Identification of the predictors of cognitive impairment in patients with cancer in palliative care: a prospective longitudinal analysis.
Studies with neuropsychological assessments in patients with cancer are sparse, and the evidence is very limited regarding their status of cognitive function over time. This study aimed at assessing the prevalence and predictors of cognitive impairment in patients with cancer in palliative care.



Prospective longitudinal investigation derived from the European Palliative Care Cancer Symptom study (2011-2013) including patients with cancer in palliative care, ≥18 years, and with at least one assessment post-inclusion. For cognitive assessment, a 4-item version of the Mini Mental State Examination was applied at inclusion and after 4 to 16 weeks. Logistic regression model with multiple imputations was applied.



The sample consisted of 1568 patients (50% male, mean age 65.5, 42% with 10-12 years schooling, mean Karnofsky Performance Status-KPS 68%). Longitudinal analysis of the patients with complete MMSE at both assessments (n = 801) showed that 64.5% were not impaired, 12.5% remained cognitively impaired, 11.4% developed impairment, and 11.6% improved. Those who improved cognitively also reported reduced pain intensity and increased appetite. The predictive model (n = 1351) showed that those with low KPS (OR = 1.6, 95% CI 1.0-2.5) most often developed cognitive impairment, while patients with breast cancer (OR = 0.4, 95% CI 0.2-0.7) had lower odds for impairment.



During palliative care, a substantial number of patients remained cognitively impaired or developed cognitive impairment; however, it is noteworthy that improvement was also observed. Physical performance and cancer type may predict cognitive impairment.
Palliative Research Group, Department of Oncology, Rigshospitalet-Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark. geana.kurita@regionh.dk.|Multidisciplinary Pain Centre, Department of Neuroanaesthesiology, Rigshospitalet-Copenhagen University Hospital, Copenhagen, Denmark. geana.kurita@regionh.dk.
Geana Paula
GP
Kurita
Palliative Research Group, Department of Oncology, Rigshospitalet-Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark.|Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
Kirstine Skov
KS
Benthien
Palliative Research Group, Department of Oncology, Rigshospitalet-Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark.|Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
Per
P
Sjøgren
Department of Oncology, Oslo University Hospital, Oslo, Norway.|European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Faculty of Medicine Norwegian University of Science and Technology, Trondheim, Norway.|Department of Oncology, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
Stein
S
Kaasa
European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Faculty of Medicine Norwegian University of Science and Technology, Trondheim, Norway.|Regional Advisory Unit for Palliative Care, Department of Oncology, Oslo University Hospital, Oslo, Norway.
Marianne Jensen
MJ
Hjermstad
D000368:Aged; D003071:Cognition; D060825:Cognitive Dysfunction / Q000175:diagnosis*; D005260:Female; D006801:Humans; D017567:Karnofsky Performance Status; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D009369:Neoplasms / Q000523:psychology* / Q000628:therapy*; D009483:Neuropsychological Tests; D010166:Palliative Care / Q000379:methods* / Q000523:psychology; D011237:Predictive Value of Tests; D015995:Prevalence; D011446:Prospective Studies
Cognition; Cognitive symptoms; Longitudinal studies; Neoplasms; Palliative care; Quality of life