Cognitive trajectories and risk factors for cognitive decline in older adults with hematologic malignancies

患有血液系统恶性肿瘤的老年人的认知轨迹和认知能力下降的危险因素

• 批准号: 10301591
• 负责人: Li-Wen Huang
• 金额: $ 15.33万
• 依托单位: NORTHERN CALIFORNIA INSTITUTE/RES/EDU
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-01 至 2023-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10301591
• 关键词: Accounting; Aftercare; Aging; Alzheimer' s disease related dementia; Anxiety; Cancer Patient; Caring; Cognition; Cognitive; Cognitive deficits; Conflict (Psychology); Counseling; Cross-Sectional Studies; Data Set; Development; Diagnosis; Disease; Elderly; Equilibrium; Foundations; Future; Goals; Health; Health and Retirement Study; Hematologic Neoplasms; Hematology; Impaired cognition; Individual; Indolent; Intervention; Interview; K-Series Research Career Programs; Knowledge; Life Style; Link; Literature; Longitudinal cohort; Malignant Neoplasms; Medicare; Mental Depression; Methods; Modality; National Institute on Aging; Oncologist; Oncology; Outcome; Patients; Physical activity; Prospective Studies; Quality of life; Reporting; Research; Research Personnel; Risk; Risk Factors; Screening procedure; Sleep; Solid Neoplasm; Subgroup; Survivors; Systemic Therapy; Systemic disease; age related; aged; base; cancer diagnosis; cancer risk; cancer therapy; cancer-related cognitive impairment; chemotherapy; clinical predictors; clinically relevant; cognitive change; cognitive function; cognitive reserve; cohort; comorbidity; disorder control; experience; follow-up; functional decline; health data; high risk; improved; malignant breast neoplasm; modifiable risk; mortality; normal aging; older patient; patient screening; prognostic; recruit; screening; secondary analysis; sociodemographics; therapy design; treatment comparison

PROJECT SUMMARY/ABSTRACT Cognitive decline associated with cancer and its therapies, or cancer-related cognitive impairment (CRCI), is a dreaded outcome among older adults with cancer who care about how well they can live after surviving serious illness. In older adults, cognitive decline can have wide-ranging impact on quality of life, functional decline, and loss of independence. However, oncologists have little information to guide counseling on the cognitive risks of cancer and its associated therapies. The existing literature on CRCI, mostly in solid tumors such as breast cancer, report conflicting results and have several limitations, such as difficulty accounting for the multiple factors that influence cognition and lack of information about long-term pre- and post-cancer cognitive trajectories. CRCI is particularly relevant to patients with hematologic malignancies since most have the potential for cure or long-term disease control. However, our understanding of CRCI in hematologic malignancies is limited, which impedes our ability to counsel patients on what to expect cognitively or to identify patients at high-risk of cognitive decline. The objectives of this study are to evaluate the long-term cognitive trajectories of older adults aged >65 years with hematologic malignancies and identify predictors of cognitive decline by leveraging data from the Health and Retirement Study (HRS), which is a longitudinal cohort of nationally representative older adults. We will examine changes in the cognitive trajectories of older adults with hematologic malignancies from years before treatment to years after and compare them to changes in cognitive trajectories in matched non-cancer controls (Aim 1 primary analysis). Because hematologic malignancies and treatments are heterogeneous, we will also characterize the cognitive trajectories of older adults with hematologic malignancies based on clinically relevant disease types, and we will also describe the different types of cognitive trajectories that may exist (Aim 1 secondary analysis). Lastly, we will seek to identify predictors of clinically meaningful cognitive decline with a focus on disease/treatment-related variables and modifiable risk factors that will inform treatment discussions and the design of interventions (Aim 2). This study will help fill the critical knowledge gap about the cognitive trajectories of older hematologic malignancy survivors by comparing the change in cognition to what happens with normal aging, characterizing potentially different trajectories based on clinically relevant disease types, and describing different types of trajectories that patients may experience. In addition, the identification of predictors of clinically meaningful cognitive decline will provide important prognostic information to inform treatment discussions and lay the groundwork for the development of future screening tools to identify high-risk subgroups and interventions to mitigate the risk of CRCI.

项目摘要/摘要 与癌症及其疗法或与癌症相关的认知障碍（CRCI）相关的认知下降是一种 癌症老年人的令人恐惧 疾病。在老年人中，认知能力下降会对生活质量，功能下降和 失去独立性。但是，肿瘤学家几乎没有信息可以指导有关认知风险的咨询 癌症及其相关疗法。现有的有关CRCI的文献，主要是在乳房等实体瘤中 癌症，报告矛盾的结果并有几个局限性，例如很难解释多重 影响认知和缺乏有关长期前后认知的信息的因素 轨迹。 CRCI与血液系统恶性肿瘤患者特别相关，因为大多数患有 治愈或长期疾病控制的潜力。但是，我们对血液学中CRCI的理解 恶性肿瘤是有限的，这阻碍了我们在认知上的期望或对患者的咨询能力 确定患者处于认知能力下降的高风险。这项研究的目标是评估长期 老年人的认知轨迹> 65岁，患有血液学恶性肿瘤，并确定 通过利用健康和退休研究（HRS）的数据来认知下降，这是一个纵向 全国代表性老年人队列。我们将检查较老的认知轨迹的变化 血液学恶性肿瘤的成年人从治疗前几年到几年之后，并将其与变化进行比较 在匹配的非癌症控制中的认知轨迹中（AIM 1主要分析）。因为血液学 恶性肿瘤和治疗是异质的，我们还将表征较老的认知轨迹 基于临床相关疾病类型的血液系统恶性肿瘤的成年人，我们还将描述 可能存在的不同类型的认知轨迹（目标1次级分析）。最后，我们将寻求 确定临床意义认知下降的预测因子，重点是疾病/与治疗相关的变量 以及可修改的风险因素，将为治疗讨论和干预设计提供依据（目标2）。这 研究将有助于填补有关旧血液系统恶性肿瘤的认知轨迹的关键知识差距 幸存者通过比较认知的变化与正常衰老发生的情况，表征了潜在的表征 基于临床相关疾病类型的不同轨迹，并描述了不同类型的轨迹 患者可能会经历。此外，识别临床意义认知的预测因子 下降将提供重要的预后信息，以告知治疗讨论并奠定基础 为了开发未来的筛查工具，以识别高风险的亚组和干预措施以减轻 CRCI的风险。