.org/10.1215/15228517-2006-012

    Article  PubMed  PubMed Central  Google Scholar 

  2. Correa DD (2010) Neurocognitive function in brain tumors. Curr Neurol Neurosci Rep 10:232–239. https://doi.org/10.1007/s11910-010-0108-4

    Article  PubMed  Google Scholar 

  3. Gately L, McLachlan S, Dowling A, Philip J (2017) Life beyond a diagnosis of glioblastoma: a systematic review of the literature. J Cancer Surviv 11:447–452. https://doi.org/10.1007/s11764-017-0602-7

    Article  CAS  PubMed  Google Scholar 

  4. Hilverda K, Bosma I, Heimans JJ, Postma TJ, Peter Vandertop W, Slotman BJ et al (2010) Cognitive functioning in glioblastoma patients during radiotherapy and temozolomide treatment: initial findings. J Neurooncol 97:89–94. https://doi.org/10.1007/s11060-009-9993-2

    Article  CAS  PubMed  Google Scholar 

  5. van Kessel E, Baumfalk AE, van Zandvoort MJE, Robe PA, Snijders TJ (2017) Tumor-related neurocognitive dysfunction in patients with diffuse glioma: a systematic review of neurocognitive functioning prior to anti-tumor treatment. J Neurooncol 134:9–18. https://doi.org/10.1007/s11060-017-2503-z

    Article  PubMed  PubMed Central  Google Scholar 

  6. Veretennikoff K, Walker D, Biggs V, Robinson G (2017) Changes in cognition and decision making capacity following brain tumour resection: illustrated with two cases. Brain Sci 7:122. https://doi.org/10.3390/brainsci7100122

    Article  PubMed Central  Google Scholar 

  7. Johnson DR, Wefel JS (2013) Relationship between cognitive function and prognosis in glioblastoma. CNS Oncol 2:195–201. https://doi.org/10.2217/cns.13.5

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Meyers CA, Hess KR (2003) Multifaceted end points in brain tumor clinical trials: cognitive deterioration precedes MRI progression. Neuro-Oncol 5:89–95. https://doi.org/10.1093/neuonc/5.2.89

    Article  PubMed  PubMed Central  Google Scholar 

  9. Weller M (2011) Neurocognitive function: an emerging surrogate endpoint for neuro-oncology trials. Neuro-Oncol 13:565–565. https://doi.org/10.1093/neuonc/nor065

    Article  PubMed  PubMed Central  Google Scholar 

  10. Meyers CA, Rock EP, Fine HA (2012) Refining endpoints in brain tumor clinical trials. J Neurooncol 108:227–230. https://doi.org/10.1007/s11060-012-0813-8

    Article  PubMed  Google Scholar 

  11. Giovagnoli AR (2012) Investigation of cognitive impairments in people with brain tumors. J Neurooncol 108:277–283. https://doi.org/10.1007/s11060-012-0815-6

    Article  PubMed  Google Scholar 

  12. Dehcordi SR, Mariano M, Mazza M, Galzio RJ (2013) Cognitive deficits in patients with low and high grade gliomas. J Neurosurg Sci 57:8

    Google Scholar 

  13. Miotto EC, Silva Junior A, Silva CC, Cabrera HN, Machado MAR, Benute GRG et al (2011) Cognitive impairments in patients with low grade gliomas and high grade gliomas. Arq Neuropsiquiatr 69:596–601. https://doi.org/10.1590/S0004-282X2011000500005

    Article  PubMed  Google Scholar 

  14. Bompaire F, Lahutte M, Buffat S, Soussain C, Ardisson AE, Terziev R et al (2018) New insights in radiation-induced leukoencephalopathy: a prospective cross-sectional study. Support Care Cancer 26:4217–4226. https://doi.org/10.1007/s00520-018-4296-9

    Article  PubMed  Google Scholar 

  15. Froklage FE, Oosterbaan LJ, Sizoo EM, de Groot M, Bosma I, Sanchez E et al (2014) Central neurotoxicity of standard treatment in patients with newly-diagnosed high-grade glioma: a prospective longitudinal study. J Neurooncol 116:387–394. https://doi.org/10.1007/s11060-013-1310-4

