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Re-examining popular screening measures in neuro-oncology: MMSE and RBANS
Farah Aslanzadeh1, Sarah Braun2,3, Julia Brechbiel1
1Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA.
Background:
The Mini-Mental Status Examination (MMSE) is routinely used in neuro-oncology clinics to rule out cognitive impairment. However, the MMSE is known to have poor sensitivity to mild cognitive impairment, raising concern regarding its continued use. More comprehensive cognitive screeners are available, such as the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), and may be better able to assess for cognitive dysfunction.
Methods:
This retrospective cross-sectional study compared the relative rates of impairment using the MMSE-2 and RBANS in a sample of neuro-oncology patients (N = 81). A preliminary analysis of the sensitivity and specificity of the MMSE-2 to the level of cognitive impairment identified on the RBANS was conducted; in addition, we examined whether an adjustment of the MMSE-2 cut-off score improved consensus with a positive screening on the RBANS.
Results:
The MMSE-2 failed to identify over half of the patients with cognitive dysfunction that were identified on the RBANS. Further analysis showed limited sensitivity of the MMSE-2 to the level of impairment detected on the RBANS, and an adjustment of the cut-off score did not improve the sensitivity or specificity of the MMSE-2.
Conclusions:
These results provide caution for neuro-oncology clinics using the MMSE. If providers continue to rely on the MMSE to screen for cognitive impairment alone, they may fail to identify individuals with mild cognitive impairments.
Insights
The Mini-Mental Status Examination (MMSE) often misses mild cognitive impairment in neuro-oncology patients. A more comprehensive tool, the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), is more effective for screening cognitive dysfunction.
Area of Science:
- Neuroscience
- Clinical Psychology
Background:
- The Mini-Mental Status Examination (MMSE) is a standard tool in neuro-oncology for cognitive impairment screening.
- The MMSE has demonstrated low sensitivity for detecting mild cognitive impairment.
- The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) is a more comprehensive alternative.
Purpose of the Study:
- To compare the efficacy of the MMSE-2 and RBANS in identifying cognitive impairment in neuro-oncology patients.
- To evaluate the sensitivity and specificity of the MMSE-2 against the RBANS.
- To determine if adjusting the MMSE-2 cut-off score enhances its diagnostic accuracy.
Main Methods:
- Retrospective cross-sectional study of 81 neuro-oncology patients.
- Comparison of impairment rates between MMSE-2 and RBANS.
- Analysis of MMSE-2 sensitivity and specificity relative to RBANS findings.
Main Results:
- The MMSE-2 failed to detect cognitive dysfunction in over half of patients identified by the RBANS.
- Limited sensitivity of the MMSE-2 was observed for detecting impairment levels identified by the RBANS.
- Adjusting the MMSE-2 cut-off score did not improve its sensitivity or specificity.
Conclusions:
- Clinics using the MMSE alone may overlook individuals with mild cognitive impairments.
- Caution is advised for neuro-oncology clinics relying solely on the MMSE for cognitive screening.
- The RBANS may offer a more reliable assessment of cognitive function in this patient population.
