Prospective Evaluation of Cognitive Functioning following Allogeneic Hematopoietic Stem Cell Transplantation

Cognitive functioning may be affected by cancer and its treatment, including allogeneic hematopoietic stem cell transplantation (HCT). However, clinicians are poorly suited to counsel patients in this regard, given the lack of prospective evidence to describe how cognitive functioning may change over time, which patients may be most vulnerable to these effects, and what the consequences of these effects may be. The objectives of this study were to: (1) evaluate cognitive functioning among patients treated with allogeneic HCT over the first six months following transplant; (2) identify demographic, physiological and psychological factors that predict cognitive functioning in the six months following transplant; (3) evaluate the relationship between neuropsychological performance and self-reported cognitive problems; and (4) explore the relationship between cognitive functioning with functional performance, specifically medication management ability. To this end, 58 patients treated with allogeneic HCT completed measures of cognitive functioning prior to transplant, and at Day 100 and six months post-transplant. Measures of cognitive functioning included a standardized battery of neuropsychological tests and questionnaires of self-reported cognitive problems. Medication management ability at each time point was assessed using a standardized task in which they were asked to dispense and make inferences about a simulated medication regimen. Finally, demographic, physiological and psychological characteristics were collected through chart abstraction and self-administered questionnaires. Linear multilevel models and correlational analyses formed the basis of the analytic procedure. Prior to transplant, 46% of participants met the criteria for neuropsychological impairment. On average, cognitive functioning at six months after transplant was stable in comparison to pre-transplant levels. This was shown for measures of both neuropsychological performance and self-reported cognitive problems. Pre-transplant characteristics, such as age, sex, IQ, education, and pre-transplant co-morbidities were significant predictors of neuropsychological performance at all time points. However, post-transplant outcomes, such as lower functional status at six months, and higher peak severity of acute graft-versus-host disease were also significant predictors of worse neuropsychological performance after allogeneic HCT. Self-reported cognitive problems were predictive of poorer neuropsychological performance, even when controlling for depression. Poorer cognitive functioning, particularly in the domain of executive functioning and working memory was associated with impaired medication management ability.Ph.D