    Article  CAS  PubMed  Google Scholar 

  16. Jacob J, Durand T, Feuvret L, Mazeron J-J, Delattre J-Y, Hoang-Xuan K et al (2018) Cognitive impairment and morphological changes after radiation therapy in brain tumors: a review. Radiother Oncol 128:221–228. https://doi.org/10.1016/j.radonc.2018.05.027

    Article  PubMed  Google Scholar 

  17. Soussain C, Ricard D, Fike JR, Mazeron J-J, Psimaras D, Delattre J-Y (2009) CNS complications of radiotherapy and chemotherapy. Lancet 374:1639–1651

    Article  CAS  Google Scholar 

  18. Flechl B, Sax C, Ackerl M, Crevenna R, Woehrer A, Hainfellner J et al (2017) The course of quality of life and neurocognition in newly diagnosed patients with glioblastoma. Radiother Oncol 125:228–233. https://doi.org/10.1016/j.radonc.2017.07.027

    Article  CAS  PubMed  Google Scholar 

  19. Stupp R, Weller M, Belanger K, Bogdahn U, Ludwin SK, Lacombe D et al (2005) Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med 352:987

    Article  CAS  Google Scholar 

  20. Durand T, Bernier M-O, Léger I, Taillia H, Noël G, Psimaras D et al (2015) Cognitive outcome after radiotherapy in brain tumor. Curr Opin Oncol 27:510–515. https://doi.org/10.1097/CCO.0000000000000227

    Article  CAS  PubMed  Google Scholar 

  21. Ricard D, Soussain C, Psimaras D (2011) Neurotoxicity of the CNS: diagnosis, treatment and prevention. Rev Neurol (Paris) 167:737–745. https://doi.org/10.1016/j.neurol.2011.08.005

    Article  CAS  Google Scholar 

  22. Taphoorn MJ, Klein M (2004) Cognitive deficits in adult patients with brain tumours. Lancet Neurol 3:159–168. https://doi.org/10.1016/S1474-4422(04)00680-5

    Article  PubMed  Google Scholar 

  23. Ali FS, Hussain MR, Gutiérrez C, Demireva P, Ballester LY, Zhu J-J et al (2018) Cognitive disability in adult patients with brain tumors. Cancer Treat Rev 65:33–40. https://doi.org/10.1016/j.ctrv.2018.02.007

    Article  PubMed  Google Scholar 

  24. Schagen SB, Klein M, Reijneveld JC, Brain E, Deprez S, Joly F et al (2014) Monitoring and optimising cognitive function in cancer patients: present knowledge and future directions. Eur J Cancer Suppl 12:29–40. https://doi.org/10.1016/j.ejcsup.2014.03.003

    Article  CAS  Google Scholar 

  25. Day J, Gillespie DC, Rooney AG, Bulbeck HJ, Zienius K, Boele F et al (2016) Neurocognitive deficits and neurocognitive rehabilitation in adult brain tumors. Curr Treat Options Neurol. https://doi.org/10.1007/s11940-016-0406-5

    Article  PubMed  Google Scholar 

  26. Olson RA, Iverson GL, Carolan H, Parkinson M, Brooks BL, McKenzie M (2011) Prospective comparison of two cognitive screening tests: diagnostic accuracy and correlation with community integration and quality of life. J Neurooncol 105:337–344. https://doi.org/10.1007/s11060-011-0595-4

    Article  PubMed  Google Scholar 

  27. Olson RA, Chhanabhai T, McKenzie M (2008) Feasibility study of the Montreal Cognitive Assessment (MoCA) in patients with brain metastases. Support Care Cancer 16:1273–1278. https://doi.org/10.1007/s00520-008-0431-3

    Article  PubMed  Google Scholar 

  28. Folstein MF, Folstein SE, McHugh PR (1975) Mini-mental state. J Psychiatr Res 12:189–198. https://doi.org/10.1016/0022-3956(75)90026-6

