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Methods: A search of PubMed, PsycInfo, CINAHL, and Cochrane Library yielded 732 abstracts, which were independently evaluated and selected for inclusion by pairs of raters. Original studies of neuropsychological functioning in HCT recipients who were adults at the time of transplant were included in the systematic review (k=17). A subset of studies assessing patients pre- and post-transplant and providing adequate data to calculate effect sizes was included in the meta-analysis (k=11).
Results: The systematic review found consensus that a subset of patients experience cognitive impairment prior to HCT. Evidence was conflicting about whether cognitive functioning improved, declined, or remained stable at follow-up. Meta-analytic findings of 404 patients indicated no significant changes in cognitive functioning pre- to post-HCT (ps>.05). Age, time since transplant, and total body irradiation were not associated with changes in cognitive functioning. Patients who received autologous transplants were more likely to demonstrate improvements in attention (p=.004), however.
Conclusions: Results of the current study suggest that on average, patients who are experiencing cognitive difficulties prior to HCT are unlikely to demonstrate significant improvement post-transplant, with the exception of improved attention in autologous HCT recipients. The failure of HCT patients to demonstrate improvements over repeated tests may itself be a sign of a deficit, as improvement due to test familiarity would be expected. Patients reporting cognitive difficulties that interfere with daily functioning should be referred to a neuropsychologist for evaluation and management.
See more of: Contributed Abstracts