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