Cognitive Trajectories Evaluated in Patients After Stem Cell Transplant
A retrospective study identifies age, sex, grip strength, and frailty as key predictors of cognitive changes after allogeneic transplantation.
Key takeaways
- A retrospective analysis of 282 allogeneic stem cell transplant patients evaluated cognitive trajectories using the Montreal Cognitive Assessment (MoCA).
- At one year post-transplant, 14.56% of patients experienced a cognitive score decline of 2 or more points, while 30.1% showed an improvement of 2 or more points.
- Predictors for decreased post-transplant cognitive scores included older age, female sex, decreased grip strength, and frailty at year one.
- Cognitive declines were most significant in the domains of abstraction, delayed recall, and orientation, with patients aged 40 to 59 showing the most decline in delayed recall and orientation.
Many patients experience cognitive decline after undergoing a hematopoietic stem cell transplant (HCT). To better understand these changes, a retrospective study published in the journal Current Problems in Cancer in September 2026 evaluated the cognitive trajectories of patients with cancer who received allogeneic HCT.
The research analyzed database records from the Duke Adult Bone Marrow Transplant clinic Clinical Pre-, Peri, and Post-HCT Optimization Program (C-POP) collected between 2018 and 2023. Investigators tracked cognitive function using the Montreal Cognitive Assessment (MoCA) to determine the most common predictors of post-transplant cognitive changes. By identifying these factors, researchers aim to support earlier identification and target interventions that could improve healthcare compliance, quality of life, and survivorship.
What Happened
The retrospective analysis examined data from 282 patients who underwent assessment in the Duke clinic's optimization program. At the pre-treatment sign-off stage, 56 participants (19.9%) had MoCA scores below 26, which is the established cutpoint for mild cognitive impairment.
When comparing pre-transplant sign-off scores to year-one post-transplant scores among the 103 participants with available follow-up data, researchers found that 57 participants (55.3%) had unchanged scores. However, year-one scores decreased by 2 or more points for 15 participants (14.56%), while 31 participants (30.1%) showed an improvement of 2 or more points. At the one-year mark, 18 participants (17.4%) scored below the mild cognitive impairment cutpoint of 26.
What The Evidence Shows
The study identified several key predictors associated with decreased MoCA scores at year one. These predictors included older age, female sex, decreased grip strength, and frailty at the one-year mark.
Furthermore, the decrease in cognitive scores was concentrated in specific domains, specifically abstraction, delayed recall, and orientation, with significant changes observed across the studied timepoints. Notably, participants aged 40 to 59 experienced the most pronounced decline in the domains of delayed recall and orientation.
What We Don't Know Yet
The study was a retrospective analysis of database records from a single institution's optimization program, which limits the ability to establish direct cause-and-effect relationships. Additionally, while 282 participants were originally assessed, the comparison between pre-treatment sign-off and year-one follow-up was limited to a smaller subset of 103 participants. The published source does not report other potential limitations, such as the specific types of cancers treated or the detailed clinical characteristics of the participants who did not complete the year-one assessment.
What Comes Next
The study authors note that future research is warranted to investigate prehabilitation strategies. Specifically, prospective studies could explore interventions designed to maximize patients' nutritional, cognitive, and physical fitness status before undergoing transplantation. The published source does not detail specific ongoing trials or planned enrollment timelines.
What This Means
The findings suggest that incorporating prospective assessments of physical measures like grip strength and frailty alongside cognitive screening tools like the MoCA could help clinicians identify vulnerable patients earlier. Identifying these physical and demographic risk factors can help guide tailored clinical support and targeted rehabilitation interventions for patients undergoing allogeneic stem cell transplants.
Original Source
PubMed (NCBI E-utilities): https://pubmed.ncbi.nlm.nih.gov/42697164/
Questions readers ask
- What are the primary predictors of cognitive decline after a stem cell transplant?
- According to the study, the primary predictors of decreased cognitive scores one year after an allogeneic hematopoietic cell transplant are older age, female sex, decreased grip strength, and frailty at year one.
- How common is cognitive impairment before and after stem cell transplantation?
- The study found that 19.9% of participants had mild cognitive impairment (MoCA score under 26) before treatment. At one year post-transplant, 17.4% of evaluated participants scored under 26, with 14.56% experiencing a score decrease of 2 or more points and 55.3% remaining unchanged.
- Which specific cognitive areas are most affected after a stem cell transplant?
- The retrospective analysis showed significant decreases across timepoints in the specific cognitive domains of abstraction, delayed recall, and orientation. Patients between the ages of 40 and 59 experienced the most substantial declines in delayed recall and orientation.
What this means
The findings suggest that incorporating prospective assessments of physical measures like grip strength and frailty alongside cognitive screening tools like the MoCA could help clinicians identify vulnerable patients earlier. Identifying these physical and demographic risk factors can help guide tailored clinical support and targeted rehabilitation interventions for patients undergoing allogeneic stem cell transplants.
Limitations and uncertainties
- The study was a retrospective analysis of database records from a single institution's optimization program, which limits the ability to establish direct cause-and-effect relationships. Additionally, while 282 participants were originally assessed, the comparison between pre-treatment sign-off and year-one follow-up was limited to a smaller subset of 103 participants. The published source does not report other potential limitations, such as the specific types of cancers treated or the detailed clinical characteristics of the participants who did not complete the year-one assessment.
