Department of Psychiatry, University of North Carolina at Chapel Hill, 101 Manning Drive, Campus Box #7160, Chapel Hill, NC, 27599, USA.
Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Support Care Cancer. 2021 Apr;29(4):2007-2014. doi: 10.1007/s00520-020-05697-2. Epub 2020 Aug 23.
Cognitive impairment is common and consequential in patients with cancer who undergo allogeneic hematopoietic stem cell transplantation (HSCT). However, there is no standard of care for evaluating cognition in patients prior to or after receiving HSCT, and it is not known which patients are at highest risk for cognitive impairment. The objectives of this study were to describe cognitive function in patients prior to allogeneic HSCT and identify demographic, disease-related, and psychosocial factors associated with cognitive function.
Prior to HSCT, participants completed the Montreal Cognitive Assessment (MoCA). We assessed bivariable associations between continuous MoCA scores and demographic, disease-related, and psychosocial variables using linear regression. Variables significant at the p < 0.2 level were adjusted for age, sex, and years of education in multiple linear regression analyses.
Over 50% of participants demonstrated evidence of cognitive impairment (MoCA < 26) prior to transplantation. When adjusted for demographic variables, two characteristics were significantly associated with worse cognitive function: the hematopoietic cell transplantation-comorbidity index score (p = 0.01) and history of alcohol or substance abuse (p = 0.02). Pre-HSCT cancer and cancer treatment-specific variables were not associated with cognitive function.
Cognitive impairment is common in patients scheduled to receive HSCT. Pre-transplantation evaluation of medical comorbidities and history of substance abuse may be important in identifying patients at risk for cognitive impairment. Further research characterizing the trajectory and impact of cognitive impairment on patient symptom burden and function may help improve outcomes.
在接受异基因造血干细胞移植（HSCT）的癌症患者中，认知障碍很常见且后果严重。然而，目前尚无评估患者接受 HSCT 前后认知功能的标准，也不知道哪些患者存在认知障碍的风险最高。本研究的目的是描述异基因 HSCT 前患者的认知功能，并确定与认知功能相关的人口统计学、疾病相关和心理社会因素。
在 HSCT 之前，参与者完成了蒙特利尔认知评估（MoCA）。我们使用线性回归分析了 MoCA 评分与人口统计学、疾病相关和心理社会变量之间的双变量关联。在多元线性回归分析中，将 p 值<0.2 的变量调整为年龄、性别和受教育年限。
超过 50%的参与者在移植前表现出认知障碍（MoCA<26）。当调整人口统计学变量时，有两个特征与认知功能较差显著相关：造血干细胞移植合并症指数评分（p=0.01）和酒精或药物滥用史（p=0.02）。HSCT 前癌症和癌症治疗特异性变量与认知功能无关。
计划接受 HSCT 的患者中认知障碍很常见。移植前评估医疗合并症和药物滥用史可能有助于识别存在认知障碍风险的患者。进一步研究认知障碍对患者症状负担和功能的轨迹和影响可能有助于改善结局。
