Cognitive function in patients prior to undergoing allogeneic hematopoietic stem cell transplantation
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ORIGINAL ARTICLE
Cognitive function in patients prior to undergoing allogeneic hematopoietic stem cell transplantation Zev M. Nakamura 1,2 & Allison M. Deal 2 & Donald L. Rosenstein 1,2,3 & Laura J. Quillen 1 & Stephanie A. Chien 1 & William A. Wood 2,3 & Thomas C. Shea 2,3 & Eliza M. Park 1,2,3 Received: 16 May 2020 / Accepted: 19 August 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose 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. Methods 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. Results 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. Conclusion 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. Keywords Hematopoietic stem cell transplantation . Bone marrow transplantation . Cognitive impairment . Cancer-related cognitive impairment . Cancer-related cognitive dysfunction
Introduction Cancer-related cognitive impairment (CRCI) refers to a constellation of problems with memory, attention, and executive function associated with cancer and/or its treatments. CRCI
* Zev M. Nakamura [email protected] 1
Department of Psychiatry, University of North Carolina at Chapel Hill, 101 Manning Drive, Campus Box #7160, Chapel Hill, NC 27599, USA
2
Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
3
Department of Medicine, Division of Hematology/Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
can have profound consequences, including adverse mental health, inability to
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