The Relationship Between Prior Cancer Diagnosis and All-Cause Dementia Progression Among US Adults

Article type: Research Article

Authors: Fowler, Mackenzie E.^{a; *} | Wright, Nicole C.^a | Triebel, Kristen^{b; c} | Rocque, Gabrielle B.^{c; d} | Irvin, Marguerite R.^a | Kennedy, Richard E.^e

Affiliations: [a] Department of Epidemiology, University of Alabama, Birmingham, Birmingham, AL, USA | [b] Division of Neuropsychology, Department of Neurology, University of Alabama, Birmingham, Birmingham, AL, USA | [c] O’Neal Comprehensive Cancer Center, University of Alabama, Birmingham, Birmingham, AL, USA | [d] Division of Hematology and Oncology, Department of Medicine, University of Alabama, Birmingham, Birmingham, AL, USA | [e] Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama, Birmingham, Birmingham, AL, USA

Correspondence: [*] Correspondence to: Mackenzie E. Fowler, PhD, Division of Hematology and Oncology, Department of Medicine, University of Alabama, Birmingham, 1720 2nd Avenue South, FOT 712, Birmingham, AL 35294, USA. Tel.: +1 205 975 5765; E-mail: mefowler@uab.edu.

Abstract: Background:Cancer-related cognitive impairment (CRCI), a frequent effect of cancer and its treatments, shares common cognitive symptoms with dementia syndromes. Cross-sectional studies demonstrate an inverse relationship between cancer and dementia. However, the longitudinal relationship between dementia decline and cancer has not been investigated. Objective:To evaluate the association between cancer and longitudinal progression of dementia. Methods:We extracted electronic health record data from July 2003 to February 2020 from a single academic medical center. We identified dementia and cancer history prior to dementia using ICD-9/10 codes. We measured cognitive decline with the Alabama Brief Cognitive Screener (ABCs). We used adjusted linear mixed models to estimate baseline cognition and rate of progression by cancer history, including differences by race. Results:The study included 3,809 participants with dementia, of which 672 (17.6%) had cancer history. Those with cancer history had higher baseline cognition (β: 1.07, 95% CI: 0.45, 1.69), but similar rate of decline. Non-Hispanic Blacks had lower cognitive scores at baseline and throughout follow-up regardless of cancer status compared to non-Hispanic Whites and other races/ethnicities with and without cancer history. Conclusion:In this longitudinal retrospective study, participants with cancer history demonstrate better cognition at dementia diagnosis and no difference in cognitive decline than those without cancer history. Smoking and comorbidities attenuate this association and results indicate non-Hispanic Blacks have worse cognitive outcomes in dementia regardless of cancer history than other race/ethnicity groups. Further exploration of the role of smoking, comorbidities, and race/ethnicity on cancer and dementia-related cognitive decline is needed.

Keywords: Aging, cancer, cognitive dysfunction, dementia

DOI: 10.3233/JAD-220054

Journal: Journal of Alzheimer's Disease, vol. 88, no. 2, pp. 521-535, 2022