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Grand Rounds

Is a Cancer Diagnosis Associated with Slower Memory Decline?

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BACKGROUND AND PURPOSE:

  • Observational studies have identified that patients with a cancer history are less likely to develop Alzheimer’s (AD)
  • Data is limited for long-term cognitive trajectories comparing those with and without a cancer diagnosis
  • Ospina-Romero et al. (JAMA Network Open, 2019) compared long-term memory trajectories before and after cancer compared to age matched individuals without a cancer diagnosis  

METHODS:

  • Population-based cohort study
  • Participants
    • US adults from the Health and Retirement Study
    • At enrollment: Born <1949 with no cancer history
  • Exposures
    • Self-reported physician diagnosis of any cancer (not including nonmelanoma skin cancer) identified during biennial assessments 
    • Follow-ups performed up to 16 years (1998 to 2014)
  • Data analysis
    • Model compared memory of
      • Those diagnosed with cancer during follow-up, before and after diagnosis
      • Those who remained cancer free during follow-up
  • Primary outcome
    • Composite memory score using immediate and delayed word-list recall and proxy assessments

RESULTS:

  • 14,583 participants were included in the study
    • Mean age, 66.4 years | 58.0% female
    • Mean follow-up: 11.5 years
    • During follow-up
      • Cancer diagnosis: 2250
      • No cancer diagnosis: 12,333 
  • The rate of memory decline was slower for those with a cancer diagnosis vs cancer-free individuals (similar age)
    • Rate of decline the decade before a cancer diagnosis: 10.5% (95% CI, 6.2% to 14.9%)
  • If diagnosis >75 years, mean memory function immediately before diagnosis was higher than that among similarly aged cancer-free individuals
  • A new cancer diagnosis was associated with a short-term decline in memory compared with memory before diagnosis
    • However, after diagnosis, the rate of memory decline was slower vs those without a cancer diagnosis

CONCLUSION:

  • In older people who developed cancer vs those without a cancer diagnosis
    • Memory decline is slower
    • Memory is better overall
  • This study provides some evidence cancer and AD “may be at opposite ends of a common pathological process”
  • Hypotheses include
    • Inverse biological process that underlies these two diseases
      • Upregulation in cancer may be downregulated in AD or vice versa
  • Patients who survive long enough to get cancer have some underlying mechanism that may protect against AD  

Learn More – Primary Sources:

Rate of Memory Change Before and After Cancer Diagnosis

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