Cognitive and emotive state in elderly treatment-naïve patients with advanced cancer compared with an elderly healthy control population

The elderly may have cognitive impairment due to several physiological and pathological conditions. In cancer patients cognitive impairment has been related to some anticancer treatments while few data are available regarding the role of advanced cancer itself. Thus, we planned a prospective study. We evaluated the Mini Mental State Examination (MMSE) of elderly patients with advanced cancer, before starting anticancer treatments, compared to a control population. Other causes of cognitive impairment, related to disease or to the treatment, were investigated and excluded. To investigate the possible influence of depression and Performance Status (PS) on cognitive status, the Geriatric Depression Scale (GDS), the Activities of Daily Living (ADL) and the Instrumental Activities of Daily Living (IADL) scores were also evaluated. Results: mean MMSE scores of cancer patients (n = 66) and control population (n = 31) were respectively 21.9 and 23.7. The difference was statistically significant (U = 694.5; p <0.05). A difference between the 2 groups was seen also for ADL and IADL scores (U = 695.5; p <0.01 and U = 501.5; p <0.001 respectively), whilst no significant difference was seen for GDS score. Among cancer patients there was a correlation between MMSE, ADL and IADL (r = 0.38; p <0.01 and r = 0.26; p <0.05 respectively) while in the control group a negative correlation was found between MMSE and GDS (r = -0.49; p <0.01). Anticancer treatment naïve patients with advanced cancer present with cognitive impairment that does not seem to be related to depression, as in healthy subjects, but to other causes among which the tumour might play a fundamental role.