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.

中文翻译：

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治疗前患有癌症的老年人身体功能的客观测量及其与认知障碍的关系

介绍

身体机能的客观测量与社区居住的老年人的认知功能有关。许多老年人在癌症治疗开始前经历认知能力下降。因此，尚不清楚身体功能低下与认知障碍之间的关联是否可以推广到治疗前患有癌症的老年人。我们的目的是检查身体功能的客观测量是否与治疗前老年肿瘤患者的认知障碍有关。

材料和方法

我们使用了从癌症中心的机构数据库中前瞻性收集的数据，以及在癌症治疗前接受过老年评估的老年人的电子病历。身体机能的客观测量包括握力和短期身体机能量表 (SPPB)。通过 Mini-Cog 评估认知障碍。作为敏感性分析的一部分，使用多变量逻辑回归来确定握力和 SPPB 是否与所有患者以及患有中度至高度合并症的患者在癌症治疗前的认知障碍相关。

结果

共有 386 名老年人（平均年龄 80.9 岁）被纳入分析。大多数参与者 (65.3%) 的握力较低和/或 SPPB 较低，而 42.2% 的参与者存在认知障碍。既不是低握力（比值比 [OR] = 1.55，95% 置信区间 [CI] = 0.92–2.63，p  = 0.097），也不是低 SPPB（OR = 1.29，95%CI = 0.69–2.42，p  = 0.41）或组合（OR = 1.05，95%CI = 0.59–1.88，p = 0.85）与所有患者的多变量分析中的认知障碍显着相关。然而，在仅限于中度至高度合并症患者的敏感性分析中，低 SPPB 与认知障碍显着相关（OR = 4.05，95%CI = 1.50–10.95，p = 0.006）。在主要分析和敏感性分析中，对一种或多种日常生活工具活动 [IADL] 的依赖始终与认知障碍相关。

讨论

低体能和 IADL 依赖与癌症治疗前患有中度至高度合并症的患者的认知障碍有关。建议对这些患者进行检查以评估可能的认知障碍。需要更大规模的研究来证实我们的发现。