Cancer History Is Associated with Slower Speed of Cognitive Decline in Patients with Amnestic Cognitive Impairment

Article type: Research Article

Authors: Castillo-Passi, Rolando I.^{a; d; e; i; 1} | Vergara, Rodrigo C.^{f; j; 1} | Rogers, Nicole K.^{c; h} | Ponce, Daniela P.^a | Bennett, Magdalena^g | Behrens, María Isabel^{a; b; c; d; *}

Affiliations: [a] Centro de Investigación Clínica Avanzada (CICA), Hospital Clínico de la Universidad de Chile, Independencia, Santiago, RM, Chile | [b] Departamento de Neurología y Neurocirugía, Hospital Clínico, Universidad de Chile, Independencia, Santiago, RM, Chile | [c] Departamento de Neurociencia, Facultad de Medicina Universidad de Chile, Independencia Santiago, RM, Chile | [d] Departamento de Neurología y Psiquiatría, CAS, Clínica Alemana Universidad del Desarrollo, Santiago, RM, Chile | [e] Millennium Nucleus to Improve the Mental Health of Adolescents and Youths, Imhay, Chile | [f] Departamento de Kinesiología, Facultad de Artes y Educación Física, Universidad Metropolitana de Ciencias de la Educación, Santiago, RM, Chile | [g] IROM Department, McCombs School of Business, The University of Texas at Austin, Austin, TX, USA | [h] Instituto de Neurocirugía Dr. Alfonso Asenjo, Providencia, Santiago, RM, Chile | [i] Laboratorio de Psiquiatría Traslacional, Clínica Psiquiátrica Universitaria, Universidad de Chile, Recoleta, Santiago, RM, Chile | [j] Centro Nacional de Inteligencia Artificial (CENIA), Macul, Santiago, RM, Chile

Correspondence: [*] Correspondence to: María Isabel Behrens, MD, PhD, Centro Investigación Clínica Avanzada (CICA), 3er piso sector A, Hospital Clínico de la Universidad de Chile, Dr. Carlos Lorca Tobar 999, Independencia, Santiago, RM, Chile. Tel.: +56 2 29788260; E-mail: behrensl@uchile.cl.

Note: [1] These authors contributed equally to this work.

Abstract: Background:Several epidemiological studies report a negative association between Cancer and Alzheimer’s disease (AD). Objective:To characterize the trajectories of memory loss in individuals with early amnestic cognitive impairment with and without history of previous cancer. Methods:Cognitive deterioration was assessed using the Montreal Cognitive Assessment (MoCA) or MoCA-Memory Index Score (MoCA-MIS) biannually in subjects with early amnestic cognitive impairment followed-up retrospectively from 2007 to 2021. History of Cancer was obtained from clinical records. Simple linear regressions of MoCA-MIS scores were calculated for each subject and analyzed with K-means cluster analysis to identify subgroups with different cognitive decline trajectories. χ2 and t tests were used for descriptive categorical and continuous variables and mixed multiple linear regressions to determine cognitive decline covariates. Results:Analysis of the trajectory of cognitive decline in 141 subjects with early amnestic cognitive impairment identified two subgroups: Fast (n = 60) and Slow (n = 81) progressors. At baseline Fast progressors had better MoCA-MIS (p < 0.001) and functionality (CDR p = 0.02, AD8 p = 0.05), took less anti-dementia medications (p = 0.005), and had higher depression rates (p = 0.02). Interestingly, Fast progressors slowed their speed of memory decline (from 1.6 to 1.1 MoCA-MIS points/year) and global cognitive decline (from 2.0 to 1.4 total MoCA points/year) when Cancer history was present. Conclusion:Two trajectories of amnestic cognitive decline were identified, possibly derived from different neurophysiopathologies or clinical stages. This study suggests that a history of previous Cancer slows down amnestic cognitive decline, specifically in a subgroup of subjects with depression at baseline and accelerated deterioration at follow-up.

Keywords: Alzheimer’s disease, cognitive decline, cancer history, memory, mild cognitive impairment

DOI: 10.3233/JAD-215660

Journal: Journal of Alzheimer's Disease, vol. 87, no. 4, pp. 1695-1711, 2022