Formulation of Mental State Examination

Mental Status Examination
Fig 1.

Graph of the mean memory recall scores from the Hopkins Verbal Learning Test (HVLT) and the score on the Mini-Mental State Examination (MMSE) before and after each course of therapy. x-axis (time points): first number, the course of treatment (1, 2, or 3); second number, the pretreatment assessment (1) or posttreatment assessment (2). Reprinted with permission.

Conversely, treatment can conceivably delay the time to expected cognitive decline in brain tumor patients. This was found in a large phase III randomized trial of motexafin gadolinium (MGd), which was used as a radiation sensitizer in patients with brain metastases. The addition of MGd to whole-brain radiation seemed to improve memory and executive function, and to prolong time to neurocognitive progression in patients with brain metastases from lung cancer. This study incorporated a brief cognitive test battery that took an average of 23 minutes to administer. A screening tool such as the MMSE would not have been able to detect such changes, which are of great significance to the patients and also to pharmaceutical companies that want to demonstrate benefit of a drug to attain US Food and Drug Administration approval. Thus, the risks versus benefits of various treatments on cognitive function, especially those that do not significantly alter survival or time to progression, cannot be determined with the MMSE.

Formal, objective, and standardized neurocognitive testing is a sensitive measure of brain functioning. Furthermore, it has been demonstrated that the combination of clinical prognostic variables and brain function assessments seem to predict survival better than the prognostic variables alone in primary brain tumor patients, and in patients with leptomeningeal or parenchymal brain metastases. Again, a screening tool such as the MMSE has not been demonstrated to predict survival in cancer populations.

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