老年人的认知轨迹被诊断为血液学恶性肿瘤

诊断出血液学恶性肿瘤（HMN）后，越来越多的人长期存活，但是HMN患者的癌症相关认知障碍的数据有限。更好地理解老年人HMN后的认知结果对于患者咨询和管理非常重要。与一项基于人群的同伙研究相比，老年人在HMN诊断前后的认知轨迹和认知率下降的速度与NMN诊断之前和之后。从相同的HRS波使用倾向得分，其中包含与认知相关的变量。认知轨迹是用分段线性花键建模的，在两组中比较了诊断之前，期间和之后的认知率下降速率。从2022年4月至2024年4月分析了数据。HMN通过Medicare诊断代码诊断。认知功能通过1992年至2020年的Langa-Weir认知摘要得分评估。社会人口统计学和与健康相关的变量与认知相关的认知变量已纳入了倾向评分。 [7.6]年； 343 [51.3％]男性; [86.6％]白色）。 HMN队列主要由更懒惰的诊断组成，只有96例患者（14.4％）接受了化学疗法。在诊断之前和2年前，HMN和对照组的认知能力下降率相似。在诊断后及以后的1年，HMN队列中的认知下降速度慢（-0.18; 95％CI，-0.23至-0.14）比对照组（-0.24; 95％CI，-0.26至-0.23）（p = .02）（p = .02）（P = .02）（pretance compands and Nesty）（竞争）（hy）（hm ci; 95％; 95％; 95％; 95％; -0.27; 95％CI，-0.34至-0.19; -0.30； 95％CI，-0.33至-0.27）。

More people are surviving long-term after diagnosis with hematologic malignant neoplasm (HMN), yet there are limited data on cancer-related cognitive impairment in people with HMN. Better understanding cognitive outcomes after HMN in older adults is important for patient counseling and management.To model cognitive trajectories and rates of cognitive decline before and after HMN diagnosis in older adults compared with a matched noncancer cohort.In this population-based cohort study, older adults from the Health and Retirement Study (HRS) diagnosed with HMN between 1998 and 2016 after age 65 years were matched 1:3 to participants without cancer from the same HRS wave using propensity scores incorporating variables relevant to cognition. Cognitive trajectories were modeled with piecewise linear splines, and rates of cognitive decline before, during, and after diagnosis were compared in the 2 groups. Data were analyzed from April 2022 to April 2024.HMN diagnosis by Medicare diagnosis codes.Cognitive function was assessed by the Langa-Weir cognitive summary score from 1992 to 2020. Sociodemographic and health-related variables relevant to cognition were incorporated into propensity scores.At baseline, there were 668 participants in the HMN cohort (mean [SD] age, 76.8 [7.6] years; 343 [51.3%] male; 72 [10.8%] Black, 33 [4.9%] Hispanic, and 585 [87.6%] White) and 1994 participants in the control cohort (mean [SD] age, 76.5 [7.3] years; 1020 [51.2%] male; 226 [11.3%] Black, 91 [4.6%] Hispanic, and 1726 [86.6%] White). The HMN cohort consisted predominantly of more indolent diagnoses, and only 96 patients (14.4%) received chemotherapy. Before and in the 2 years around the time of diagnosis, the HMN and control cohorts had similar rates of cognitive decline. At 1 year postdiagnosis and beyond, the rate of cognitive decline was slower in the HMN cohort (-0.18; 95% CI, -0.23 to -0.14) than in the control group (-0.24; 95% CI, -0.26 to -0.23) (P = .02), but this difference was no longer significant after accounting for the competing risk of death (HMN group, -0.27; 95% CI, -0.34 to -0.19; control group, -0.30; 95% CI, -0.33 to -0.27; P = .48).In this cohort study of older adults, the HMN and matched noncancer control cohorts had similar rates of cognitive decline before, during, and after diagnosis after accounting for the competing risk of death.