Thuy T Koll, Jillian Timperley, Moataz Ellithi, Vijaya R Bhatt, Hongying Dai, Marcia Free, Amelia L Nelson-Sheese, Patrick J Smith, Lauren Hill, Ernaya Johnson, Rebecca A Shelby, Caroline S Dorfman, Aaron T Zhao, Tanya M Wildes, Daniel L Murman, Alfred L Fisher, Anthony D Sung
{"title":"使用蒙特利尔认知评估接受同种异体造血细胞移植的老年人认知功能的变化模式和预测因素。","authors":"Thuy T Koll, Jillian Timperley, Moataz Ellithi, Vijaya R Bhatt, Hongying Dai, Marcia Free, Amelia L Nelson-Sheese, Patrick J Smith, Lauren Hill, Ernaya Johnson, Rebecca A Shelby, Caroline S Dorfman, Aaron T Zhao, Tanya M Wildes, Daniel L Murman, Alfred L Fisher, Anthony D Sung","doi":"10.1007/s11764-025-01835-z","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>This study examined the pattern of change in cognitive function using the Montreal Cognitive Assessment (MoCA) in the context of physical function and identified risk factors for poor cognitive function post allogeneic HCT in adults ≥ 60 years.</p><p><strong>Materials and methods: </strong>This is a two-center prospective cohort study, measuring cognitive and physical function pre-HCT and 3 months post-HCT. A MoCA score of 26 and above is considered normal. We defined mild impairment as a MoCA score of 23-25, and < 23 as moderate impairment. The Sankey plot was generated to assess the transition of impairment status on the MoCA screen from pre-HCT to 3 months post-HCT. The association of predetermined clinical and demographic variables and 3-month cognitive function and cognitive categories was determined using linear mixed-effects model and ordinal logistic regression, respectively. Predetermined variables including physical function, age, gender, education, depressive symptoms, KPS, HCT-CI, disease type, and treatment intensity were used in multivariate analyses.</p><p><strong>Results: </strong>A total of 171 participants were identified. Pre-HCT, 84 (49%) had normal MoCA scores, 51 (30%) had mild, and 36 (21%) had moderate impairment scores. The prevalence of post-HCT mild impairment scores decreased, and moderate impairment scores nearly doubled. Female gender and pre-HCT functional mobility impairment predicted performance on the MoCA post-HCT above and beyond pre-HCT depressive symptoms, comorbid conditions, KPS, and transplant-related factors. Pre-HCT MoCA and functional mobility scores also predicted post-HCT cognitive categories (normal, mild and moderate impairment).</p><p><strong>Conclusion: </strong>Our findings suggest that the pre-HCT MoCA screen can identify those at risk for cognitive impairment post-HCT and can help monitor cognitive function post-HCT.</p><p><strong>Implications for cancer survivors: </strong>Employing the widely used MoCA threshold for impairment (MoCA < 26) could fail to identify a subgroup requiring intervention and monitoring.</p>","PeriodicalId":15284,"journal":{"name":"Journal of Cancer Survivorship","volume":" ","pages":""},"PeriodicalIF":3.1000,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Pattern of change and predictors of cognitive function in older adults receiving allogeneic hematopoietic cell transplantation using the Montreal cognitive assessment.\",\"authors\":\"Thuy T Koll, Jillian Timperley, Moataz Ellithi, Vijaya R Bhatt, Hongying Dai, Marcia Free, Amelia L Nelson-Sheese, Patrick J Smith, Lauren Hill, Ernaya Johnson, Rebecca A Shelby, Caroline S Dorfman, Aaron T Zhao, Tanya M Wildes, Daniel L Murman, Alfred L Fisher, Anthony D Sung\",\"doi\":\"10.1007/s11764-025-01835-z\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>This study examined the pattern of change in cognitive function using the Montreal Cognitive Assessment (MoCA) in the context of physical function and identified risk factors for poor cognitive function post allogeneic HCT in adults ≥ 60 years.</p><p><strong>Materials and methods: </strong>This is a two-center prospective cohort study, measuring cognitive and physical function pre-HCT and 3 months post-HCT. A MoCA score of 26 and above is considered normal. We defined mild impairment as a MoCA score of 23-25, and < 23 as moderate impairment. The Sankey plot was generated to assess the transition of impairment status on the MoCA screen from pre-HCT to 3 months post-HCT. The association of predetermined clinical and demographic variables and 3-month cognitive function and cognitive categories was determined using linear mixed-effects model and ordinal logistic regression, respectively. Predetermined variables including physical function, age, gender, education, depressive symptoms, KPS, HCT-CI, disease type, and treatment intensity were used in multivariate analyses.