The Role of Age in Neurocognitive Functioning among Adult Allogeneic Hematopoietic Cell Transplant Recipients

Abstract

Improvements in supportive care have enabled allogeneic hematopoietic cell transplant (HCT) to be performed in increasingly older patients. HCT is associated with neurocognitive impairment, which may be exacerbated in older adults due to normal neurocognitive decline associated with aging. The goal of this study was to evaluate whether increased age in allogeneic HCT recipients is associated with worse neurocognitive outcomes over time relative to a matched sample of individuals without cancer. Patients (n = 140; 42% female, M age = 51, range = 20–76; 31% with acute myeloid leukemia) completed neurocognitive assessments before transplant and three months and one year post-transplant. Controls (n = 75; 56% female, M age = 53, range = 21–74) completed assessments at comparable time intervals. Linear mixed models revealed that regardless of age, patients demonstrated worse performance than controls prior to transplant in verbal memory, visual memory, and total neuropsychological performance, and over time in executive functioning. In addition, older age was associated with worse performance in verbal memory (p = .02) and verbal fluency (p = .05) over time in patients relative to controls. Specifically, older (65+ years of age) patients had worse verbal memory and verbal fluency than older and younger (<65 years of age) controls post-transplant (Cohen's d values=.22–.39). These data indicate that age may be a risk factor for worse neurocognitive outcomes after allogeneic HCT. If replicated, our results suggest that older allogeneic HCT candidates should be counseled regarding the risk of cognitive problems after transplant.

Cognitive Function and Quality of Life in Vorinostat-Treated Patients after Matched Unrelated Donor Myeloablative Conditioning Hematopoietic Cell Transplantation

“…Interestingly, we found that older age (65 years) was a significant predictor of worse visual working memory, to the extent of nearly a full SD (.9 SD), regardless of study cohort (ie, vorinostat-treated, autologous control subjects, allogeneic control subjects). This finding is consistent with recent studies of cognitive impairment in older patients [4,35]. Because of the potential impact of steroid use on neurocognitive function, we also included it as a covariate in our models.…”

Neurocognitive dysfunction in hematopoietic cell transplant recipients: expert review from the late effects and Quality of Life Working Committee of the CIBMTR and complications and Quality of Life Working Party of the EBMT

“…In the few studies that have reported findings in this population, results suggest regardless of age, HCT survivors have more neurocognitive dysfunction than healthy individuals. 25 Further, age was not associated with outcomes such as graft-versus-host disease, non-relapse mortality or overall survival. 25 …”

“…25 Further, age was not associated with outcomes such as graft-versus-host disease, non-relapse mortality or overall survival. 25 …”

Frailty in Hematologic Malignancy

“…(62, 63) Specifically, at 3 years post-HCT, reduced-intensity HCT recipients scores declined significantly (P<0.003) for executive function, verbal fluency, and working memory compared to non-cancer controls (63). The ability to manage a complex medication regimen, enjoy a hobby, and return to prior social roles is more difficult with cognitive impairment (64).…”