老年血液恶性肿瘤患者的认知轨迹分析

随着越来越多的患者在血液恶性肿瘤（HMN）诊断后实现长期存活，但关于HMN患者的认知功能障碍的研究仍然有限。深入理解老年患者在HMN后的认知结局，对于患者咨询和管理具有重要意义。本研究旨在建立模型，描述老年患者在HMN诊断前后认知轨迹及认知衰退速度，与匹配的非癌症对照组进行比较。在这项基于人群的队列研究中，利用健康与退休研究（HRS）中的数据，筛选出在1998年至2016年间诊断为HMN的65岁以上老年人，采用倾向评分匹配，将其与同期未患癌症的参与者一对三匹配，考虑认知相关变量。采用分段线性样条模型描述认知轨迹，比较两组在诊断前、诊断期间和诊断后的认知衰退速度。数据分析截止至2024年4月。HMN的诊断依据为Medicare诊断编码。认知功能通过1992年至2020年的兰加-韦尔认知总结评分（Langa-Weir）进行评估。模型中融入了与认知相关的社会人口学和健康变量的倾向评分。在基线，HMN组有668名参与者（平均年龄76.8岁±7.6；男性占51.3%，343人；黑人10.8%，72人；西班牙裔4.9%，33人；白人87.6%，585人），对照组有1994名（平均年龄76.5±7.3岁；男性占51.2%，1020人；黑人11.3%，226人；西班牙裔4.6%，91人；白人86.6%，1726人）。HMN多为缓慢进展的类型，只有14.4%（96人）接受了化疗。在诊断前两年及其左右，HMN组与对照组的认知衰退速度相似。诊断后1年及以后，HMN组的认知衰退速度较慢（-0.18，95% CI：-0.23到-0.14），而对照组为（-0.24，95% CI：-0.26到-0.23）（P=0.02），但在考虑死亡竞争风险后，此差异不再显著（HMN组-0.27，95% CI：-0.34到-0.19；对照组-0.30，95% CI：-0.33到-0.27；P=0.48）。在本研究中，老年HMN患者与匹配的非癌症对照组在诊断前、期间及之后的认知衰退速度在考虑死亡竞争风险后无显著差异。

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.