    Article  CAS  PubMed  Google Scholar 

  29. Nasreddine ZS, Phillips NA, Bédirian V, Charbonneau S, Whitehead V, Collin I et al (2005) The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment: MOCA: A BRIEF SCREENING TOOL FOR MCI. J Am Geriatr Soc 53:695–699. https://doi.org/10.1111/j.1532-5415.2005.53221.x

    Article  PubMed  Google Scholar 

  30. Meyers CA, Wefel JS (2003) The use of the mini-mental state examination to assess cognitive functioning in cancer trials: no ifs, ands, buts, or sensitivity. J Clin Oncol 21:3557–3558. https://doi.org/10.1200/JCO.2003.07.080

    Article  PubMed  Google Scholar 

  31. Robinson GA, Biggs V, Walker DG (2015) Cognitive screening in brain tumors: short but sensitive enough? Front Oncol. https://doi.org/10.3389/fonc.2015.00060

    Article  PubMed  PubMed Central  Google Scholar 

  32. Boone M, Roussel M, Chauffert B, Le Gars D, Godefroy O (2016) Prevalence and profile of cognitive impairment in adult glioma: a sensitivity analysis. J Neurooncol 129:123–130. https://doi.org/10.1007/s11060-016-2152-7

    Article  PubMed  Google Scholar 

  33. Smith T, Gildeh N, Holmes C (2007) The Montreal Cognitive Assessment: validity and utility in a memory clinic setting. Can J Psychiatry 52:329–332. https://doi.org/10.1177/070674370705200508

    Article  PubMed  Google Scholar 

  34. 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. Support Care Cancer 19:1849–1855. https://doi.org/10.1007/s00520-010-1028-1

    Article  PubMed  Google Scholar 

  35. Wefel JS, Vardy J, Ahles T, Schagen SB (2011) International Cognition and Cancer Task Force recommendations to harmonise studies of cognitive function in patients with cancer. Lancet Oncol 12:703–708. https://doi.org/10.1016/S1470-2045(10)70294-1

    Article  PubMed  Google Scholar 

  36. Zvi Ram on behalf of the EF-14 Trial Investigators, Zhu J-J, Demireva P, Kanner AA, Pannullo S, Mehdorn M et al (2017) Health-related quality of life, cognitive screening, and functional status in a randomized phase III trial (EF-14) of tumor treating fields with temozolomide compared to temozolomide alone in newly diagnosed glioblastoma. J Neurooncol 135:545–552. https://doi.org/10.1007/s11060-017-2601-y

    Article  CAS  PubMed Central  Google Scholar 

  37. Wang Q, Xiao F, Song X, Yu Y (2019) Risk factors for cognitive impairment in high grade glioma patients treated with postoperative radiochemotherapy. Cancer Res Treat. https://doi.org/10.4143/crt.2019.242

    Article  PubMed  PubMed Central  Google Scholar 

  38. Durand T, Jacob S, Lebouil L, Douzane H, Lestaevel P, Rahimian A et al (2015) EpiBrainRad: an epidemiologic study of the neurotoxicity induced by radiotherapy in high grade glioma patients. BMC Neurol. https://doi.org/10.1186/s12883-015-0519-6

    Article  PubMed  PubMed Central  Google Scholar 

  39. Taillia H, Léger I, Moroni C, Boone M, Belin C, Maillet D, et al (2015) La batterie du Grec-Onco (Groupe de Réflexion sur les Evaluations Cognitives en Oncologie). Grémoire 2 - Tests Echelles Mal. Neurol. Avec Symptomatologie Cogn. 1st ed., Paris: De Boeck Solal, pp 33–7

  40. Lange M, Castel H, Le Fel J, Tron L, Maillet D, Bernaudin M et al (2019) How to assess and manage cognitive impairment induced by treatments of non-central nervous system cancer. Neurosci Biobehav Rev 107:602–614. https://doi.org/10.1016/j.neubiorev.2019.09.028

    Article  PubMed  Google Scholar 

  41. Colombo F, Assal G (1992) Le test de dénomination de Boston: adaptation française et versions abrégées. Rev Eur Psychol Appliquée 1:67–73

