Pretreatment cancer-related cognitive impairment in older patients

Abstract

Introduction. Cognitive impairment is common in older adults and may be worsened by cancer and its treatment. While cancer-related cognitive impairment (CRCI) during and after therapy is well documented, less is known about cognitive deficits present before treatment begins. The objective herein, was to identify factors independently associated with pretreatment CRCI in older adults with cancer, using data from a geriatric oncology service in a tertiary hospital in Lima, Peru. Material and methods. This observational case-control study analyzed data from Comprehensive Geriatric Assessments (CGA) conducted in patients aged ≥ 60 years prior to initiating chemotherapy or surgery. Cognitive function was assessed using the Mini-Mental State Examination (MMSE), with CRCI defined as an MMSE score < 24. Multivariate logistic regression was used to identify independent predictors of CRCI. Results. A total of 189 patients were included (58 with CRCI, 131 without), with a mean age of 75.1 years; 45% were women. The overall prevalence of CRCI was 30.7%. In univariate analysis, CRCI was associated with older age, fewer years of education, malnutrition, depression, higher comorbidity burden, functional dependence, lower handgrip strength, and sarcopenia in women (all p < 0.05). In multivariate analysis, three variables remained significantly associated with CRCI years in education (adjusted OR = 0.75; 95% CI 0.67–0.84; p < 0.001), handgrip strength (adjusted OR = 0.90; 95% CI 0.83–0.98; p = 0.015), and presence of depression (adjusted OR = 3.32; 95% CI 1.20–9.17; p = 0.020). Conclusions. Nearly one in three older adults with cancer presented with cognitive impairment before treat- ment. Higher educational attainment and greater handgrip strength were associated with lower odds of CRCI, while depression significantly increased the risk. These findings highlight the need for early cognitive screening and comprehensive interventions targeting modifiable factors in geriatric oncology care.