Supportive Care in Cancer

, Volume 16, Issue 11, pp 1273–1278 | Cite as

Feasibility study of the Montreal Cognitive Assessment (MoCA) in patients with brain metastases

  • Robert Anton OlsonEmail author
  • Taruna Chhanabhai
  • Michael McKenzie
Original Article


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.

Main results

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.


Brain metastases Cognition Oncology Radiotherapy Cognitive screen 


  1. 1.
    Brown P, Buckner J, O’Fallon J, Iturria N, Brown C, O’Neil B et al (2003) Effects of radiotherapy on cognition in patients with low-grade glioma measure by the Folstein mini-mental state examination. J Clin Oncol 21(13):2519–2524PubMedCrossRefGoogle Scholar
  2. 2.
    Chang E, Wefel J, Maor M, Hassenbush S III, Mahajan A, Lang F et al (2007) A pilot study of neurocognitive function in patients with one to three new brain metastases initially treated with stereotactic radiosurgery alone. Neurosurgery 60(2):277–284PubMedCrossRefGoogle Scholar
  3. 3.
    Crum RM, Anthony JC, Bassett SS, Folstein MF (1993) Population-based norms for the mini-mental state examination by age and educational level. JAMA 269(18):2386–2391PubMedCrossRefGoogle Scholar
  4. 4.
    Fadul N, Kaur G, Zhang T, Palmer JL, Bruera E (2007) Evaluation of the memorial delirium assessment scale (MDAS) for the screening of delirium by means of simulated cases by palliative care health professionals. Support Care Cancer 15(11):1271–1276PubMedCrossRefGoogle Scholar
  5. 5.
    Folstein M, Folstein SE, McHugh PR (1975) “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12(3):189–198PubMedCrossRefGoogle Scholar
  6. 6.
    Fox SW, Mitchell SA, Booth-Jones M (2006) Cognitive impairment in patients with brain tumors: assessment and intervention in the clinic setting. Clin J Oncol Nurs 10(2):169–176PubMedCrossRefGoogle Scholar
  7. 7.
    Gauthier S, Reisberg B, Zaudig M, Petersen RC, Ritchie K, Broich K et al (2006) Mild cognitive impairment. Lancet 367(9518):1262–1270PubMedCrossRefGoogle Scholar
  8. 8.
    Herman MA, Tremont-Lukats I, Meyers CA, Trask DD, Froseth C, Renschler MF et al (2003) Neurocognitive and functional assessment of patients with brain metastases: a pilot study. Am J Clin Oncol 26(3):273–279PubMedCrossRefGoogle Scholar
  9. 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
  10. 10.
    Li J, Bentzen SM, Renschler M, Mehta MP (2007) Regression after whole-brain radiation therapy for brain metastases correlates with survival and improved neurocognitive function. J Clin Oncol 25(10):1260–1266PubMedCrossRefGoogle Scholar
  11. 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. 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
  13. 13.
    Meyers CA, Brown PD (2006) Role and relevance of neurocognitive assessment in clinical trials of patients with CNS tumors. J Clin Oncol 24(8):1305–1309PubMedCrossRefGoogle Scholar
  14. 14.
    Meyers CA, Hess KR (2003) Multifaceted end points in brain tumor clinical trials: cognitive deterioration precedes MRI progression. Neuro Oncol 5(2):89–95PubMedCrossRefGoogle Scholar
  15. 15.
    Meyers CA, Hess KR, Yung WKA, Levin VA (2000) Cognitive function as a predictor of survival in patients with recurrent malignant glioma. J Clin Oncol 18(3):646–650PubMedGoogle Scholar
  16. 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
  17. 17.
    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(19):3557–3558PubMedCrossRefGoogle Scholar
  18. 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
  19. 19.
    Nasreddine ZS, Phillips NA, Bedirian V, Charbonneau S, Whitehead V, Collin I et al (2005) The montreal cognitive assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc 53(4):695–699PubMedCrossRefGoogle Scholar
  20. 20.
    Patel RR, sMehta MP (2007) Targeted therapy for brain metastases: improving the therapeutic ratio. Clin Cancer Res 13(6):1675–1683PubMedCrossRefGoogle Scholar
  21. 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
  22. 22.
    Sherman AM, Jaeckle K, Meyers CA (2002) Pretreatment cognitive performance predicts survival in patients with leptomeningeal disease. Cancer 95(6):1311–1316PubMedCrossRefGoogle Scholar
  23. 23.
    Smith T, Gildeh N, Holmes C (2007) The Montreal cognitive assessment: validity and utility in a memory clinic setting. Can J Psychiatry 52(5):329–332PubMedGoogle Scholar
  24. 24.
    Taphoorn MJB, Klein M (2004) Cognitive deficits in adult patients with brain tumours. Lancet Neurol 3(3):159–168PubMedCrossRefGoogle Scholar
  25. 25.
    Vardy J, Wong K, Yi Q, Park A, Maruff P, Wagner L et al (2006) Assessing cognitive function in cancer patients. Support Care Cancer 14:1111–1118PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Robert Anton Olson
    • 1
    • 2
    Email author
  • Taruna Chhanabhai
    • 1
  • Michael McKenzie
    • 1
    • 2
  1. 1.Department of Radiation Oncology, Vancouver Cancer CentreBC Cancer AgencyVancouverCanada
  2. 2.University of British ColumbiaVancouverCanada

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