Cognitive function in patients prior to undergoing allogeneic hematopoietic stem cell transplantation

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 thep < 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.

Automated summary

The study found that over 50% of cancer patients undergoing allogeneic transplantation exhibit cognitive impairment prior to the procedure. Factors related to worse cognitive function include hematopoietic cell transplantation-comorbidity index score and history of alcohol or substance abuse. Pre-transplant evaluation of medical comorbidities and substance abuse history may help identify patients at risk for cognitive impairment.