Neuropsychological Impairments in Hematological Malignancies Patients Expected to Allo-BMT

Introduction: Hematological malignancies treatment is associated with various side effects, some of them are inversive, other - not. The psychiatric disorders including deficits in cognition functions frequently occur (Vybornykh et al. Int J. of Hematol Res 2016; 2 (1) 103-114). Cognitive impairments (for example, in attention, memory domains) in pre and post bone marrow transplantation (BMT) period are common disabling disturbance, associated with further decrease in quality of life among hematological malignancy patients. Neuropsychological impairment understanding can facilitate to patients future rehabilitation. It is very important to study of existing cognitive impairments in the pre-allo-BMT period.

Aim: To define the main neuropsychological impairments before BMT.

Materials: 32 patients with various hematological malignancies in pre-allo-BMT period with multiple myeloma (MM) (n=16), acute lymphoblastic leukemia (ALL) (n=10), acute myeloid leukemia (AML) (n=6). Mean age of the 32 study participants (13 men and 19 women) was 31.6 (+-8.5 years). Neuropsychological assessment was made by using Luria neuropsychological battery, also self-reported questionnaire was used. Statistical analyzes were performed using the licensed package Statistica for Windows 5.5.

Results and discussion: In 75% (n=24) patients observed decrement (15.7% population norms) in one or more cognitive domain (more 1-1.5 st.dev.). Results in attention, memory, motor skills and complex executive function tests were most likely to be decreased (р. = 0.01). 1-1.5 st.dev. was denoted as mild deficiency and 2-3 st.dev denoted as moderate to total deficiency; within this criteria: 75% (n=24) of participants had at least mild deficits in psychomotor skills, 50 %(n=16) moderate to total (including impairment in kinetic and kinesthetic praxis). 37,5% had deficits in executive function (n=7 - mild and n=5 - moderate to total impairment). 87% (n=28) had deficits in verbal memory (n=10 mild and n=18 moderate to total). 34% (n=11) in attention (n=4 - mild, n=7 - moderate to total). Also it was found the significant correlation (р=0.05) between patients cognitive impairments self-reports and results of neuropsychological assessment which confirmed deficits. In 25% (n=8) patients were no observations of discernible symptoms of neuropsychological impairments. Therefore on the basis of qualitative and quantitative analysis of neuropsychological approach and results of neuropsychological assessment can be supposed that patient's cognitive impairments probably connected with deficits in basal structures and left hemisphere.

Conclusion: Memory, attention, motor skills and complex executive functions are most damaged cognitive domains (probably depends on preceded chemotherapy and some others risk factors) in patients with hematological malignancies before BMT, but their intimate investigation can help in prospective neuropsychological rehabilitation and socialization of patients, so further research of cognitive impairments in dynamics needed to be done.