Advertisement

Objective measures of physical function and their association with cognitive impairment in older adults with cancer prior to treatment

      Abstract

      Introduction

      Objective measures of physical function are associated with cognitive function in community-dwelling older adults. Many older adults experience cognitive declines prior to cancer treatment initiation. Thus, it is unclear whether the association between low physical function and cognitive impairment is generalizable to older adults with cancer prior to treatment. Our objective was to examine whether objective measures of physical function were associated with cognitive impairment in geriatric oncology patients prior to treatment.

      Materials and methods

      We used prospectively collected data from an institutional database within a cancer centre and electronic medical records of older adults who had undergone a geriatric assessment before cancer treatment. Objective measures of physical function included grip strength and the Short Physical Performance Battery (SPPB). Cognitive impairment was assessed via the Mini-Cog. Multivariable logistic regression was used to determine whether grip strength and SPPB were associated with cognitive impairment prior to cancer treatment in all patients, as well as in patients with moderate-to-high comorbidity as part of a sensitivity analysis.

      Results

      A total of 386 older adults (mean age 80.9 years) were included in the analysis. Most participants (65.3%) had low grip strength and/or low SPPB, whereas 42.2% were cognitively impaired. Neither low grip strength (odds ratio [OR] = 1.55, 95% confidence interval [CI] = 0.92–2.63, p = 0.097) nor low SPPB (OR = 1.29, 95%CI = 0.69–2.42, p = 0.41) alone or combined (OR = 1.05, 95%CI = 0.59–1.88, p = 0.85) were significantly associated with cognitive impairment in multivariable analyses of all patients. However, low SPPB was significantly associated with cognitive impairment in the sensitivity analysis restricted to patients with moderate-to-high comorbidity (OR = 4.05, 95%CI = 1.50–10.95, p = 0.006). Dependence in one or more instrumental activities of daily living [IADLs] was consistently associated with cognitive impairment in the main and sensitivity analyses.

