Cognitive assessment for older adults with cancer: A Young International Society of Geriatric Oncology and Nursing & Allied Health Interest Group initiative

Abstract

Cancer is a disease that mostly affects older adults around the world and the incidence is expected to increase further due to the aging of the world population [ [1] Pilleron S. Sarfati D. Janssen-Heijnen M. et al. Global cancer incidence in older adults, 2012 and 2035: a population-based study. Int J Cancer. 2019; 144: 49-58 Crossref PubMed Scopus (162) Google Scholar ]. Cognitive impairment is also common in the older adult population, and can span in severity from Mild Cognitive Impairment (MCI) to dementia. Dementia is a prevalent condition, occurring in 5–7% in older adults aged 60 years and older and this prevalence is also expected to increase due to the aging of the population [ [2] Prince M. Bryce R. Albanese E. Wimo A. Ribeiro W. Ferri C.P. The global prevalence of dementia: a systematic review and metaanalysis. Alzheimers Dement. 2013; 9 (63–75.e62) Abstract Full Text Full Text PDF Scopus (2840) Google Scholar ]. Dementia, also referred to as major neurocognitive disorder in the DSM-5, is diagnosed when an older adult has substantial cognitive impairment in one or more cognitive domains that interferes with independence in daily activities [ [3] Brodaty H. Aerts L. Crawford J.D. et al. Operationalizing the diagnostic criteria for mild cognitive impairment: the salience of objective measures in predicting incident dementia. Am J Geriatr Psychiatry. 2017; 25: 485-497 Abstract Full Text Full Text PDF PubMed Scopus (22) Google Scholar ]. Whereas, MCI is an early stage of memory loss that is defined as: a) a cognitive complaint or concern, ideally corroborated by an informant, b) objective evidence of cognitive impairment that is abnormal for their age on standardized testing (usually defined as 1–2 standard deviations below normal on the test used); and c) no significant impact on function [ [3] Brodaty H. Aerts L. Crawford J.D. et al. Operationalizing the diagnostic criteria for mild cognitive impairment: the salience of objective measures in predicting incident dementia. Am J Geriatr Psychiatry. 2017; 25: 485-497 Abstract Full Text Full Text PDF PubMed Scopus (22) Google Scholar ]. There is no clear data on how many older adults with MCI develop dementia as rates vary between clinical and population samples, but reversal to normal function is also possible [ [3] Brodaty H. Aerts L. Crawford J.D. et al. Operationalizing the diagnostic criteria for mild cognitive impairment: the salience of objective measures in predicting incident dementia. Am J Geriatr Psychiatry. 2017; 25: 485-497 Abstract Full Text Full Text PDF PubMed Scopus (22) Google Scholar ]. MCI incidence varies widely but meta-analyses showed ranges per 1000 person-years from 22.5 (5.1–51.4) for ages 75-79y, 40.9 (7.7–97.5) for ages 80-84y, to 60.1 (6.7–159.0) for ages 85 and older [ [4] Gillis C. Mirzaei F. Potashman M. Ikram M.A. Maserejian N. The incidence of mild cognitive impairment: a systematic review and data synthesis. Alzheimers Dement (Amst). 2019; 11: 248-256 Abstract Full Text Full Text PDF PubMed Scopus (42) Google Scholar ]. In older adults with pre-existing MCI or dementia who are subsequently diagnosed with cancer, cognitive impairment can lead to challenges in cancer care, including later diagnosis, receive less treatment, having more complications during their cancer treatment and have shorter cancer survival [ [5] Hopkinson J.B. Milton R. King A. Edwards D. People with dementia: what is known about their experience of cancer treatment and cancer treatment outcomes? A systematic review. Psychooncology. 2016; 25: 1137-1146 Crossref PubMed Scopus (26) Google Scholar ]. A prior study using the Surveillance, Epidemiology and End Results (SEER) database reported a prevalence of precancer diagnosis of dementia of 7.4% in patients with breast cancer, 10.0% for colon cancer, and 5.1% for prostate cancer [ [6] Raji M.A. Kuo Y.F. Freeman J.L. Goodwin J.S. Effect of a dementia diagnosis on survival of older patients after a diagnosis of breast, colon, or prostate cancer: implications for cancer care. Arch Intern Med. 2008; 168: 2033-2040 Crossref PubMed Scopus (96) Google Scholar ].