</p><p><strong>Results: </strong>A total of 171 participants were identified. Pre-HCT, 84 (49%) had normal MoCA scores, 51 (30%) had mild, and 36 (21%) had moderate impairment scores. The prevalence of post-HCT mild impairment scores decreased, and moderate impairment scores nearly doubled. Female gender and pre-HCT functional mobility impairment predicted performance on the MoCA post-HCT above and beyond pre-HCT depressive symptoms, comorbid conditions, KPS, and transplant-related factors. Pre-HCT MoCA and functional mobility scores also predicted post-HCT cognitive categories (normal, mild and moderate impairment).</p><p><strong>Conclusion: </strong>Our findings suggest that the pre-HCT MoCA screen can identify those at risk for cognitive impairment post-HCT and can help monitor cognitive function post-HCT.</p><p><strong>Implications for cancer survivors: </strong>Employing the widely used MoCA threshold for impairment (MoCA < 26) could fail to identify a subgroup requiring intervention and monitoring.</p>\",\"PeriodicalId\":15284,\"journal\":{\"name\":\"Journal of Cancer Survivorship\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":3.1000,\"publicationDate\":\"2025-06-20\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Cancer Survivorship\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1007/s11764-025-01835-z\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"ONCOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Cancer Survivorship","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s11764-025-01835-z","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ONCOLOGY","Score":null,"Total":0}
Pattern of change and predictors of cognitive function in older adults receiving allogeneic hematopoietic cell transplantation using the Montreal cognitive assessment.
Purpose: This study examined the pattern of change in cognitive function using the Montreal Cognitive Assessment (MoCA) in the context of physical function and identified risk factors for poor cognitive function post allogeneic HCT in adults ≥ 60 years.
Materials and methods: This is a two-center prospective cohort study, measuring cognitive and physical function pre-HCT and 3 months post-HCT. A MoCA score of 26 and above is considered normal. We defined mild impairment as a MoCA score of 23-25, and < 23 as moderate impairment. The Sankey plot was generated to assess the transition of impairment status on the MoCA screen from pre-HCT to 3 months post-HCT. The association of predetermined clinical and demographic variables and 3-month cognitive function and cognitive categories was determined using linear mixed-effects model and ordinal logistic regression, respectively. Predetermined variables including physical function, age, gender, education, depressive symptoms, KPS, HCT-CI, disease type, and treatment intensity were used in multivariate analyses.
Results: A total of 171 participants were identified. Pre-HCT, 84 (49%) had normal MoCA scores, 51 (30%) had mild, and 36 (21%) had moderate impairment scores. The prevalence of post-HCT mild impairment scores decreased, and moderate impairment scores nearly doubled. Female gender and pre-HCT functional mobility impairment predicted performance on the MoCA post-HCT above and beyond pre-HCT depressive symptoms, comorbid conditions, KPS, and transplant-related factors. Pre-HCT MoCA and functional mobility scores also predicted post-HCT cognitive categories (normal, mild and moderate impairment).
Conclusion: Our findings suggest that the pre-HCT MoCA screen can identify those at risk for cognitive impairment post-HCT and can help monitor cognitive function post-HCT.
Implications for cancer survivors: Employing the widely used MoCA threshold for impairment (MoCA < 26) could fail to identify a subgroup requiring intervention and monitoring.
期刊介绍：
Cancer survivorship is a worldwide concern. The aim of this multidisciplinary journal is to provide a global forum for new knowledge related to cancer survivorship. The journal publishes peer-reviewed papers relevant to improving the understanding, prevention, and management of the multiple areas related to cancer survivorship that can affect quality of care, access to care, longevity, and quality of life. It is a forum for research on humans (both laboratory and clinical), clinical studies, systematic and meta-analytic literature reviews, policy studies, and in rare situations case studies as long as they provide a new observation that should be followed up on to improve outcomes related to cancer survivors. Published articles represent a broad range of fields including oncology, primary care, physical medicine and rehabilitation, many other medical and nursing specialties, nursing, health services research, physical and occupational therapy, public health, behavioral medicine, psychology, social work, evidence-based policy, health economics, biobehavioral mechanisms, and qualitative analyses. The journal focuses exclusively on adult cancer survivors, young adult cancer survivors, and childhood cancer survivors who are young adults. Submissions must target those diagnosed with and treated for cancer.
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