Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Qol and Patients' Care

Relationship between neurocognitive functioning and medication management ability over the first 6 months following allogeneic stem cell transplantation

Bone Marrow Transplantation volume 51, pages 841–847 (2016)Cite this article

Subjects

Abstract

Although neurocognitive impairment has been established as a major issue among cancer survivors, the real-world consequences of this impairment are unclear. This study investigated the relationship between neurocognitive functioning and medication management ability over time among 58 patients treated with allogeneic hematopoietic stem cell transplantation (HCT). Participants completed a neuropsychological test battery and a simulated medication management task at three time points: pre-transplant (T0), Day 100 (T1) and 6 months post transplant (T2). Neurocognitively impaired participants performed worse on the medication management task than neurocognitively normal participants at each time point, and were more likely to score in the impaired range of medication management ability post transplant (72% vs 20%, P<0.001 at T1; 67% vs 23%, P=0.013 at T2). In multivariate analyses, worse performance in executive functioning/working memory consistently predicted impaired medication management ability, even when controlling for sociodemographic and clinical confounders (odds ratio=0.89, 95% confidence interval (0.80, 0.98), P=0.023). Lower physical symptom distress also predicted impaired medication management ability, but this effect decreased over time. Self-reported cognitive problems were not correlated with medication management ability at any time point. Findings suggest that poor neurocognitive functioning, particularly in the domain of executive functioning/working memory, is associated with worse medication management ability within the first 6 months after allogeneic HCT.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1

Similar content being viewed by others

References

  1. Booth-Jones M, Jacobsen PB, Ransom S, Soety E . Characteristics and correlates of cognitive functioning following bone marrow transplantation. Bone Marrow Transplant 2005; 36: 695–702.

    Article  CAS  PubMed  Google Scholar 

  2. Syrjala KL, Dikmen S, Langer SL, Roth-Roemer S, Abrams JR . Neuropsychologic changes from before transplantation to 1 year in patients receiving myeloablative allogeneic hematopoietic cell transplant. Blood 2004; 104: 3386–3392.

    Article  CAS  PubMed  Google Scholar 

  3. Syrjala KL, Artherholt SB, Kurland BF, Langer SL, Roth-Roemer S, Elrod JB et al. Prospective neurocognitive function over 5 years after allogeneic hematopoietic cell transplantation for cancer survivors compared with matched controls at 5 years. J Clin Oncol 2011; 29: 2397–2404.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Scherwath A, Schirmer L, Kruse M, Ernst G, Eder M, Dinkel A et al. Cognitive functioning in allogeneic hematopoietic stem cell transplantation recipients and its medical correlates: a prospective multicenter study. Psychooncology 2013; 22: 1509–1516.

    Article  PubMed  Google Scholar 

  5. Ahles TA, Root JC, Ryan EL . Cancer- and cancer treatment–associated cognitive change: an update on the state of the science. J Clin Oncol 2012; 30: 3675–3686.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Saykin AJ, Ahles TA, McDonald BC . Mechanisms of chemotherapy-induced cognitive disorders: neuropsychological, pathophysiological, and neuroimaging perspectives. Semin Clin Neuropsychiatry 2003; 8: 201–216.

    Article  PubMed  Google Scholar 

  7. Harder H, Van Gool AR, Duivenvoorden HJ, Cornelissen JJ, Eijkenboom WM, Barge RM et al. Case-referent comparison of cognitive functions in patients receiving haematopoietic stem-cell transplantation for haematological malignancies: two-year follow-up results. Eur J Cancer 2007; 43: 2052–2059.

    Article  PubMed  Google Scholar 

  8. Meadows ME, Chang G, Jones JA, Antin JR, Orav EJ . Predictors of neuropsychological change in patients with chronic myelogenous leukemia and myelodysplastic syndrome. Arch Clin Neuropsychol 2013; 28: 363–374.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Meyers CA, Albitar M, Estey E . Cognitive impairment, fatigue, and cytokine levels in patients with acute myelogenous leukemia or myelodysplastic syndrome. Cancer 2005; 104: 788–793.

    Article  CAS  PubMed  Google Scholar 

  10. Majhail NS, Rizzo JD, Lee SJ, Aljurf M, Atsuta Y, Bonfim C et al. Recommended screening and preventive practices for long-term survivors after hematopoietic cell transplantation. Bone Marrow Transplant 2012; 47: 337–341.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. National Comprehensive Cancer Network. Survivorship, Version 2.2014: National Comprehensive Cancer Network; 2014.

