Cognition and Cognitive Impairment in Older Adults with Cancer

Abstract

Aging is a risk factor for cognitive impairment as well as cancer. However, the interplay between these three entities – aging, cognition and cancer – is not well understood. Mounting evidence indicates that both cancer and cancer therapies, such as chemotherapy, can negatively affect cognition and that older adults with pre-existing cognitive impairment may be more susceptible to cognitive decline with therapy than younger patients. For an older adult, decline in cognition may significantly compromise their ability to remain independent in the community. Pre-existing cognitive impairment, at the time of a cancer diagnosis, may also carry an increased risk of treatment-related adverse events in older adults receiving chemotherapy. Growing research suggests behavioral interventions may be helpful in improving chemotherapy-related cognitive changes; however, these interventions have been mainly evaluated in younger patients in whom pre-existing cognitive impairment is less prevalent. Here we review the studies on: cognitive changes associated with cancer and cancer therapies with an emphasis on studies conducted in older adults, relevant screening tools to evaluate cognition in the geriatric oncology setting, and possible intervention strategies for managing cognitive impairment.

Cognitive Effects of Chemotherapy and Cancer-Related Treatments in Older Adults

“…70 SEER Medicare studies suggest that the estimated prevalence of dementia in cancer patients age 65 and over ranges from 3.8 to 7%, 71–73 although these estimates may be lower than true prevalence due to lack of reporting of these diagnoses within Medicare claims. 70 Few studies have examined how a prior diagnosis of MCI or dementia specifically impacts treatment decision-making for cancer and what percentage of these patients are offered various types of cancer therapies, such as surgery or chemotherapy. 70 Gupta and Lamont found that colon cancer patients with a pre-existing dementia diagnosis were more likely to be diagnosed without biopsies and less likely to be treated with curative intent, compared to non-dementia colon cancer patients.…”

“…70 Few studies have examined how a prior diagnosis of MCI or dementia specifically impacts treatment decision-making for cancer and what percentage of these patients are offered various types of cancer therapies, such as surgery or chemotherapy. 70 Gupta and Lamont found that colon cancer patients with a pre-existing dementia diagnosis were more likely to be diagnosed without biopsies and less likely to be treated with curative intent, compared to non-dementia colon cancer patients. 71 Chemotherapy and radiation are administered less frequently to breast cancer patients with a preexisting dementia diagnosis compared to non-dementia breast cancer patients.…”

Early temporal characteristics of elderly patient cognitive impairment in electronic health records

“…For the topic in the medication section, we observed medications to control high blood sugar [38]. The topic in the diagnosis section includes the terms related to cancer [39][40][41][42]. Table 3, set of section and history of present illness include hyperlipidemia that can be considered as a risk factor of CI [43], coronary artery disease and hypertension, which are relevant to cognitive decline [44,45].…”

“…Words like edema, distress, memory, hypertension, coronary, urinary and hyperlipidemia as the potential risk factor of cognitive dysfunction was discussed [44][45][46][47]. Carcinoma, melanoma, cancer, and squamous in the last row are the terms related to cancer [39][40][41][42].…”

“…5a, 6a, and 10b,c. Researchers studied the association between cancer and cognitive decline in older ages [39][40][41][42]. They concluded that cancer therapy could negatively impact cognition in some patients.…”