越来越多的人在诊断出血液恶性肿瘤 (HMN) 后能够长期存活，但有关 HMN 患者癌症相关认知障碍的数据有限。更好地了解老年人 HMN 后的认知结果对于患者咨询和管理非常重要。与匹配的非癌症队列相比，对老年人 HMN 诊断前后的认知轨迹和认知下降率进行建模。在这项基于人群的队列研究中，老年人来自健康与退休研究 (HRS) 的 1998 年至 2016 年间在 65 岁之后诊断出患有 HMN 的成年人，使用包含与认知相关变量的倾向评分，与来自同一 HRS 波的未患癌症的参与者进行 1:3 匹配。使用分段线性样条对认知轨迹进行建模，并比较两组在诊断之前、期间和之后的认知下降率。分析2022年4月至2024年4月的数据。通过医疗保险诊断代码进行HMN诊断。通过1992年至2020年的Langa-Weir认知总结评分评估认知功能。与认知相关的社会人口学和健康相关变量纳入倾向评分。基线时，HMN 队列中有 668 名参与者（平均 [SD] 年龄，76.8 [7.6] 岁；343 [51.3%] 男性；72 [10.8%] 黑人，33 [4.9%] 西班牙裔，585 [87.6%]白人）和 1994 名对照组参与者（平均 [SD] 年龄，76.5 [7.3] 岁；1020 名 [51.2%] 男性；226 名 [11.3%] 黑人，91 名 [4.6%] 西班牙裔，1726 名 [86.6%] 白人）。 HMN 队列主要由惰性诊断组成，只有 96 名患者 (14.4%) 接受了化疗。在诊断之前和诊断前后的两年内，HMN 组和对照组的认知能力下降率相似。诊断后 1 年及以后，HMN 队列的认知能力下降速度（-0.18；95% CI，-0.23 至 -0.14）比对照组（-0.24；95% CI，-0.26 至 -0.23）慢）（P = .02），但在考虑死亡竞争风险后，这种差异不再显着（HMN组，-0.27；95% CI，-0.34至-0.19；对照组，-0.30；95% CI， -0.33 至 -0.27；P = .48）。在这项针对老年人的队列研究中，考虑到死亡的竞争风险，HMN 和匹配的非癌症对照队列在诊断前、诊断期间和诊断后的认知能力下降率相似。

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.