Abstract
Goals of work
Some patients with cancer suffer cognitive impairment after chemotherapy. A brief, sensitive instrument is required to screen patients for cognitive impairment. In this study, we compare three possible screening instruments.
Materials and methods
Cancer patients (n=31) who had received adjuvant chemotherapy within 2 years underwent cognitive evaluation on three occasions. Fluent English speakers (n=20) completed the High Sensitivity Cognitive Screen (HSCS), the computer-based Headminder and CogHealth, and the Functional Assessment of Cancer Therapy-cognitive function (FACT-COG) questionnaire. Patients not fluent in English (NESB) (n=11) performed CogHealth and Headminder.
Results
The patients were aged 31–65 years, and 94% were women with breast cancer. At baseline, 6 of 20 (30%) had moderate–severe cognitive impairment on HSCS, 17 of 31 (55%) had scores greater than one standard deviation (SD) below the mean for normative data in one to two of three domains on Headminder, and on CogHealth, 8 of 31 (26%) were greater than one SD below the mean in at least two of six domains. A large practice effect was seen for the HSCS, with moderate–severe cognitive impairment decreasing from 30 to 5% between the first and second assessment. On FACT-COG, 9 of 19 patients (47%) rated their cognition as greater than one SD below that of a pre-chemotherapy breast cancer control group, with impact on quality of life greater than one SD below for 10 of 19 (53%) patients. No correlation was seen between objective cognitive testing and the FACT-COG.
Conclusions
CogHealth and Headminder were suitable for NESB patients. The HSCS is not recommended for longitudinal studies with short intervals between testing due to practice effect. There is poor correlation between the patients’ perception of their cognitive impairment and the objective tests.
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References
van Dam FS, Schagen SB, Muller MJ, Boogerd W, vd Wall E, Droogleever Fortuy, ME, Rodenhuis S (1998) Impairment of cognitive function in women receiving adjuvant treatment for high-risk breast cancer: high-dose versus standard-dose chemotherapy. J Natl Cancer Inst 90:210–218
Wieneke MH, Dienst DE (1995) Neuropsychological assessment of cognitive functioning following chemotherapy for breast cancer. Psychooncology 4:61–66
Schagen SB, van Dam FS, Muller MJ, Boogerd W, Lindeboom J, Bruning PF (1999) Cognitive deficits after postoperative adjuvant chemotherapy for breast carcinoma. Cancer 85:640–650
Brezden CB, Phillips KA, Abdolell M, Bunston T, Tannock IF (2000) Cognitive function in breast cancer patients receiving adjuvant chemotherapy. J Clin Oncol 18:2695–2701
Ahles TA, Saykin AJ, Furstenberg CT, Cole B, Mott LA, Skalla K, Whedon MB, Bivens S, Mitchell T, Greenberg ER, Silberfarb PM (2002) Neuropsychologic impact of standard-dose systemic chemotherapy in long-term survivors of breast cancer and lymphoma. J Clin Oncol 20:485–493
Tchen N, Juffs HG, Downie FP, Yi QL, Hu H, Chemerynsky I, Clemons M, Crump M, Goss PE, Warr D, Tweedale ME, Tannock IF (2003) Cognitive function, fatigue, and menopausal symptoms in women receiving adjuvant chemotherapy for breast cancer. J Clin Oncol 21:4175–4183
Phillips KA, Bernhard J (2003) Adjuvant breast cancer treatment and cognitive function: current knowledge and research directions. J Natl Cancer Inst 95:190–197
Tannock IF, Ahles TA, Ganz PA, van Dam FS (2004) Cognitive impairment associated with chemotherapy for cancer: report of a workshop. J Clin Oncol 22:2233–2239
Bornstein R (1994) Methodological and conceptual issues in the study of cognitive change in HIV infection. In: Grant I, Martin A (eds) Neuropsychology of HIV Infection. Oxford Univ. Press, New York, pp 146–160
Butters N, Grant I, Haxby J, Judd LL, Martin A, McClelland J, Pequegnat W, Schacter D, Stover E (1990) Assessment of AIDS-related cognitive changes: recommendations of the NIMH workshop on neuropsychological assessment approaches. J Clin Exp Neuropsychol 12:963–978
White DA, Heaton RK, Monsch AU (1995) Neuropsychological studies of asymptomatic human immunodeficiency virus-type-1 infected individuals. The HNRC group. HIV Neurobehavioral Research Center. J Int Neuropsychol Soc 1:304–315
Faust D, Fogel BS (1989) The development and initial validation of a sensitive bedside cognitive screening test. J Nerv Ment Dis 177:25–31
Fogel BS (1991) The high sensitivity cognitive screen. Int Psychogeriatr 3:273–288
