造血细胞移植受者的认知主诉与随时间变化的神经心理学表现
Cognitive complaints by hematopoietic cell transplantation recipients and change in neuropsychological performance over time.
机构信息
Department of Psychology, Eastern Michigan University, Ypsilanti, MI, USA.
Department of Psychiatry, University of Michigan, 1500 E. Medical Center Drive, F6321 UH-South, Ann Arbor, MI, 48109-5295, USA.
出版信息
Support Care Cancer. 2021 Jan;29(1):247-254. doi: 10.1007/s00520-020-05458-1. Epub 2020 Apr 28.
PURPOSE
Hematopoietic stem cell transplant (HSCT) recipients are at risk for cognitive decline. Cross-sectional studies show patients' complaints of cognitive decline do not correlate well with concurrently measured objective neuropsychological performance, but rather with emotional variables and health-related quality of life. This longitudinal study investigated whether patient self-report of cognitive status would be concordant with objectively measured neuropsychological performance after accounting for change from their own pre-transplant objective baseline.
METHODS
Pre-HSCT and at 30 and 100 days post-HSCT, 46 patients underwent computerized neuropsychological testing (CogState) and completed surveys assessing patient-reported cognitive complaints, emotional symptoms (depression, anxiety), sleep quality, daytime sleepiness, and physical and functional well-being. Correlations were calculated between cognitive complaints and neuropsychological performance (at each time-point and across time-points), as well as all other patient-reported variables.
RESULTS
Patient-reported cognitive complaints were largely independent of concurrently assessed objective neuropsychological performance. Uniquely, our longitudinal data demonstrated significant medium to large effect size associations between subjective cognitive complaints post-HSCT with objectively measured change from pre-HSCT in attention, visual learning, and working memory (p < .05-.01). Subjective cognitive complaints post-HSCT were also associated with depression, anxiety, daytime sleepiness and physical well-being (p < .05-.001).
CONCLUSIONS
Patients appear better able to assess their cognitive functioning relative to their own baseline and changes across time rather than relative to community norms. Thus, patient complaints of cognitive compromise justify further in-depth neuropsychological, emotional, and functional assessment. Future research into relationships between cognitive complaints and neuropsychological performance should account for changes in performance over time.
目的
造血干细胞移植（HSCT）受者存在认知能力下降的风险。横断面研究表明，患者对认知能力下降的抱怨与同时测量的客观神经心理学表现相关性较差，但与情绪变量和健康相关的生活质量相关。本纵向研究调查了在考虑到从自身移植前的客观基线变化后，患者自我报告的认知状态是否与客观测量的神经心理学表现一致。
方法
在 HSCT 前和 HSCT 后 30 天和 100 天，46 名患者接受了计算机化神经心理学测试（CogState），并完成了评估患者报告的认知抱怨、情绪症状（抑郁、焦虑）、睡眠质量、白天嗜睡以及身体和功能健康的调查。计算了认知抱怨与神经心理学表现（在每个时间点和所有时间点）以及所有其他患者报告的变量之间的相关性。
结果
患者报告的认知抱怨在很大程度上独立于同时评估的客观神经心理学表现。独特的是，我们的纵向数据表明，HSCT 后主观认知抱怨与注意力、视觉学习和工作记忆从移植前的客观测量变化之间存在显著的中到大效应大小关联（p<.05-.01）。HSCT 后主观认知抱怨还与抑郁、焦虑、白天嗜睡和身体幸福感相关（p<.05-.001）。
结论
患者似乎能够更好地评估他们的认知功能相对于他们自己的基线和随时间的变化，而不是相对于社区标准。因此，患者对认知障碍的抱怨需要进一步进行深入的神经心理学、情绪和功能评估。未来关于认知抱怨与神经心理学表现之间关系的研究应考虑到随时间变化的表现变化。
Zotero 插件