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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

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Abstract

Purpose

The Mini Mental State Examination (MMSE) is the most commonly chosen cognitive screening test (CST) in clinical practice and trials, despite its poor sensitivity, likely because of its prognostic utility. The Montreal Cognitive Assessment (MoCA) is an alternative CST, is more sensitive, and is better correlated with quality of life.

Methods

Sixty-five patients with brain metastases were prospectively accrued and completed both the MMSE and MoCA. We compared the prognostic utility of both CSTs.

Results

The mean age of patients was 59.0 years; 42.0% had single brain metastases. Median MMSE and MoCA scores were 28 and 22, respectively. Median overall survival (OS) was worse for individuals with below- versus above-average MMSE scores (10.4 versus 36.3 weeks, p = 0.007). Likewise, below- versus above-average MoCA scores were prognostic (6.3 versus 50.0 weeks, p < 0.001). Median OS for MoCA scores <22, 22–26, and >26 were 6.3, 30.9, and 61.7 weeks, respectively (p < 0.001). On multivariable analysis, below-average MMSE scores were no longer prognostic (hazard ratio [HR] = 1.71 [0.90–3.26]), though below-average MoCA scores were (HR = 5.44 [2.70–10.94]). Furthermore, the MoCA demonstrated superior prognostic utility when comparing multivariable models with continuous CST scores.

Conclusions

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.

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Acknowledgements

Grant funding was provided by the Fraser Valley Interdisciplinary Research Grant and the Hershey & Yvette Porte Neuro-Oncology Fund. The authors thank Dr. Brian Brooks and Prof. Grant Iverson from BC Mental Health & Addictions Services for their input into the diagnostic study design, as well as Prof. Roger Davis from the Harvard School of Public Health for his valuable input into the multivariable analyses.

Conflict of interest statement

No potential conflict of interest exists for any of the authors.

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Authors and Affiliations

  1. Vancouver Cancer Centre, BC Cancer Agency, 600 West 10th Avenue, Vancouver, BC, Canada, V5Z 4E6

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

  2. Division of Radiation Oncology and Developmental Radiotherapeutics, University of British Columbia, Vancouver, BC, Canada

    Robert Olson, Scott Tyldesley, Hannah Carolan & Michael McKenzie

  3. Fraser Valley Cancer Centre, BC Cancer Agency, Vancouver, BC, Canada

    Maureen Parkinson

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  1. Robert Olson
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Correspondence to Robert Olson.

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Olson, R., Tyldesley, S., Carolan, H. et al. 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 (2011). https://doi.org/10.1007/s00520-010-1028-1

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