Collie A, Darby D, Maruff P (2001) Computerised cognitive assessment of athletes with sports related head injury. Br J Sports Med 35:297–302
Collie A, Maruff P, Darby DG, McStephen M (2003) The effects of practice on the cognitive test performance of neurologically normal individuals assessed at brief test–retest intervals. J Int Neuropsychol Soc 9:419–428
Makdissi M, Collie A, Maruff P, Darby DG, Bush A, McCrory P, Bennell K (2001) Computerised cognitive assessment of concussed Australian rules footballers. Br J Sports Med 35:354–360
Erlanger DM, Kaushik T, Broshek D, Freeman J, Feldman D, Festa J (2002) Development and validation of a web-based screening tool for monitoring cognitive status. J Head Trauma Rehabil 17:458–476
Erlanger D, Feldman D, Kutner K, Kaushik T, Kroger H, Festa J, Barth J, Freeman J, Broshek D (2003) Development and validation of a web-based neuropsychological test protocol for sports-related return-to-play decision-making. Arch Clin Neuropsychol 18:293–316
Silbert BS, Maruff P, Evered LA, Scott DA, Kalpokas M, Martin KJ, Lewis MS, Myles PS (2004) Detection of cognitive decline after coronary surgery: a comparison of computerized and conventional tests. Br J Anaesth 92:814–820
Miller EN, Wilkie FL (1994) Computerized testing to assess cognition in HIV-positive individuals. In: Grant I, Martin A (eds) Neuropsychology of HIV infection. Oxford Univ. Press, New York, pp 161–175
Gonzalez R, Heaton RK, Moore DJ, Letendre S, Ellis RJ, Wolfson T, Marcotte T, Cherner M, Rippeth J, Grant I (2003) Computerized reaction time battery versus a traditional neuropsychological battery: detecting HIV-related impairments. J Int Neuropsychol Soc 9:64–71
Collie A, Maruff P, Makdissi M, McCrory P, McStephen M, Darby D (2003) CogSport: reliability and correlation with conventional cognitive tests used in postconcussion medical evaluations. Clin J Sport Med 13:28–32
Erlanger D, Kaushik T, Cantu R, Barth JT, Broshek DK, Freeman JR, Webbe FM (2003) Symptom-based assessment of the severity of a concussion. J Neurosurg 98:477–784
Cella DF, Tulsky DS, Gray G, Sarafian B, Linn E, Bonomi A, Silberman M, Yellen SB, Winicour P, Brannon J et al (1993) The functional assessment of cancer therapy scale: development and validation of the general measure. J Clin Oncol 11:570–579
Wagner LI, SJ, Cella D, Donninger N (2003) Chemotherapy-related cognitive deficits: A qualitative examination of patients and providers. Ann Behav Med 25:S056
Fan H, Houédé-Tchen N, Yi Q-L, Chemerynsky I, Downie FP, Sabate K, Tannock IF (2005) Fatigue, menopausal symptoms and cognitive function in women following adjuvant chemotherapy for breast cancer: one and two year follow-up of a prospective controlled study. J Clin Oncol 23:8025–8032
Falleti MG, Maruff P, Collie A, Darby DG (2006) Practice effects associated with the repeated assessment of cognitive function using the CogState battery at 10-minute, one week and one month test–retest intervals. J Clin Exp Neuropsychol (in press)
Symes E, Maruff P, Ajani A, Currie J (2000) Issues associated with the identification of cognitive change following coronary artery bypass grafting. Aust N Z J Psychiatry 34:770–784
Borowicz LM, Goldsborough MA, Selnes OA, McKhann GM (1996) Neuropsychologic change after cardiac surgery: a critical review. J Cardiothorac Vasc Anesth 10:105–111
Woods SP, Weinborn M, Lovejoy DW (2003) Are classification accuracy statistics underused in neuropsychological research? J Clin Exp Neuropsychol 25:431–439
Taylor MJ, Heaton RK (2001) Sensitivity and specificity of WAIS-III/WMS-III demographically corrected factor scores in neuropsychological assessment. J Int Neuropsychol Soc 7:867–874
Benedict RH, Zgaljardic DJ (1998) Practice effects during repeated administrations of memory tests with and without alternate forms. J Clin Exp Neuropsychol 20:339–352
Collie A, Maruff P, Makdissi M, McStephen M, Darby DG, McCrory P (2004) Statistical procedures for determining the extent of cognitive change following concussion. Br J Sports Med 38:273–278
McCaffrey RJ, Cousins JP, Westervelt HJ, Martynowicz M, Remick SC, Szebenyi S, Wagle WA, Bottomley PA, Hardy CJ, Haase RF (1995) Practice effects with the NIMH AIDS abbreviated neuropsychological battery. Arch Clin Neuropsychol 10:241–250
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Vardy, J., Wong, K., Yi, Ql. et al. Assessing cognitive function in cancer patients. Support Care Cancer 14, 1111–1118 (2006). https://doi.org/10.1007/s00520-006-0037-6
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DOI: https://doi.org/10.1007/s00520-006-0037-6