  12. Syrjala KL, Langer SL, Abrams JR, Storer B, Sanders JE, Flowers ME et al. Recovery and long-term function after hematopoietic cell transplantation for leukemia or lymphoma. JAMA 2004; 291: 2335–2343.

    Article  CAS  PubMed  Google Scholar 

  13. Kirchhoff AC, Leisenring W, Syrjala KL . Prospective predictors of return to work in the 5 years after hematopoietic cell transplantation. J Cancer Surviv 2010; 4: 33–44.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Socie G, Mary JY, Esperou H, Robert DV, Aractingi S, Ribaud P et al. Health and functional status of adult recipients 1 year after allogeneic haematopoietic stem cell transplantation. Br J Haematol 2001; 113: 194–201.

    Article  CAS  PubMed  Google Scholar 

  15. Lee SJ, Fairclough D, Parsons SK, Soiffer RJ, Fisher DC, Schlossman RL et al. Recovery after stem-cell transplantation for hematologic diseases. J Clin Oncol 2001; 19: 242–252.

    Article  CAS  PubMed  Google Scholar 

  16. Von Ah D, Jansen CE, Allen DH . Evidence-based interventions for cancer- and treatment-related cognitive impairment. Clin J Oncol Nurs 2014; 18 (suppl): 17–25.

    Article  PubMed  Google Scholar 

  17. Alosco ML, Spitznagel MB, Cohen R, Sweet LH, Colbert LH, Josephson R et al. Cognitive impairment is independently associated with reduced instrumental activities of daily living in persons with heart failure. J Cardiovasc Nurs 2012; 27: 44–50.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Alosco ML, Spitznagel MB, van Dulmen M, Raz N, Cohen R, Sweet LH et al. Cognitive function and treatment adherence in older adults with heart failure. Psychosom Med 2012; 74: 965–973.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Albert SM, Flater SR, Clouse R, Todak G, Stern Y, Marder K et al. Medication management skill in HIV: I. Evidence for adaptation of medication management strategies in people with cognitive impairment. II. Evidence for a pervasive lay model of medication efficacy. AIDS Behav 2003; 7: 329–338.

    Article  PubMed  Google Scholar 

  20. Heaton RK, Marcotte TD, Mindt MR, Sadek J, Moore DJ, Bentley H et al. The impact of HIV-associated neuropsychological impairment on everyday functioning. J Int Neuropsychol Soc 2004; 10: 317–331.

    Article  PubMed  Google Scholar 

  21. Thames AD, Arentoft A, Rivera-Mindt M, Hinkin CH . Functional disability in medication management and driving among individuals with HIV: a 1-year follow-up study. J Clin Exp Neuropsychol 2013; 35: 49–58.

    Article  PubMed  Google Scholar 

  22. Manning KJ, Clarke C, Lorry A, Weintraub D, Wilkinson JR, Duda JE et al. Medication management and neuropsychological performance in Parkinson's disease. Clin Neuropsychol 2012; 26: 45–58.

    Article  PubMed  Google Scholar 

  23. Jeste SD, Patterson TL, Palmer BW, Dolder CR, Goldman S, Jeste DV . Cognitive predictors of medication adherence among middle-aged and older outpatients with schizophrenia. Schizophr Res 2003; 63: 49–58.

    Article  PubMed  Google Scholar 

  24. Ruscin JM, Semla TP . Assessment of medication management skills in older outpatients. Ann Pharmacother 1996; 30: 1083–1088.

    Article  CAS  PubMed  Google Scholar 

  25. Patton DE, Woods SP, Franklin D Jr., Cattie JE, Heaton RK, Collier AC et al. Relationship of Medication Management Test-Revised (MMT-R) performance to neuropsychological functioning and antiretroviral adherence in adults with HIV. AIDS Behav 2012; 16: 2286–2296.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Anderson-Hanley C, Sherman ML, Riggs R, Agocha VB, Compas BE . Neuropsychological effects of treatments for adults with cancer: a meta-analysis and review of the literature. J Int Neuropsychol Soc 2003; 9: 967–982.

    Article  PubMed  Google Scholar 

  27. Falleti MG, Sanfilippo A, Maruff P, Weih L, Phillips KA . The nature and severity of cognitive impairment associated with adjuvant chemotherapy in women with breast cancer: a meta-analysis of the current literature. Brain Cogn 2005; 59: 60–70.