    Google Scholar 

  42. Le Osterrieth PA (1944) test de copie d’une figure complexe. Arch Psychol 30:206–356

    Google Scholar 

  43. Buschke H (1984) Cued recall in amnesia. Clin Exp Neuropsychol 6:433–440

    Article  CAS  Google Scholar 

  44. Meulemans T (2008) La batterie GREFEX: présentation générale. Fonct. Exéc. Pathol. Neurol. Psychiatr. 1st ed., Marseille: Solal, pp 217–29

  45. Fuhrer R, Rouillon FL (1989) version française de l’échelle CES-D (Center for Epidemiologic Studies-Depression Scale). Description et traduction de l’échelle d’autoévaluation [The French version of the CES-D (Center for Epidemiologic Studies-Depression Scale). Psychiatr Psychobiol 4:163–166

    Article  Google Scholar 

  46. Goldberg D, Bridges K, Duncan-Jones P, Grayson D (1988) Detecting anxiety and depression in general medical settings. BMJ 297:897–899

    Article  CAS  Google Scholar 

  47. Godefroy O, Gibbons L, Diouf M, Nyenhuis D, Roussel M, Black S et al (2014) Validation of an integrated method for determining cognitive ability: implications for routine assessments and clinical trials. Cortex 54:51–62. https://doi.org/10.1016/j.cortex.2014.01.016

    Article  PubMed  PubMed Central  Google Scholar 

  48. Roussel M, Godefroy O (2017) La batterie GRECOGVASC: evaluation et diagnostic des troubles neurocognitifs vasculaires avec ou sans contexte d’accident vasculaire cérébral

  49. Barbay M, Taillia H, Nédélec-Ciceri C, Bompaire F, Bonnin C, Varvat J et al (2018) Prevalence of poststroke neurocognitive disorders using National Institute of Neurological Disorders and Stroke-Canadian Stroke Network, VASCOG Criteria (vascular behavioral and cognitive disorders), and optimized criteria of cognitive deficit. Stroke 49:1141–1147. https://doi.org/10.1161/STROKEAHA.117.018889

    Article  PubMed  Google Scholar 

  50. Hubley AM, Tremblay D (2002) Comparability of total score performance on the Rey-Osterrieth complex figure and a modified Taylor complex figure. J Clin Exp Neuropsychol 24:370–382. https://doi.org/10.1076/jcen.24.3.370.984

    Article  PubMed  Google Scholar 

  51. Loring M (2003) The Medical College of Georgia (MCG) complex figures: four forms for follow-up. Handb. Rey-Osterrieth Complex Fig. Usage Clin. Res. Appl. Psychological Assessment Resources, Lutz

    Google Scholar 

  52. Habets EJJ, Kloet A, Walchenbach R, Vecht CJ, Klein M, Taphoorn MJB (2014) Tumour and surgery effects on cognitive functioning in high-grade glioma patients. Acta Neurochir (Wien) 156:1451–1459. https://doi.org/10.1007/s00701-014-2115-8

    Article  Google Scholar 

  53. Johnson DR, Sawyer AM, Meyers CA, O’Neill BP, Wefel JS (2012) Early measures of cognitive function predict survival in patients with newly diagnosed glioblastoma. Neuro-Oncol 14:808–816. https://doi.org/10.1093/neuonc/nos082

    Article  PubMed  PubMed Central  Google Scholar 

  54. Klein M, Taphoorn MJB, Heimans JJ, van der Ploeg HM, Vandertop WP, Smit EF et al (2001) Neurobehavioral status and health-related quality of life in newly diagnosed high-grade glioma patients. J Clin Oncol 19:4037–4047. https://doi.org/10.1200/JCO.2001.19.20.4037

    Article  CAS  PubMed  Google Scholar 

  55. Talacchi A, Santini B, Savazzi S, Gerosa M (2011) Cognitive effects of tumour and surgical treatment in glioma patients. J Neurooncol 103:541–549. https://doi.org/10.1007/s11060-010-0417-0

    Article  PubMed  Google Scholar 

  56. Shallice T, Mussoni A, D’Agostino S, Skrap M (2010) Right posterior cortical functions in a tumour patient series. Cortex 46:1178–1188. https://doi.org/10.1016/j.cortex.2010.04.005

