Aging
Ten-year cognition transitions in older cancer survivors in the National Health and Aging Trends Study (NHATS) Emilie D Duchesneau* Emilie D Duchesneau Zhang Zhang Michelle M Mielke Heidi D Klepin Amresh D Hanchate
Background
Aging, cancer, and cancer treatments are risk factors for cognitive impairment. While studies have described cognition transitions during the period surrounding cancer diagnosis and treatment, few have focused on the long-term survivorship period. We described 10-year cognition transitions in older cancer survivors.
Methods
We used Rounds 1-10 of NHATS, a prospective cohort of adults 65+ years with annual assessments of cognition and age-related conditions. We included 1303 older adults reporting any cancer history at Round 1 (2011). Cognition was assessed annually for 10 years using a validated measure based on self-report, the AD8 Dementia Screening Interview, and objective assessments of memory, orientation, and executive function. Cognition was categorized as “possible”, “probable”, or “no dementia”. One-year transitions between the 3 cognition states were described using Sankey diagrams and an age- and sex-adjusted Markov transition probability matrix, including death as its own state. We used multiple imputation and inverse probability of censoring weights to account for missing data and attrition.
Results
In Round 1, 12% had probable, 14% possible, and 74% no dementia. The Figure visualizes transitions across cognition states. One-year probabilities of death were 6%, 13%, and 23% for those with no, possible, and probable dementia. The 1-year probability of remaining in the current state at any round was high for those with probable (69%) and no dementia (84%). Transitions were common among those with possible dementia, with a 17% probability of transitioning to probable and 44% to no dementia.
Conclusions
One-year transitions were uncommon in older cancer survivors with probable or no dementia. Transitions were more common in those with possible dementia. Research is needed to identify risk factors for cognition transitions, particularly among those with possible dementia who may benefit from interventions to prevent further cognitive decline.
