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J Geriatr Oncol. 2019 Dec 9. pii: S1879-4068(19)30332-7. doi: 10.1016/j.jgo.2019.11.007. [Epub ahead of print]

Screening for cognitive impairment in older adults with hematological malignancies using the Montreal Cognitive Assessment and neuropsychological testing.

Author information

1
Division of Geriatrics, Gerontology, and Palliative Medicine, Department of Internal Medicine, University of Nebraska Medical Center, 986155 Nebraska Medical Center, Omaha, NE 68198-6155, USA. Electronic address: thuy.koll@unmc.edu.
2
Division of Neuropsychology, Department of Neurological Sciences, 988425 Nebraska Medical Center, University of Nebraska Medical Center, Omaha, NE 68198-8425, USA.
3
Division of Geriatrics, Gerontology, and Palliative Medicine, Department of Internal Medicine, University of Nebraska Medical Center, 986155 Nebraska Medical Center, Omaha, NE 68198-6155, USA.
4
Department of Biostatistics, University of Nebraska Medical Center, 984375 Nebraska Medical Center, Omaha, NE 68198-4375, USA.
5
Division of Medical Oncology, Department of Medicine, Washington University School of Medicine, 660 South Euclid Ave., Campus Box 8056, St. Louis, MO 63110, USA.
6
Department of Neurological Sciences, University of Nebraska Medical Center, 988440 Nebraska Medical Center, Omaha, NE 68198-8440, USA.

Abstract

OBJECTIVES:

The primary objective of the current study is to describe the prevalence and profile of cognitive domains affected in older adults with hematological malignancies evaluated for hematopoietic cell transplantation (HCT) using the Montreal Cognitive Assessment (MoCA) and neuropsychological tests. The secondary objective is to determine if a specific MoCA cut-off score would correlate with the identification of cognitive impairment detected by neuropsychological tests. This would facilitate interpretation of cognitive screening and referral of patients who would likely need further neuropsychological testing.

MATERIALS AND METHODS:

Fifty-one patients 60 years and older who were evaluated for HCT were assessed using a battery of standardized neuropsychological tests and MoCA. We analyzed Receiver Operating Characteristics (ROC) comparing MoCA scores and four different neuropsychological test criteria for cognitive impairment.

RESULTS:

The prevalence of cognitive impairment detected by neuropsychological tests was 53 to 70.6% using the criteria for patients with cancer by the International Cancer Cognition Task Force (ICCTF). The following cognitive domains were most affected: language, learning and memory, visuospatial skills, and executive function. MoCA is an appropriate screening test for cognitive impairment. Using the ICCTF criteria, 86 to 100% of patients are correctly classified as having significant cognitive impairment on neuropsychological tests using a cut-off score of 20 or less.

CONCLUSION:

There is a high prevalence of cognitive impairment identified by neuropsychological tests in older patients with hematological malignancies evaluated for HCT. Identification of an appropriate MoCA cut-off score in this population is important to identify patients who would benefit from further assessment.

KEYWORDS:

Cognitive impairment; Cognitive screens; Hematological malignancies; Hematopoietic cell transplant; Montreal Cognitive Assessment (MoCA); Neuropsychological tests; Older adults

PMID:
31831362
DOI:
10.1016/j.jgo.2019.11.007

Conflict of interest statement

Declaration of Competing Interest All authors declare no conflicts of interest. Dr. Wildes acted as a site PI on a clinical trial for Janssen and received an honorarium for consulting and work on a webinar from Carevive.

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