gms | German Medical Science

Objective: Neuropsychological test batteries are time consuming. However, evaluating neurological outcome of brain tumor surgery involves assessment of neuropsychological status. The aim was 1) to test feasibility and acceptance of the German version of the Montreal Cognitive Assessment (MoCA) in patients with brain tumors perioperatively with regard to practicability of the test for neuropsychological screening and 2) to compare results in MoCA perioperatively.

Methods: We assessed patients with supratentorial located brain tumors preoperatively (preOP, day -1) and postoperatively (postOP, day 3-5) applying the EORTC-QLQ-C30 + BN20, Distress Thermometer (DT), NIHSS and the MoCA test (different versions). The MoCA consists of 8 domains, adding to a total number of 30 points (cut-off score for normal results = 26/30). We evaluated feasibility to implementing the test in clinical routine by assessing, inter alia, time needed to complete the questionnaire, difficulties experienced by the patients during the testing and potential disturbing factors. Additionally, patients were asked about perceived complexity of MoCA, possible discomfort and overstraining due to the testing.

Results: The study included 56 patients, 20 were male. Mean age was 57 years (range 23-81 years). Most represented diagnoses were brain metastases (29%), glioma (41%), followed by meningioma (18%). Mean completion time preoperatively was 11.14 min and 11.10 min postoperatively (range 6-26 min). Postoperatively implementation of MoCA testing resulted to be slightly more challenging as in 21.8% of the assessments by MoCA “severe” difficulties occurred vs. 14.0% preOP. MoCA test was well accepted: pre- and postoperatively the majority of the patients (preOP 93%, postOP 89%) negated to feel uncomfortable or overstrained by the screening test, however, preoperatively more patients indicated being distracted (42%) than postoperatively (33%). The result of the MoCA test was postoperatively significantly worse (preOP mean=22 vs. postOP mean=19, p=0.001, Wilcoxon). However, preOP and postOP (72% vs. 79%) most of the patients scored ≤26 points, although patients who preoperatively declared to have recognized cognitive issues scored lower than those who denied such problems (preOP mean=20 and postOP mean=17 vs. preOP mean=23 and postOP mean=20).

Many patients had problems with regard to memory skills (preOP 2.2 words and postOP 1.5 words out of 5 could be memorized), whereas most patients maintained good temporal and spatial orientation, however decreasing postOP (preOP 88% answered correctly ≥5 questions out of 6 regarding temporal and spatial orientation and postOP 79%).

Conclusion: The MoCA test was well accepted by the patients and implementable in clinical routine. Further investigations with regard to reliability and predictive power of MoCA are required.