    Article  PubMed  Google Scholar 

  57. Castaneda AE, Tuulio-Henriksson A, Marttunen M, Suvisaari J, Lönnqvist J (2008) A review on cognitive impairments in depressive and anxiety disorders with a focus on young adults. J Affect Disord 106:1–27. https://doi.org/10.1016/j.jad.2007.06.006

    Article  PubMed  Google Scholar 

  58. Rock PL, Roiser JP, Riedel WJ, Blackwell AD (2014) Cognitive impairment in depression: a systematic review and meta-analysis. Psychol Med 44:2029–2040. https://doi.org/10.1017/S0033291713002535

    Article  CAS  PubMed  Google Scholar 

  59. Hassler MR, Elandt K, Preusser M, Lehrner J, Binder P, Dieckmann K et al (2010) Neurocognitive training in patients with high-grade glioma: a pilot study. J Neurooncol 97:109–115. https://doi.org/10.1007/s11060-009-0006-2

    Article  PubMed  Google Scholar 

  60. Flechl B, Ackerl M, Sax C, Dieckmann K, Crevenna R, Gaiger A et al (2012) Neurocognitive and sociodemographic functioning of glioblastoma long-term survivors. J Neurooncol 109:331–339. https://doi.org/10.1007/s11060-012-0897-1

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neuro-Oncology, Sorbonne University, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière-Charles Foix, 75013, Paris, France

    Monica Ribeiro, Dimitri Psimaras & Khê Hoang-Xuan

  2. Centre Borelli, Service de Santé Des Armées, Paris-Saclay University, Paris Universities, CNRS, Inserm, 94230, Cachan, France

    Monica Ribeiro, Thomas Durand, Julian Jacob & Damien Ricard

  3. Neurology Department, Amiens University Hospital (CHU), 80054, Amiens, France

    Martine Roussel & Olivier Godefroy

  4. Radiation Oncology Department, Sorbonne University, Groupe Hospitalier Pitié-Salpêtrière-Charles Foix, Assistance Publique-Hôpitaux de Paris, 75013, Paris, France

    Loïc Feuvret & Julian Jacob

  5. INSERM, CNRS, Sorbonne University, Institut du Cerveau et de La Moelle Epinière, Groupe Hospitalier Pitié-Salpêtrière-Charles Foix, Assistance Publique Hôpitaux de Paris, 75013, Paris, France

    Dimitri Psimaras & Khê Hoang-Xuan

  6. Radiation Oncology Department, Centre Paul Strauss, 67033, Strasbourg, France

    Georges Noel & Audrey Keller

  7. Laboratory of Epidemiology (LEPID), Institut de Radioprotection et de Sûreté Nucléaire (IRSN), 92260, Fontenay aux Roses, France

    Marie-Odile Bernier

  8. Neurology Department, Service de Santé des Armées, Hôpital D’Instruction Des Armées Percy, 92140, Clamart, France

    Flavie Bompaire & Damien Ricard

  9. Ecole du Val-de-Grâce, Service de Santé des Armées, 75230, Paris, France

    Flavie Bompaire & Damien Ricard

  10. Laboratory of Functional Neurosciences and Diseases, University of Picardy Jules Verne, 80054, Amiens, France

    Martine Roussel & Olivier Godefroy

Authors
  1. Monica Ribeiro
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Thomas Durand
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Martine Roussel
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Loïc Feuvret
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Julian Jacob
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Dimitri Psimaras
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Georges Noel
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Audrey Keller
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Flavie Bompaire
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Khê Hoang-Xuan
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Marie-Odile Bernier
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Olivier Godefroy
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Damien Ricard
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Monica Ribeiro.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ribeiro, M., Durand, T., Roussel, M. et al. Sensitivity of the Montreal Cognitive Assessment in screening for cognitive impairment in patients with newly diagnosed high-grade glioma. J Neurooncol 148, 335–342 (2020). https://doi.org/10.1007/s11060-020-03524-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11060-020-03524-6

Keywords

Search

Navigation