Predictive value of geriatric assessment for patients older than 70 years, treated with chemotherapy.

INTRODUCTION: Comprehensive geriatric assessment (CGA) gives useful information on the functional status of older cancer patients. However, its meaning for a proper selection of elderly patients before chemotherapy and, even more important, the influence of chemotherapy on the outcome of geriatric assessment is unknown. METHODS: 202 cancer patients, for whom an indication for chemotherapy was made by the medical oncologist, underwent a GA before start of chemotherapy by Mini Nutritional Assessment (MNA), Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE), Groningen Frailty Index (GFI) and Mini Mental State Examination (MMSE). After completion of a minimum of four cycles of chemotherapy or at 6 months after the start of chemotherapy the GFI and MMSE assessment was repeated. RESULTS: Frailty was shown in 10% of patients by means of MMSE, 32% by MNA, 37% by GFI and in 15% by IQCODE. Compared to patients who received 4 or more cycles of chemotherapy, the MNA and MMSE scores were significantly lower for patients treated with less than 4 cycles (p = 0.001 and p = 0.04 respectively). The mortality rate after start of chemotherapy was increased for patients with low MNA and high GFI scores with hazard ratios of 2.19 (95% confidence interval [CI]: 1.42-3.39; p < 0.001) and 1.80 (95% CI: 1.17-2.78; p = 0.007), respectively. After adjusting for sex, age, purpose of chemotherapy and type of malignancy these hazard ratios remained significant (p < 0.001 and p = 0.004), respectively. Finally, for the 51 patients who underwent repeated post-chemotherapy evaluation by GFI and MMSE, a statistically significant deterioration for the MMSE (p = 0.041) was found but not for the GFI. CONCLUSIONS: Both inferior MNA and MMSE scores increased the probability not to complete chemotherapy. Also, an inferior score for MNA and GFI showed an increased mortality risk after the start of chemotherapy. The mean MMSE score worsened significantly during chemotherapy.

Effects of maintenance electroconvulsive therapy on cognitive functions.

BACKGROUND: This study examined cognitive side effects of maintenance electroconvulsive (ECT) in comparison with maintenance pharmacotherapy after index ECT. METHOD: Clinical outcome data and neuropsychological measurements were compared in 11 maintenance ECT patients and 13 control patients treated with maintenance pharmacotherapy after index ECT. Data were gathered in a prospective naturalistic study during follow-up. RESULTS: There were no significant differences in patient characteristics and effects of index ECT between groups. In control patients treated with maintenance pharmacotherapy, cognitive function as well as depression ratings remained stable. During maintenance ECT neuropsychological test performance and depression ratings improved slightly but not significantly. CONCLUSIONS: Neuropsychological functioning during the maintenance phase of treatment did not differ between the two treatment groups. Cognitive function remained stable during maintenance ECT.

Prevalence of dementia in centenarians.

Above age 65, the prevalence of dementia rises exponentially from 1 to 15% at age 85. Despite many studies concerning dementia, little is known about the prevalence of dementia in the 'oldest old'. Whether the prevalence levels off around age 95 is yet unanswered. This question is important because it addresses whether dementia is an inevitable consequence of ageing or a disorder occurring within a specific age range. All 17 persons aged 100 or more in three Dutch towns with 250 000 inhabitants were examined by means of cognitive tests, informant questionnaires, clinical interviews and anamneses. Fifteen out of 17 Dutch centenarians in a complete population sample of 250 000 were found to be demented. Two could not be examined.

Prevalence of dementia over age 100.

All nine persons aged 100 or older in a Dutch town with some 100,000 inhabitants were examined by means of cognitive tests, informant questionnaires, and clinical interviews. Formal testing was difficult in most subjects because of visual, auditory, and motor handicaps. By combining the results of cognitive tests and clinical examinations, a diagnosis of moderate to severe dementia could be made in eight subjects. One subject was not examined but by informant questionnaire was found to be mildly demented.