Hshieh TT, et al. - Among older patients with blood cancer, the prevalence of domain-specific cognitive impairment, as well as its relation to overall survival, was determined. As per findings, domains of cognitive dysfunction may be prevalent in older patients with blood cancer and may have differential predictive value for survival. This vulnerable patient population requires targeted interventions.

• This is a prospective observational cohort study.
• Study participants included all patients 75 years and older who presented for initial consultation in the leukemia, myeloma, or lymphoma clinics of a large tertiary hospital in Boston, Massachusetts, from February 1, 2015, to March 31, 2017.
• Patients were screened for frailty and cognitive dysfunction and were followed up for survival.
• They were screened for executive dysfunction, using the Clock-in-the-Box (CIB) test.
• The impairment in working memory was screened using a 5-word delayed recall test.
• Additionally, the Fried frailty phenotype and Rockwood cumulative deficit model of frailty were also evaluated to characterize participants as robust, prefrail, or frail.

• A total of 420 consecutive patients were approached, of those, 360 (85.7%) agreed to undergo frailty assessment (232 men [64.4%] and 128 women [35.6%]; mean [SD] age, 79.8 [3.9] years), and 341 of those (94.7%) completed both cognitive screening tests.
• Findings demonstrated that a total of 127 patients (35.3%) had probable executive dysfunction on the CIB, and 62 (17.2%) had probable impairment in working memory on the 5-word delayed recall.
• Researchers found a modest correlation of the impairment in either domain with the Fried frailty phenotype (CIB, ρ = 0.177; delayed recall, ρ = 0.170; P=.01 for both).
• They also noted that many phenotypically robust patients also had probable cognitive impairment (24 of 104 [23.1%] on CIB and 9 of 104 [8.7%] on delayed recall).
• In addition, data revealed worse median survival in patients with impaired working memory (10.9 [SD, 12.9] vs 12.2 [SD, 14.7] months; log-rank P < .001), including when stratified by indolent cancer (log-rank P=.01) and aggressive cancer (P < .001) and in multivariate analysis when adjusting for age, comorbidities, and disease aggressiveness (odds ratio, 0.26; 95% CI, 0.13-0.50).
• An association of impaired working memory with worse survival was noted for those undergoing intensive treatment (log-rank P < .001).
• Researchers noted an association of executive dysfunction with worse survival only among patients who underwent intensive treatment (log-rank P=.03).