      Discussion

      Low physical performance and IADL dependence are associated with cognitive impairment in patients with moderate-to-high comorbidity prior to cancer treatment. Scrutiny is advised for these patients to assess for possible cognitive impairment. Larger studies are warranted to confirm our findings.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Geriatric Oncology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Canada PHAo
        Aging and chronic diseases. A profile of Canadian seniors. Ottawa.
        2020
        • Canadian Cancer Society'’s Advisory Committee on Cancer Statistics
        Canadian Cancer Statistics 2021.
        2021
        • Mohile S.G.
        • Dale W.
        • Somerfield M.R.
        • Hurria A.
        Practical assessment and Management of Vulnerabilities in older patients receiving chemotherapy: ASCO guideline for geriatric oncology summary.
        J Oncol Pract. 2018; 14: 442-446
        • Wildiers H.
        • Heeren P.
        • Puts M.
        • Topinkova E.
        • Janssen-Heijnen M.L.
        • Extermann M.
        • et al.
        International Society of Geriatric Oncology consensus on geriatric assessment in older patients with cancer.
        J Clin Oncol. 2014; 32: 2595-2603
        • Hamaker M.E.
        • Te Molder M.
        • Thielen N.
        • van Munster B.C.
        • Schiphorst A.H.
        • van Huis L.H.
        The effect of a geriatric evaluation on treatment decisions and outcome for older cancer patients - a systematic review.
        J Geriatr Oncol. 2018; 9: 430-440
        • Hamaker M.
        • Lund C.
        • Te Molder M.
        • Soubeyran P.
        • Wildiers H.
        • van Huis L.
        • et al.
        Geriatric assessment in the management of older patients with cancer - a systematic review (update).
        J Geriatr Oncol. 2022; 13: 761-777
        • Matsuoka A.
        • Mizutani T.
        • Kaji Y.
        • Yaguchi-Saito A.
        • Odawara M.
        • Otsuki A.
        • et al.
        Barriers and facilitators of geriatric assessment implementation in daily oncology practice: a qualitative study applying a theoretical implementation framework.
        J Clin Oncol. 2021; 39: 12012
        • Ghignone F.
        • van Leeuwen B.L.
        • Montroni I.
        • Huisman M.G.
        • Somasundar P.
        • Cheung K.L.
        • et al.
        The assessment and management of older cancer patients: a SIOG surgical task force survey on surgeons’ attitudes.
        Eur J Surg Oncol. 2016; 42: 297-302
        • Cui M.
        • Zhang S.
        • Liu Y.
        • Gang X.
        • Wang G.
        Grip strength and the risk of cognitive decline and dementia: a systematic review and Meta-analysis of longitudinal cohort studies.
        Front Aging Neurosci. 2021; 13625551
        • Fritz N.E.
        • McCarthy C.J.
        • Adamo D.E.
        Handgrip strength as a means of monitoring progression of cognitive decline - a scoping review.
        Ageing Res Rev. 2017; 35: 112-123
        • Teruya S.L.
        • Dimino C.
        • Silverman K.D.
        • Mielenz T.
        Poor lower extremity functioning is associated with modest increased incidence of probable dementia.
        Geriatrics (Basel). 2021; 6
        • Handing E.P.
        • Leng X.I.
        • Kritchevsky S.B.
        • Craft S.
        Association between physical performance and cognitive function in older adults across multiple studies: a pooled analysis study. Innov.
        Aging. 2020; 4igaa050
        • Hardy S.J.
        • Krull K.R.
        • Wefel J.S.
        • Janelsins M.
        Cognitive changes in cancer survivors.
        Am Soc Clin Oncol Educ Book. 2018; 38: 795-806
        • Lange M.
        • Giffard B.
        • Noal S.
        • Rigal O.
        • Kurtz J.E.
        • Heutte N.
        • et al.
        Baseline cognitive functions among elderly patients with localised breast cancer.
        Eur J Cancer. 2014; 50: 2181-2189
        • Ahles T.A.
        • Saykin A.J.
        • McDonald B.C.
        • Furstenberg C.T.
        • Cole B.F.
        • Hanscom B.S.
        • et al.
        Cognitive function in breast cancer patients prior to adjuvant treatment.
        Breast Cancer Res Treat. 2008; 110: 143-152
        • Meyers C.A.
        • Albitar M.
        • Estey E.
        Cognitive impairment, fatigue, and cytokine levels in patients with acute myelogenous leukemia or myelodysplastic syndrome.
        Cancer. 2005; 104: 788-793
        • Wefel J.S.
        • Vidrine D.J.
        • Veramonti T.L.
        • Meyers C.A.
        • Marani S.K.
        • Hoekstra H.J.
        • et al.
        Cognitive impairment in men with testicular cancer prior to adjuvant therapy.
        Cancer. 2011; 117: 190-196
        • Meyers C.A.
        • Byrne K.S.
        • Komaki R.
        Cognitive deficits in patients with small cell lung cancer before and after chemotherapy.
        Lung Cancer. 1995; 12: 231-235
        • Mohile S.G.
        • Lacy M.
        • Rodin M.
        • Bylow K.
        • Dale W.
        • Meager M.R.
        • et al.
        Cognitive effects of androgen deprivation therapy in an older cohort of men with prostate cancer.
        Crit Rev Oncol Hematol. 2010; 75: 152-159
        • Vance D.
        • Larsen K.I.
        • Eagerton G.
        • Wright M.A.
        Comorbidities and cognitive functioning: implications for nursing research and practice.
        J Neurosci Nurs. 2011; 43: 215-224
        • Park H.Y.
        • Park J.W.
        • Song H.J.
        • Sohn H.S.
        • Kwon J.W.
        The association between polypharmacy and dementia: a nested case-control study based on a 12-year longitudinal cohort database in South Korea.