    Article  PubMed  Google Scholar 

  28. Wefel JS, Vardy J, Ahles T, Schagen SB . International Cognition and Cancer Task Force recommendations to harmonise studies of cognitive function in patients with cancer. Lancet Oncol 2011; 12: 703–708.

    Article  PubMed  Google Scholar 

  29. Heaton RK, Miller SW, Taylor MJ, Grant I . Revised Comprehensive Norms for an Expanded Halstead-Reitan Battery: Demographically Adjusted Neuropsychological Norms for African American and Caucasian Adults, Professional Manual. PAR: Lutz, FL, USA, 2004.

    Google Scholar 

  30. Wechsler D . Wechsler Adult Intelligence Scale. Third Edition: Administration and scoring manual: San Antonio, TX: The Psychological Corporation, 1997.

    Google Scholar 

  31. Wechsler D WMS-III: Wechsler Memory Scale Administration and Scoring Manual:396 Psychological Corporation, San Antonio, TX, 1997.

  32. Benedict RH, Schretlen D, Groninger L, Brandt J . Hopkins Verbal Learning Test - revised: normative data and analysis of inter-form and test-retest reliability. Clin Neuropsychol 1998; 12: 43–65.

    Article  Google Scholar 

  33. Brandt J . The Hopkins Verbal Learning Test: development of a new memory test with six equivalent forms. Clin Neuropsychol 1991; 5: 125–142.

    Article  Google Scholar 

  34. The Neuropsychology Center Manual for Administration and Scoring, Trail Making Test. The Neuropsychology Center : Plano, TX, USA, 2008.

  35. Gladsjo JA, Schuman CC, Evans JD, Peavy GM, Miller SW, Heaton RK . Norms for letter and category fluency: demographic corrections for age, education, and ethnicity. Assessment 1999; 6: 147–178.

    Article  CAS  PubMed  Google Scholar 

  36. Strauss E, Spreen O, Sherman EMS, Spreen O . A Compendium of Neuropsychological Tests: Administration, Norms, and Commentary. Oxford University Press : Oxford; New York, 2006; 1216.

    Google Scholar 

  37. Brandt J, Benedict RH . Hopkins Verbal Learning Test - Revised, Professional Manual. PAR: Lutz, FL, USA, 2001.

    Google Scholar 

  38. Broadbent DE, Cooper PF, FitzGerald P, Parkes KR . The Cognitive Failures Questionnaire (CFQ) and its correlates. Br J Clin Psychol. 1982; 21: 1–16.

    Article  PubMed  Google Scholar 

  39. Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ et al. The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 1993; 85: 365–376.

    Article  CAS  PubMed  Google Scholar 

  40. Sorror ML, Maris MB, Storb R, Baron F, Sandmaier BM, Maloney DG et al. Hematopoietic cell transplantation (HCT)-specific comorbidity index: a new tool for risk assessment before allogeneic HCT. Blood 2005; 106: 2912–2919.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Lezak MD, Howieson DB, Loring DW . Neuropsychological Assessment. Oxford University Press: New York, 2004.

    Google Scholar 

  42. Yellen SB, Cella DF, Webster K, Blendowski C, Kaplan E . Measuring fatigue and other anemia-related symptoms with the Functional Assessment of Cancer Therapy (FACT) measurement system. J Pain Symptom Manage 1997; 13: 63–74.

    Article  CAS  PubMed  Google Scholar 

  43. Portenoy RK, Thaler HT, Kornblith AB, Lepore JM, Friedlander-Klar H, Kiyasu E et al. The Memorial Symptom Assessment Scale: an instrument for the evaluation of symptom prevalence, characteristics and distress. Eur J Cancer 1994; 30A: 1326–1336.

    Article  CAS  PubMed  Google Scholar 

  44. Chang VT, Hwang SS, Feuerman M, Kasimis BS, Thaler HT . The memorial symptom assessment scale short form (MSAS-SF). Cancer 2000; 89: 1162–1171.

    Article  CAS  PubMed  Google Scholar 

  45. Radloff LS . The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas 1977; 1: 385–401.

    Article  Google Scholar 

  46. Karnofsky DA, Burchenal JH . MacLeod CM (ed.) Evaluation of Chemotherapeutic Agents; Symposium Held at the New York Academy of Medicine, Mar 25 and 26, 1948. Columbia University Press: New York, 1949, 196.

    Google Scholar 

  47. Schag CC, Heinrich RL, Ganz PA . Karnofsky performance status revisited: reliability, validity, and guidelines. J Clin Oncol 1984; 2: 187–193.

