Neuropsychologic changes from before transplantation to 1 year in patients receiving myeloablative allogeneic hematopoietic cell transplant

Department of Psychiatry and Behavioral Sciences, University of Washington Seattle, Seattle, Washington, United States
Blood (Impact Factor: 10.45). 11/2004; 104(10):3386-92. DOI: 10.1182/blood-2004-03-1155
Source: PubMed


Research indicates that myeloablative hematopoietic cell transplantation (HCT) impairs neurocognitive function. However, prospective studies on long-term effects are lacking. This longitudinal study examined neurocognitive changes over the first year in 142 adult recipients of allogeneic HC transplants who received neuropsychologic testing before transplantation and again after 80 days and 1 year. Age-, sex-, and education-adjusted population-based standardized scores were used for normative comparisons. Performance on all tests declined from before transplantation to 80 days (P < .05) and improved by 1 year (P < .05), returning to pretransplantation levels on all tests except for grip strength and motor dexterity. Although verbal fluency and memory recovered by 1 year, both were below norms at all 3 testing times (P < .01). Logistic regressions indicated that patients without chemotherapy, other than hydroxyurea, previous to HCT and patients not receiving chronic graft-versus-host disease (GVHD) medication at 1 year had lower risk of impaired function (P < .05). In conclusion, HCT was associated with significant generalized decline in neurocognitive performance at 80 days, with subsequent recovery to pretransplantation levels by 1 year for most survivors, except on motor tasks. Results indicate that long-term cognitive decrements, as distinct from motor disabilities, infrequently derive directly from HCT.

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Available from: Sari Roth-Roemer, Mar 18, 2014
    • "Although mild cognitive impairments were observed at baseline in some of these studies, follow-up data were mixed, with most showing declines or no improvement in neuropsychological functioning after transplant (Ahles et al., 1996; Meyers et al., 1994; Parth et al., 1989; Sostak et al., 2003; Wenz et al., 2000). For example, in a recent and well-designed study, Syrjala et al. (2004) found a decline on all cognitive tests from baseline to 80 days posttransplant. By the 1-year follow-up, however, scores had returned to the baseline level, although memory and verbal fluency scores remained half a standard deviation below normal, despite average IQ in the sample. "
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    ABSTRACT: The current study characterizes cognitive and psychiatric status in hematopoietic stem cell transplantation (HSCT) patients shortly before and after transplant. Thirty adult patients were assessed prospectively 1-2 weeks before transplantation and 100 days posttransplantation on neuropsychological and psychiatric measures. Before transplant, participants showed mild impairments on several neuropsychological measures, with the poorest performances occurring on learning and attention. Psychiatric functioning was significantly elevated compared with normative data. Significant improvements, however, were observed on neuropsychological measures by 100 days after transplant. Depression and anxiety scores also improved. Candidates for HSCT experienced mild diffuse cognitive dysfunction and psychiatric morbidity before the procedure, but these symptoms significantly improved by 3 months following their transplant in this small sample. Education about these possible pretransplant sequelae and the potential for rebound may be helpful to patients and families as they prepare for this treatment and the recovery period.
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