        PLoS One. 2017; 12e0169463
        • Liu J.H.
        • Zhang Y.J.
        • Ma Q.H.
        • Sun H.P.
        • Xu Y.
        • Pan C.W.
        Elevated blood neutrophil to lymphocyte ratio in older adults with cognitive impairment.
        Arch Gerontol Geriatr. 2020; 88104041
        • Magnuson A.
        • Mohile S.
        • Janelsins M.
        Cognition and cognitive impairment in older adults with Cancer.
        Curr Geriatr Rep. 2016; 5: 213-219
        • Verweij N.M.
        • Schiphorst A.H.
        • Pronk A.
        • van den Bos F.
        • Hamaker M.E.
        Physical performance measures for predicting outcome in cancer patients: a systematic review.
        Acta Oncol. 2016; 55: 1386-1391
        • Ahles T.A.
        • Root J.C.
        Cognitive effects of cancer and cancer treatments.
        Annu Rev Clin Psychol. 2018; 14: 425-451
        • Grusdat N.P.
        • Stauber A.
        • Tolkmitt M.
        • Schnabel J.
        • Schubotz B.
        • Wright P.R.
        • et al.
        Routine cancer treatments and their impact on physical function, symptoms of cancer-related fatigue, anxiety, and depression.
        Support Care Cancer. 2022; 30: 3733-3744
        • Studenski S.A.
        • Peters K.W.
        • Alley D.E.
        • Cawthon P.M.
        • McLean R.R.
        • Harris T.B.
        • et al.
        The FNIH sarcopenia project: rationale, study description, conference recommendations, and final estimates.
        J Gerontol A Biol Sci Med Sci. 2014; 69: 547-558
        • Beaudart C.
        • Rolland Y.
        • Cruz-Jentoft A.J.
        • Bauer J.M.
        • Sieber C.
        • Cooper C.
        • et al.
        Assessment of muscle function and physical performance in daily clinical practice : a position paper endorsed by the European Society for Clinical and Economic Aspects of osteoporosis, osteoarthritis and musculoskeletal diseases (ESCEO).
        Calcif Tissue Int. 2019; 105: 1-14
        • Pavasini R.
        • Guralnik J.
        • Brown J.C.
        • di Bari M.
        • Cesari M.
        • Landi F.
        • et al.
        Short physical performance battery and all-cause mortality: systematic review and meta-analysis.
        BMC Med. 2016; 14: 215
        • da Camara S.M.
        • Alvarado B.E.
        • Guralnik J.M.
        • Guerra R.O.
        • Maciel A.C.
        Using the short physical performance battery to screen for frailty in young-old adults with distinct socioeconomic conditions.
        Geriatr Gerontol Int. 2013; 13: 421-428
        • Borson S.
        • Scanlan J.
        • Brush M.
        • Vitaliano P.
        • Dokmak A.
        The mini-cog: a cognitive ‘vital signs’ measure for dementia screening in multi-lingual elderly.
        Int J Geriatr Psychiatry. 2000; 15: 1021-1027
        • Li X.
        • Dai J.
        • Zhao S.
        • Liu W.
        • Li H.
        Comparison of the value of Mini-cog and MMSE screening in the rapid identification of Chinese outpatients with mild cognitive impairment.
        Medicine (Baltimore). 2018; 97e10966
        • Milian M.
        • Leiherr A.M.
        • Straten G.
        • Muller S.
        • Leyhe T.
        • Eschweiler G.W.
        The Mini-cog versus the Mini-mental state examination and the clock drawing test in daily clinical practice: screening value in a German memory clinic.
        Int Psychogeriatr. 2012; 24: 766-774
        • George L.K.
        • Fillenbaum G.G.
        OARS methodology. A decade of experience in geriatric assessment.
        J Am Geriatr Soc. 1985; 33: 607-615
        • Charlson M.E.
        • Carrozzino D.
        • Guidi J.
        • Patierno C.
        Charlson comorbidity index: a critical review of clinimetric properties.
        Psychother Psychosom. 2022; 91: 8-35
        • Kroenke K.
        • Spitzer R.L.
        • Williams J.B.
        The patient health Questionnaire-2: validity of a two-item depression screener.
        Med Care. 2003; 41: 1284-1292
        • Kroenke K.
        • Spitzer R.L.
        • Williams J.B.
        The PHQ-9: validity of a brief depression severity measure.
        J Gen Intern Med. 2001; 16: 606-613
        • Yang L.
        • Koyanagi A.
        • Smith L.
        • Hu L.
        • Colditz G.A.
        • Toriola A.T.
        • et al.
        Hand grip strength and cognitive function among elderly cancer survivors.
        PLoS One. 2018; 13e0197909
        • Doi T.
        • Shimada H.
        • Makizako H.
        • Lee S.
        • Park H.
        • Tsutsumimoto K.
        • et al.
        Cognitive activities and instrumental activity of daily living in older adults with mild cognitive impairment.
        Dement Geriatr Cogn Dis Extra. 2013; 3: 398-406
        • Hall J.R.
        • Vo H.T.
        • Johnson L.A.
        • Barber R.C.
        • O’Bryant S.E.
        The link between cognitive measures and ADLs and IADL functioning in mild Alzheimer’s: what has gender got to do with it?.
        Int J Alzheimers Dis. 2011; 2011276734
        • Cupp M.A.
        • Cariolou M.
        • Tzoulaki I.
        • Aune D.
        • Evangelou E.
        • Berlanga-Taylor A.J.
        Neutrophil to lymphocyte ratio and cancer prognosis: an umbrella review of systematic reviews and meta-analyses of observational studies.
        BMC Med. 2020; 18: 360
        • Bourgognon J.M.
        • Cavanagh J.
        The role of cytokines in modulating learning and memory and brain plasticity.
        Brain Neurosci Adv. 2020; 4 (2398212820979802)
        • Sartori A.C.
        • Vance D.E.
        • Slater L.Z.
        • Crowe M.
        The impact of inflammation on cognitive function in older adults: implications for healthcare practice and research.
        J Neurosci Nurs. 2012; 44: 206-217