Cognitive Dysfunction
Recognizing Cognitive Dysfunction in Cancer

A number of cognitive function scales or tools have been developed to help healthcare providers recognize changes in cognitive functioning. Examples of screening tools your healthcare provider may use include:

Folstein Mini Mental Status Examination

Task	Inbstructions	Scoring
Date Orientation	"Tell me the date?" Ask for omitted items.	One point each for year, season, date, day of week, and month	5
Place Orientation	"Where are you?" Ask for omitted items.	One point each for state, county, town, building, and floor or room	5
Register 3 Objects	Name three objects slowly and clearly. Ask the patient to repeat them.	One point for each item correctly repeated	3
Serial Sevens	Ask the patient to count backwards from 100 by 7. Stop after five answers. (Or ask them to spell "world" backwards.)	One point for each correct answer (or letter)	5
Recall 3 Objects	Ask the patient to recall the objects mentioned above.	One point for each item correctly remembered	3
Naming	Point to your watch and ask the patient "what is this?" Repeat with a pencil.	One point for each correct answer	2
Repeating a Phrase	Ask the patient to say "no ifs, ands, or buts."	One point if successful on first try	1
Verbal Commands	Give the patient a plain piece of paper and say "Take this paper in your right hand, fold it in half, and put it on the floor."	One point for each correct action	3
Written Commands	Show the patient a piece of paper with "CLOSE YOUR EYES" printed on it.	One point if the patient's eyes close	1
Writing	Ask the patient to write a sentence.	One point if sentence has a subject, a verb, and makes sense	1
Drawing	Ask the patient to copy a pair of intersecting pentagons onto a piece of paper.	One point if the figure has ten corners and two intersecting lines	1
Scoring	A score of 24 or above is considered normal.		3

Note. From "Mini-mental state: A practical method for grading the state of patients for the clinician," by M. Folstein, S. Folstein and P. McHugh, 1975, Journal of Psychiatric Research, p. 189-198.

1. What are the date, month, and year?



2. What is the day of the week?



3. What is the name of this place?



4. What is your phone number?



5. How old are you?



6. When were you born?



7. Who is the current president?



8. Who was the president before him?



9. What was your mother's maiden name?



10. Can you count backward from 20 by 3's?

Scoring
0-2 errors: normal mental functioning
3-4 errors: mild cognitive impairment
5-7 errors: moderate cognitive impairment
8 or more errors: severe cognitive impairment

*One more error is allowed in the scoring if a patient has had a grade school education or less. *One less error is allowed if the patient has had education beyond the high school level.

The consequences of cognitive impairment for people with cancer include interfering with the ability to make treatment related decisions, complete normal activities of daily living, and maintaining professional and social roles.