Northeast Ohio Medical University, Rootstown, OH.
Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC.
Clin Lymphoma Myeloma Leuk. 2022 Dec;22(12):920-927. doi: 10.1016/j.clml.2022.08.002. Epub 2022 Aug 15.
Cancer-related cognitive impairment (CRCI) has been largely unstudied in patients with multiple myeloma (MM). This study describes patient-reported cognition over time and patient factors associated with adverse cognitive outcomes in MM.
Participants enrolled in a registry in which they completed a geriatric assessment at study entry, and 3 & 6 months after entry. Cognitive function was assessed using the EORTC QLQ-C30 Cognitive Function subscale, with CRCI defined as scores < 75. Generalized estimating equation (GEE) models were used to fit longitudinal models to investigate differences by group and differences in changes over time by group, with adjustment for time since diagnosis.
One hundred and four adults with MM had mean age of 67 years and 30% identified as Black. Patient-reported CRCI was present in 18% of participants at enrollment, 21% at 3 months, and 30% at 6 months. Worse cognitive function was reported in those with impairments in physical function (P = .002), IADLs (P = .02), and performance status (P = .04), as well as in those who were prefrail/frail (P = .02) and depressed (P = .049). Greater cognitive decline over time was observed in patients without CRCI at enrollment (P < .0001) and those with lower levels of education (P = .04).
This is one of the first studies to describe longitudinal changes in patient-reported cognition in patients with MM. Several potentially intervenable factors, including physical function impairment and depression, were associated with worse cognition at study entry, but only baseline CRCI status and education level were predictive of future decline.
多发性骨髓瘤（MM）患者的癌症相关认知障碍（CRCI）研究甚少。本研究描述了 MM 患者随时间推移的认知变化以及与认知不良结局相关的患者因素。
参与者在注册中心登记，在登记时以及登记后 3 个月和 6 个月进行了老年评估。使用 EORTC QLQ-C30 认知功能子量表评估认知功能，CRCI 定义为得分<75。使用广义估计方程（GEE）模型拟合纵向模型，以研究组间差异和组间随时间变化的差异，并根据诊断后时间进行调整。
104 名 MM 成年患者的平均年龄为 67 岁，30%的患者为黑人。18%的参与者在登记时报告存在认知障碍，3 个月时为 21%，6 个月时为 30%。身体功能（P=0.002）、IADLs（P=0.02）和表现状态（P=0.04）受损、衰弱/脆弱（P=0.02）和抑郁（P=0.049）的患者报告的认知功能更差。在登记时无 CRCI 的患者（P<0.0001）和受教育程度较低的患者（P=0.04）随时间观察到更大的认知下降。
这是首批描述 MM 患者报告认知随时间变化的研究之一。一些潜在的可干预因素，包括身体功能障碍和抑郁，与研究开始时的认知障碍有关，但只有基线 CRCI 状态和教育程度与未来的认知下降有关。
