Abstract
Cognitive assessment is a cornerstone of geriatric care. Cognitive impairment has the potential to significantly impact multiple phases of a person’s cancer care experience. Accurately identifying this vulnerability is a challenge for many cancer care clinicians, thus the use of validated cognitive assessment tools are recommended. As international cancer guidelines for older adults recommend Geriatric Assessment (GA) which includes an evaluation of cognition, clinicians need to be familiar with the overall interpretation of the commonly used cognitive assessment tools. This rapid review investigated the cognitive assessment tools that were most frequently recommended by Geriatric Oncology guidelines: Blessed Orientation-Memory-Concentration test (BOMC), Clock Drawing Test (CDT), Mini-Cog, Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and Short Portable Mental Status Questionnaire (SPMSQ). A detailed appraisal of the strengths and limitations of each tool was conducted, with a focus on practical aspects of implementing cognitive assessment tools into real-world clinical settings. Finally, recommendations on choosing an assessment tool and the additional considerations beyond screening are discussed.
Highlights
Cognitive impairment affects various aspects of care in older adults with cancer, such as the ability to participate in clinical decision-making, cope with treatment, and selfmanage treatment regimens, as well as being associated with worse cancer and non-cancer outcomes [1,2,3,4,5]
This review focuses on assessing for pre-existing cognitive impairment disorders (e.g., Mild Cognitive Impairment (MCI) or dementia) in older adults with cancer, as distinct from delirium or Cancer-Related Cognitive Decline (CRCD) [6]
Consistency was seen across most of the guidelines, with only the Society for Medical Oncology (SEOM) recommending a tool that was not recommended by any other guideline, the Short Portable Mental Status Questionnaire (SPMSQ) [24]
Summary
Cognitive impairment affects various aspects of care in older adults with cancer, such as the ability to participate in clinical decision-making, cope with treatment, and selfmanage treatment regimens, as well as being associated with worse cancer and non-cancer outcomes [1,2,3,4,5]. Adapting to changes in daily routine due to treatment-associated side effects or reduction in functional ability may exceed the mental flexibility of those with executive impairment. This can have profound impacts such as increased hospitalizations during treatment, reduced ability to report complications, increased need for caregiver support potentially contributing to caregiver distress, and even compromised independence with potential increased relocation to supported accommodation [6,8]. It is not unexpected that cognitive impairment is associated with worse cancer and non-cancer outcomes including increased toxicity from the treatment, lower completion rate of treatment, worse overall survival, increased caregiver burden, cognitive decline with the treatment, and poorer patient-reported outcomes [1,2,3,4]
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