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Cognitive impairment in candidates for allogeneic hematopoietic stem cell transplantation

Bone Marrow Transplantation volume 57, pages 89–94 (2022)Cite this article

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Abstract

Hematopoietic cell transplant (HCT) is an increasingly common and curative treatment strategy to improve survival among individuals with malignant and nonmalignant diseases, with over one million HCTs having been performed worldwide. Neurocognitive dysfunction is a common and untoward consequence of HCT for many recipients, although few studies have examined the profile of neurocognitive impairments in HCT or their association with clinical features, such as frailty, or the incidence of pre-HCT neurocognitive impairments across all ages, which may influence post-HCT neurocognitive impairments. We examined the pattern and correlates of pre-transplant neurocognitive dysfunction in a prospective sample of adults undergoing HCT. Neurocognition was assessed using the Montreal Cognitive Assessment Battery. Frailty was assessed using the Short Physical Performance Battery. Linear regression analysis was used to examine the associations between neurocognitive performance and frailty. Neurocognitive screening profiles were also examined by partitioning MoCA into domain scores, including Executive Function and Memory. We also examined the associations between neurocognition, frailty, and clinical outcomes, including length of transplant hospitalization and survival. One hundred and ten adults were evaluated across a wide age range (range: 19–75; mean age = 54.7 [SD = 14.1]). Neurocognitive performance tended to fall below published normative levels (mean MoCA = 25.5 [SD = 4.1]), with 17% of participants demonstrating impaired performance compared with medical normative data (MoCA ≤ 22) and 34% exhibiting impaired performance relative to healthy samples (MoCA ≤ 25). Mild impairments (MoCA ≤ 25) were common across age ranges, including middle-aged patients (23% for age < 50; 35% for age 50–60, 41% for age ≥ 60), particularly for items assessing Executive Function. Greater levels of frailty associated with lower neurocognitive screening scores (r = −0.29, P < 0.01) and Executive Functioning (r = −0.24, P < 0.01), whereas greater age was associated with poorer Memory performance only (r = −0.33, P < 0.01). Greater levels of frailty prior to transplant associated with longer length of stay (β = 0.10, P = 0.046), but were not associated with survival. Neurocognitive impairments are common among adults undergoing HCT and the pattern of performance varies by age. Pre-transplant frailty is associated with neurocognitive functioning and may portend worse post-transplant early clinical outcomes.

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Fig. 1: Frailty and cognitive functioning.

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  1. Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA

    Patrick J. Smith

  2. Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, NC, USA

    Meagan Lew, Yen Lowder, Kristi Romero, Jillian C. Thompson, Lauren Bohannon, Alyssa Pittman, Alexandra Artica, Sendhilnathan Ramalingam, Taewoong Choi, Cristina Gasparetto, Mitchell Horwitz, Gwynn Long, Richard Lopez, David Rizzieri, Stefanie Sarantopoulos, Keith Sullivan, Nelson Chao & Anthony D. Sung

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PJS collected the data, analyzed the data, wrote the paper, revised the paper, and secured funding for the project; ML collected the data, analyzed the data, revised the paper; YL collected the data, analyzed the data, and revised the paper; KR collected the data, analyzed the data, and revised the paper; JCT collected the data, analyzed the data, and revised the paper; LB collected the data, analyzed the data, and revised the paper; AP collected the data and revised the paper; AA collected the data, analyzed the data, and revised the paper; SR collected the data, analyzed the data, and revised the paper; TC revised the paper; CG revised the paper; MH revised the paper; GL revised the paper; RL revised the paper; DR revised the paper; SS revised the paper; KS revised the paper; NC revised the paper; ADS analyzed the data, revised the paper, and secured funding for the project.

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Smith, P.J., Lew, M., Lowder, Y. et al. Cognitive impairment in candidates for allogeneic hematopoietic stem cell transplantation. Bone Marrow Transplant 57, 89–94 (2022). https://doi.org/10.1038/s41409-021-01470-z

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  • DOI: https://doi.org/10.1038/s41409-021-01470-z

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