Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
J Geriatr Oncol. 2022 Sep;13(7):987-996. doi: 10.1016/j.jgo.2022.04.010. Epub 2022 Apr 26.
Older adults with plasma cell disorders (PCDs) experience cognitive dysfunction that may be attributable to the disease and associated therapies. Yet, this has seldom been reported in the literature. Our objectives were to describe cognitive function (objective and patient-reported) in adults with PCDs and to explore clinical correlates of cognitive impairment.
Participants completed a geriatric assessment between March 2018 and February 2020. Cognitive function was evaluated using two objective measures - Montreal Cognitive Assessment (MoCA, cutpoint <26) and Blessed Orientation Memory Concentration Test (BOMC, cutpoint >4) - and two patient-reported outcome (PRO) measures - Patient-Reported Outcomes Measurement Information System Cognitive Function (PROMIS-CF, cutpoint <45) and European Organization for Research and Treatment of Cancer Cognitive Functioning subscale (EORTC-CF, cutpoint <75). Spearman correlations examined relationships among these measures and log binomial regression was used to examine characteristics associated with cognitive impairment, as defined by the MoCA and PROMIS-CF measures.
Among 86 participants with a mean age of 69 (range: 46-91), the prevalence of cognitive dysfunction was between 20% (BOMC) and 63% (MoCA). There was moderate correlation among objective measures (r = 0.51, p < 0.0001), moderate to high correlation among PRO measures (r = 0.69, p < 0.0001), but no correlation between objective and PRO measures. Factors associated with objective impairment included ≤ high school education (RR 1.46, p = 0.009), living alone (RR 1.42, p = 0.02), relapsed/refractory disease (RR 1.39, p = 0.04), empirically de-intensified induction therapy (RR 1.62, p = 0.008), frailty (RR 1.49, p = 0.04), and peripheral vascular disease (RR 1.54, p = 0.002). Factors associated with PRO impairment included social isolation (RR 3.43, p = 0.003), depression (RR 3.30, p = 0.004) and anxiety (RR 4.43, p = 0.0002), frailty (RR 3.60, p = 0.02), falls in the previous 6 months (RR 2.53, p = 0.02), and deficits in physical function (RR 4.44, p = 0.01). Older age was not associated with either objective or PRO impairment.
Cognitive impairment, using objective and PRO screening measures, was relatively common in adults with PCDs. Cancer-related factors and medical comorbidities were associated with objective cognitive impairment whereas psychosocial and functional factors were associated with PRO impairment.
患有浆细胞疾病（PCD）的老年人会出现认知功能障碍，这可能是由于疾病和相关治疗所致。然而，这在文献中很少有报道。我们的目的是描述患有 PCD 的成年人的认知功能（客观和患者报告），并探讨认知障碍的临床相关性。
参与者在 2018 年 3 月至 2020 年 2 月期间完成了老年评估。使用两种客观测量方法——蒙特利尔认知评估（MoCA，得分<26）和祝福定向记忆浓度测试（BOMC，得分>4）——以及两种患者报告的结果（PRO）测量方法——患者报告的结果测量信息系统认知功能（PROMIS-CF，得分<45）和欧洲癌症研究与治疗组织认知功能子量表（EORTC-CF，得分<75）来评估认知功能。Spearman 相关性检验用于检验这些测量之间的关系，对数二项式回归用于检验与 MoCA 和 PROMIS-CF 测量定义的认知障碍相关的特征。
在 86 名平均年龄为 69 岁（范围：46-91 岁）的参与者中，认知功能障碍的患病率在 20%（BOMC）至 63%（MoCA）之间。客观测量之间存在中度相关性（r=0.51，p<0.0001），PRO 测量之间存在中度至高度相关性（r=0.69，p<0.0001），但客观测量与 PRO 测量之间无相关性。与客观损伤相关的因素包括：≤高中教育（RR 1.46，p=0.009）、独居（RR 1.42，p=0.02）、复发/难治性疾病（RR 1.39，p=0.04）、经验性减强度诱导治疗（RR 1.62，p=0.008）、衰弱（RR 1.49，p=0.04）和外周血管疾病（RR 1.54，p=0.002）。与 PRO 损伤相关的因素包括社会隔离（RR 3.43，p=0.003）、抑郁（RR 3.30，p=0.004）和焦虑（RR 4.43，p=0.0002）、衰弱（RR 3.60，p=0.02）、6 个月内跌倒（RR 2.53，p=0.02）和身体功能缺陷（RR 4.44，p=0.01）。年龄较大与客观或 PRO 损伤均无关。
使用客观和 PRO 筛查测量方法，患有 PCD 的成年人中认知障碍较为常见。与癌症相关的因素和合并症与客观认知损伤相关，而心理社会和功能因素与 PRO 损伤相关。
