Cognitive problems following hematopoietic stem cell transplant: relationships with sleep, depression and fatigue

Abstract

Cognitive problems are a significant, persistent concern for patients undergoing hematopoietic stem cell transplant (HSCT). Sleep is important for many cognitive tasks; however, the relationship between sleep and cognitive problems for HSCT patients is unknown. This study examined the relationship between sleep and cognitive problems for HSCT patients from pre to post-transplant. Patients undergoing HSCT (N=138) completed questionnaires at pre-transplant and during the 12 months following transplant. Questionnaires assessed sleep and cognitive problems as well as commonly co-occurring symptoms: depressive symptoms, fatigue, and pain. Post-hoc analyses examined the relationship of specific sleep problems with cognitive problems. Sleep problems covaried with cognitive problems even after controlling for depressive symptoms, fatigue, and pain. Depressive symptoms and fatigue were also uniquely related to cognitive problems. Post-hoc analyses suggest that sleep somnolence, shortness of breath, snoring, and perceptions of inadequate sleep may contribute to the association found between sleep and cognitive problems. Findings suggest that sleep problems are associated with and may contribute to cognitive problems for HSCT patients. However, sleep problems are rarely screened for or discussed during clinic visits. Assessing and treating specific sleep problems in addition to depressive symptoms and fatigue may have implications for improving cognitive problems for HSCT patients.

Brain glucose metabolism in patients with newly diagnosed multiple myeloma significantly decreases after high-dose chemotherapy followed by autologous stem cell transplantation

“…Cognitive problems are a significant concern for patients undergoing stem cell transplant. More than 50% of patients who undergo stem cell transplant report cognitive changes and over 25% of patients have cognitive problems rated as moderate to severe [19][20][21]. A study by Harder et al…”

An mHealth Pain Coping Skills Training Intervention for Hematopoietic Stem Cell Transplantation Patients: Development and Pilot Randomized Controlled Trial

“…An initial mPCST protocol was developed that was informed by the investigators’ expertise in several areas including PCST protocol development [ 9 , 23 - 31 ], mHealth applications [ 32 - 34 ], and observational studies of pain and other symptoms in HCT patients [ 8 , 35 ]. Traditional PCST protocols have been delivered over several weekly sessions (eg, 6-12), conducted face-to-face at a major medical center or sometimes by telephone, and are often about an hour long [ 36 - 39 ].…”

Impact of Cancer Treatment on Cognitive Function: A Systematic Review of Data in Hematological Malignancies

“…However, numbers are too small to interpret whether higher dose leads to a greater cognitive impairment. Ghazikhanian, et al [35] demonstrated that HSCT patients experience more sleep problems than general population and these patients also experienced more cognitive issues [35]. A prospective follow up of 71 allogeneic bone marrow transplant patients, 14±3 months posttransplant, by Sostak, et al [34] reported neurologic sequelae in 65% of patients.…”

“…Risk factors for neurocognitive dysfunction in hematological malignancies include high intensity cancer treatment, cranial radiation, female gender, co-existing neurologic problems, sleep deprivation, depression, fatigue, absence of social partner, HSCT, extensive chronic GVHD, use of corticosteroids, narcotics, and sedatives [35,[40][41][42][43]. Evaluation and documentation of neurocognitive deficits using standard neuropsychological battery of tests at baseline, during treatment, pre and post HSCT will help us gain more insight into the problem.…”