Feasibility study of the Montreal Cognitive Assessment (MoCA) in patients with brain metastases
Goal of work
Detection of cognitive impairment in patients with brain metastases is important for both patient management and clinical trials. The most commonly used cognitive screen, the Mini Mental State Examination (MMSE), though convenient, is not sensitive in these patients. More sensitive tools are less convenient and, therefore, uncommonly used. Therefore, a practical and sensitive tool is needed. The Montreal Cognitive Assessment (MoCA) is a good candidate, shown to be sensitive in detecting mild cognitive impairment in the pre-dementia setting. This study is the first to explore the MoCA in cancer patients and is aimed at determining the feasibility of administering the MoCA in brain tumor patients. The secondary objective is to explore the relationship between MoCA and MMSE scores.
Patients and methods
Forty patients with brain metastases being treated with whole brain radiotherapy were prospectively accrued from January to May 2007. All patients were administered both the MoCA and MMSE.
The MoCA was completed in 10 min in 88% of patients. 92% of all the patients found the MoCA to be only mildly or not at all inconvenient. Eighty percent of the patients were deemed cognitively impaired by the MoCA compared with 30% by the MMSE (p < 0.0001). Of the 28 patients with a normal MMSE, 71% had cognitive impairment according to the MoCA. Overall, 50% of the patients had an abnormal MoCA, yet normal MMSE.
The MoCA was well tolerated and provided additional information over the MMSE, justifying further validation studies of the MoCA in brain tumor patients.
KeywordsBrain metastases Cognition Oncology Radiotherapy Cognitive screen
- 9.Keime-Guiber F, Chinot O, Taillandier L, Cartalat-Carel S, Frenay M, Kantor G, Guillamo J-S, Jadaud E, Colin P, Bondiau P-Y, Meneï P, Loiseau H, Bernier V, Honnorat J, Barrié M, Mokhtari K, Mazeron J-J, Bissery A, Delattre J-Y (2007) Radiotherapy for gliobastoma in the elderly. N Engl J Med 356:1527–1535CrossRefGoogle Scholar
- 11.Mallory P, Cummings J, Coffey C, Duffy J, Fink M, Lauterbach E et al (1997) Cognitive Screening instruments in neuropsychiatry: a report of the committee on research in Neuropsychiatric Assocation. J Neuropsychiatry 9(2):189–197Google Scholar
- 12.Mehta MP, Shapiro WR, Glantz MJ, Patchell RA, Weitzner MA, Meyers CA et al (2002) Lead-in phase to randomized trial of motexafin gadolinium and whole-brain radiation for patients with brain metastases: centralized assessment of magnetic resonance imaging, neurocognitive, and neurologic end points. J Clin Oncol 20(16):3445–3453PubMedCrossRefGoogle Scholar
- 16.Meyers CA, Smith JA, Bezjak A, Mehta MP, Liebmann J, Illidge T et al (2004) Neurocognitive function and progression in patients with brain metastases treated with whole-brain radiation and motexafin gadolinium: results of a randomized phase III trial. J Clin Oncol 22(1):157–165PubMedCrossRefGoogle Scholar
- 18.Murray KJ, Scott C, Zachariah B, Michalski JM, Demas W, Vora NL et al (2000) Importance of the mini-mental status examination in the treatment of patients with brain metastases: a report from the radiation therapy oncology group protocol 91–04. Int J Radiat Oncol Biol Phys 48(1):59–64PubMedCrossRefGoogle Scholar
- 21.Regine WF, Schmitt FA, Scott CB, Dearth C, Patchell RA, Nichols RC et al (2004) Feasibility of neurocognitive outcome evaluations in patients with brain metastases in a multi-institutional cooperative group setting: results of radiation therapy oncology group trial BR-0018. Int J Radiat Oncol Biol Phys 58(5):1346–1352PubMedCrossRefGoogle Scholar