Department of Medicine, University Health Network, Toronto, ON, Canada.
Department of Medicine, University of Toronto, Toronto, ON, Canada.
J Geriatr Oncol. 2022 Nov;13(8):1141-1148. doi: 10.1016/j.jgo.2022.07.007. Epub 2022 Jul 22.
Objective measures of physical function are associated with cognitive function in community-dwelling older adults. Many older adults experience cognitive declines prior to cancer treatment initiation. Thus, it is unclear whether the association between low physical function and cognitive impairment is generalizable to older adults with cancer prior to treatment. Our objective was to examine whether objective measures of physical function were associated with cognitive impairment in geriatric oncology patients prior to treatment.
We used prospectively collected data from an institutional database within a cancer centre and electronic medical records of older adults who had undergone a geriatric assessment before cancer treatment. Objective measures of physical function included grip strength and the Short Physical Performance Battery (SPPB). Cognitive impairment was assessed via the Mini-Cog. Multivariable logistic regression was used to determine whether grip strength and SPPB were associated with cognitive impairment prior to cancer treatment in all patients, as well as in patients with moderate-to-high comorbidity as part of a sensitivity analysis.
A total of 386 older adults (mean age 80.9 years) were included in the analysis. Most participants (65.3%) had low grip strength and/or low SPPB, whereas 42.2% were cognitively impaired. Neither low grip strength (odds ratio [OR] = 1.55, 95% confidence interval [CI] = 0.92-2.63, p = 0.097) nor low SPPB (OR = 1.29, 95%CI = 0.69-2.42, p = 0.41) alone or combined (OR = 1.05, 95%CI = 0.59-1.88, p = 0.85) were significantly associated with cognitive impairment in multivariable analyses of all patients. However, low SPPB was significantly associated with cognitive impairment in the sensitivity analysis restricted to patients with moderate-to-high comorbidity (OR = 4.05, 95%CI = 1.50-10.95, p = 0.006). Dependence in one or more instrumental activities of daily living [IADLs] was consistently associated with cognitive impairment in the main and sensitivity analyses.
Low physical performance and IADL dependence are associated with cognitive impairment in patients with moderate-to-high comorbidity prior to cancer treatment. Scrutiny is advised for these patients to assess for possible cognitive impairment. Larger studies are warranted to confirm our findings.
在社区居住的老年人中，身体功能的客观测量与认知功能相关。许多老年人在开始癌症治疗前就经历了认知能力下降。因此，尚不清楚低身体功能与认知障碍之间的关联是否适用于接受癌症治疗前的老年癌症患者。我们的目的是检查在接受癌症治疗之前，老年肿瘤患者的身体功能客观测量是否与认知障碍相关。
我们使用了机构数据库和癌症中心内电子病历中前瞻性收集的数据，这些数据来自于接受癌症治疗前接受老年评估的老年人。身体功能的客观测量包括握力和简短体能状况测试（SPPB）。认知障碍通过 Mini-Cog 进行评估。多变量逻辑回归用于确定在所有患者中，握力和 SPPB 是否与癌症治疗前的认知障碍相关，以及在作为敏感性分析一部分的中高合并症患者中是否与认知障碍相关。
共纳入 386 名老年人（平均年龄 80.9 岁）进行分析。大多数参与者（65.3%）握力较低和/或 SPPB 较低，而 42.2%的参与者认知受损。握力较低（比值比 [OR] = 1.55，95%置信区间 [CI] = 0.92-2.63，p = 0.097）、SPPB 较低（OR = 1.29，95%CI = 0.69-2.42，p = 0.41）或两者均较低（OR = 1.05，95%CI = 0.59-1.88，p = 0.85）在多变量分析中均与所有患者的认知障碍无关。然而，在仅包括中高合并症患者的敏感性分析中，低 SPPB 与认知障碍显著相关（OR = 4.05，95%CI = 1.50-10.95，p = 0.006）。在主要和敏感性分析中，一项或多项工具性日常生活活动（IADLs）的依赖始终与认知障碍相关。
在接受癌症治疗前，中高合并症患者的身体功能表现较差和 IADL 依赖与认知障碍相关。建议对这些患者进行仔细检查以评估是否存在认知障碍。需要更大的研究来证实我们的发现。
