Department of Haematology, Clinical Cancer Research Unit, Aalborg University Hospital, Mølleparkvej 4, Aalborg 9000, Denmark; Department of Clinical Medicine, Aalborg University, Selma Lagerløfs Vej 249, Gistrup 9260, Denmark.
Department of Haematology, Clinical Cancer Research Unit, Aalborg University Hospital, Mølleparkvej 4, Aalborg 9000, Denmark; Department Mathematical Sciences, Aalborg University, Skjernvej 4A, Aalborg 9220, Denmark.
J Geriatr Oncol. 2024 Jan;15(1):101672. doi: 10.1016/j.jgo.2023.101672. Epub 2023 Nov 16.
Treatment of lymphoma can be associated with cognitive challenges, and some patients may fear development of dementia as long-term complication. Studies report a lower risk of dementia after cancer. Some believe this difference to be a protective mechanism of cancer, others believe it to be driven by bias. The risk of developing dementia after lymphoma has not been investigated in a population-based setting. The aim of this study was to identify the risk of being diagnosed with dementia after lymphoma treatment.
This Danish nationwide matched cohort study included patients aged ≥65 years with a first-time diagnosis of a non-central nervous system lymphoma between 2005 and 2018 in complete remission after treatment with chemotherapy. Patients diagnosed with dementia or treated with dementia medication before lymphoma diagnosis were excluded. Each patient was matched 1:5 on sex, year of birth, and a modified Charlson comorbidity index. Patients and matched comparators were followed from the corresponding patient's date of complete remission. The risk of developing dementia was calculated using cause-specific hazard ratios (HR), and the cumulative risk was estimated by Aalen-Johansen with death as the competing risk.
A total of 3,244 patients and 16,220 matched comparators were included in the study. There was no difference in risk of all-cause dementia among patients with lymphoma compared to matched comparators with cause-specific HR of 0.85 (95% confidence interval [CI]: 0.70;1.04). The risk of both Alzheimer's disease and non-Alzheimer's dementia was equal among patients and comparators: HR 0.89 (95% CI: 0.66;1.21) and 0.82 (95% CI: 0.63;1.07), respectively. Stratified by lymphoma subtype, age, or year of diagnosis, the risk of all-cause dementia remained equal among patients and matched comparators. The cumulative risk of all-cause dementia was significantly lower among patients with lymphoma compared to matched comparators (Gray's test p < 0.001), probably reflecting higher mortality in patients with lymphoma.
The risk of all-cause dementia, Alzheimer's disease, and non-Alzheimer's dementia was equal among older patients with lymphoma compared to matched comparators. Our data suggests that risk of developing dementia is not changed after lymphoma treatment.
淋巴瘤的治疗可能会导致认知挑战，一些患者可能会担心作为长期并发症出现痴呆。研究报告癌症后痴呆的风险较低。一些人认为这种差异是癌症的一种保护机制，另一些人则认为这是由偏见驱动的。在基于人群的环境中，尚未研究淋巴瘤治疗后发生痴呆的风险。本研究的目的是确定淋巴瘤治疗后诊断为痴呆的风险。
这是一项丹麦全国性匹配队列研究，纳入了 2005 年至 2018 年间在化疗完全缓解后患有非中枢神经系统淋巴瘤且年龄≥65 岁的患者。排除了在淋巴瘤诊断前患有痴呆或接受痴呆药物治疗的患者。每位患者按性别、出生年份和改良 Charlson 合并症指数进行 1:5 匹配。患者和匹配的对照组从相应患者的完全缓解日期开始随访。使用特定原因的风险比（HR）计算发展为痴呆的风险，通过 Aalen-Johansen 估计累积风险，以死亡为竞争风险。
共有 3244 名患者和 16220 名匹配的对照组纳入研究。与匹配的对照组相比，淋巴瘤患者的全因痴呆风险无差异，特定原因 HR 为 0.85（95%置信区间[CI]：0.70；1.04）。患者和对照组患阿尔茨海默病和非阿尔茨海默病痴呆的风险相等：HR 分别为 0.89（95%CI：0.66；1.21）和 0.82（95%CI：0.63；1.07）。按淋巴瘤亚型、年龄或诊断年份分层，患者和匹配的对照组全因痴呆风险仍然相等。与匹配的对照组相比，淋巴瘤患者的全因痴呆累积风险显著降低（Gray 检验 p<0.001），这可能反映了淋巴瘤患者的死亡率较高。
与匹配的对照组相比，老年淋巴瘤患者发生全因痴呆、阿尔茨海默病和非阿尔茨海默病痴呆的风险相等。我们的数据表明，淋巴瘤治疗后发生痴呆的风险没有改变。
