Mini-Cog: A brief screening tool for cognitive impairment in older cancer patients.

Abstract

9064 Background: The incidence of both cancer and cognitive impairment (CI) increases with age. Up to 20% of older cancer patients may have baseline CI, which may be overlooked in a busy oncology practice due to time constraints, staff availability, and complexity of the screening tools. This review compares the prevalence of CI as measured by different screening tools and describes the role of the Mini-Cog (MC) in evaluating CI in older cancer patients. Methods: A retrospective chart review of patients age ≥65 years referred to a Geriatric Oncology clinic with a new diagnosis of solid tumors, lymphoma, or multiple myeloma who had baseline cognitive assessment evaluated by 5 screening tools: Single-item memory question, three-item recall (3IR), clock drawing test (CDT), Mini-Cog (3IR and CDT), and Mini-Mental Status Exam (MMSE). Outcome measures include CI as detected by any of these screening tools and their association with the MMSE score. Results: Participants (n=191) had a mean age of 78 ± 6.6 years (65-99 years) with 68.1% ≥ 75 years, 78% Caucasian, 60.7% women and 51.3% ≥ 12 years of education. Tumor types included breast (33%), colorectal (17%), lung (15%), prostate (9%), and other (26%). 22% had stage IV disease. Among the 77% (n = 147) of patients with a normal MMSE (score >24), 84% had a normal MC, 65% a normal recall and 60% a normal CDT. The overall prevalence of CI in this population was approximately 35%. Conclusions: CI in older cancer patients may be more common than previously expected. Since CI may impact decision making capacity and treatment outcome, identifying CI is essential. The MC is a short and easy to administer screening tool that is not confounded by language or education. Based on our review, the MC may be an effective alternative to the MMSE. Screening for CI with MC should be considered for all older cancer patients. A prospective study to evaluate the applicability of the MC in detecting any CI in this population is warranted. Prevalence of CI by age and screening tools Age (yrs) Memory question Recall CDT MC MMSE 65-74 27.78% 36.07% 38.92% 14.75% 16.39% 75-84 41.18% 40.82% 53.68% 15.18% 24.49% 85-94 34.78% 74.07% 64% 51.85% 29.63% >94 50% 80% 75% 60% 40% Total 36.14% 45.03% 50.82% 28.8% 23.04% No significant financial relationships to disclose.