    Article  CAS  PubMed  Google Scholar 

  48. Przepiorka D, Weisdorf D, Martin P, Klingemann HG, Beatty P, Hows J et al. 1994 Consensus Conference on Acute GVHD Grading. Bone Marrow Transplant 1995; 15: 825–828.

    CAS  PubMed  Google Scholar 

  49. Filipovich AH, Weisdorf D, Pavletic S, Socie G, Wingard JR, Lee SJ et al. National Institutes of Health consensus development project on criteria for clinical trials in chronic graft-versus-host disease: I. Diagnosis and staging working group report. Biol Blood Marrow Transplant 2005; 11: 945–956.

    Article  PubMed  Google Scholar 

  50. MacMillan ML, Weisdorf DJ, Wagner JE, DeFor TE, Burns LJ, Ramsay NK et al. Response of 443 patients to steroids as primary therapy for acute graft-versus-host disease: comparison of grading systems. Biol Blood Marrow Transplant 2002; 8: 387–394.

    Article  CAS  PubMed  Google Scholar 

  51. Montgomery DC, Peck EA, Vining GG . Introduction to Linear Regression Analysis. Wiley-Interscience: Hoboken, NJ, USA, 2006; 612.

    Google Scholar 

  52. Woods SP, Moore DJ, Weber E, Grant I . Cognitive neuropsychology of HIV-associated neurocognitive disorders. Neuropsychol Rev 2009; 19: 152–168.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Pullens MJ, De Vries J, Roukema JA . Subjective cognitive dysfunction in breast cancer patients: a systematic review. Psychooncology 2010; 19: 1127–1138.

    Article  PubMed  Google Scholar 

  54. Gisslen M, Price RW, Nilsson S . The definition of HIV-associated neurocognitive disorders: are we overestimating the real prevalence? BMC Infect Dis 2011; 11: 356.

    Article  PubMed  PubMed Central  Google Scholar 

  55. McCutchan JA, Wu JW, Robertson K, Koletar SL, Ellis RJ, Cohn S et al. HIV suppression by HAART preserves cognitive function in advanced, immune-reconstituted AIDS patients. AIDS 2007; 21: 1109–1117.

    Article  PubMed  Google Scholar 

  56. Farmer KC . Methods for measuring and monitoring medication regimen adherence in clinical trials and clinical practice. Clin Ther 1999; 21: 1074–1090.

    Article  CAS  PubMed  Google Scholar 

  57. Ho L, Akada K, Messner H, Kuruvilla J, Wright J, Seki JT . Pharmacist's role in improving medication safety for patients in an allogeneic hematopoietic cell transplant ambulatory clinic. Can J Hosp Pharm 2013; 66: 110–117.

    PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

Fred Banting and Charles Best Canada Graduate Scholarship – Doctoral Award, Canadian Institutes of Health Research; Rosenstadt Dissertation Award and Lawrence S. Bloomberg Faculty of Nursing were the research support. This manuscript contains original material previously presented at the annual scientific meeting of the Canadian Bone and Marrow Transplant Group in June 2014. The views expressed in this article are those of the authors and not an official position of the institution or the funders.

Author information

Authors and Affiliations

  1. Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada

    S Mayo, D Howell & K Metcalfe

  2. Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada

    H A Messner, D Howell, J Kuruvilla, J H Lipton, V Gupta, D D Kim, C Piescic, D Breen, A Lambie, D Loach, F V Michelis, N Alam, J Uhm & L McGillis

  3. Centre for Research on Inner City Health, St. Michael’s Hospital, Toronto, Ontario, Canada

    S B Rourke

  4. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada

    J C Victor

  5. Women’s College Research Institute, Toronto, Ontario, Canada

    K Metcalfe

Authors
  1. S Mayo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. H A Messner
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S B Rourke
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. D Howell
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. J C Victor
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. J Kuruvilla
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. J H Lipton
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. V Gupta
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. D D Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. C Piescic
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. D Breen
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. A Lambie
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. D Loach
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. F V Michelis
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. N Alam
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. J Uhm
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. L McGillis
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. K Metcalfe
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to S Mayo.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Additional information

Supplementary Information accompanies this paper on Bone Marrow Transplantation website

Supplementary information

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mayo, S., Messner, H., Rourke, S. et al. Relationship between neurocognitive functioning and medication management ability over the first 6 months following allogeneic stem cell transplantation. Bone Marrow Transplant 51, 841–847 (2016). https://doi.org/10.1038/bmt.2016.2

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/bmt.2016.2

Search

Advanced search

Quick links