Short-Term Memory Recall Decline in AYA Cancer Survivors May Lead to an Increased Risk of Dementia, Alzheimer's

HealHeal Fall 2021

Experts from the St. Jude’s Children’s Research Hospital advise young-adult childhood cancer survivors to increase their physical activity levels, eat well and stay socially active to reduce their risk of becoming frail and prevent cognitive decline.

Survivors of childhood cancer who were defined as frail or at a significant risk of becoming frail were more likely to struggle with cognitive skills such as visual-motor processing speeds, verbal fluency, memory, and attention over a span of five years than those who were not frail, according to study results recently published in the Journal of Clinical Oncology.

“(These results) indicate to us that we should be focusing physical activity interventions early on, perhaps even for current patients who are actively in treatment, to try to prevent any of that physiologic decline and maintain their physical function over this entire period instead of waiting until they actually experience that decline and intervening then,” lead study author AnnaLynn Williams, a postdoctoral research fellow at St. Jude’s Children’s Research Hospital in Memphis, Tennessee, said in an interview with CURE®.

Frailty is often associated with neurocognitive decline in the elderly population, but there has yet to be an association discovered in the 8% of childhood cancer survivors who have become frail or at risk of becoming frail.

To assess if frailty predicted future neurocognitive decline among young-adult survivors of childhood cancer, Williams and colleagues evaluated 845 childhood cancer survivors (average age, 30 years; average time from diagnosis, 22 years) for frailty or at risk of becoming frail. At enrollment, 18.2% of the survivors were considered at risk for becoming frail and 6.1% were frail. The goal was to assess if survivors who were frail at the time of enrollment would experience greater cognitive declines than their non-frail counterparts during a five-year follow-up.

Of note, from the time of enrollment to the five-year follow-up, 17.6% of the survivors moved from at risk of becoming frail to frail while 11.5% improved their frailty status.

The data demonstrated that survivors who were frail or at risk of becoming frail performed worse on cognitive skills assessments compared to survivors who were not frail.

At the five-year follow-up, survivors who were frail or at risk of becoming frail experienced a decline in short-term memory recall assessments. Notably, a decline in short-term memory recall is a common symptom associated with aging and dementia. Williams noted that this decline is normally seen in an older patient population.

“To see this striking decline in short-term recall at such a young age really concerns us and makes us worry that this particular group of survivors is at an increased risk of dementia and/or Alzheimer’s as they continue to age,” Williams said.

Cancer survivors who are frail often appear to be several decades older than they are, Kirsten Ness said in an interview with CURE®. Ness, who was an author on this study and is a member in the department of epidemiology and cancer control at St. Jude’s Children’s Research Hospital, explained that frailty among young-adult cancer survivors can prohibit them from being able to perform daily tasks such as crossing the street efficiently, going to the grocery story, engaging in social activities, and later on could result in the inability to bathe, dress and cook for themselves.

“If we can prevent conditions like frailty and neurocognitive decline, we’ll improve (survivors’) ability to return to work or school and have successful careers, have successful family and social lives and live the life they should have lived had they never been diagnosed with cancer in the first place,” Williams said.

Williams and Ness, as well as their colleague and study author Kevin Krull, a member in the department of epidemiology cancer control and the department of psychology at St. Jude’s Children’s Research Hospital, stress that current survivors should maintain their physical activity, eat a well-balanced diet and keep socially active to prevent frailty and its effects.

“My standard line is, ‘move, eat in moderation — mostly plants — don’t smoke and do your crossword puzzles,’” Ness advised.

Krull added that it is “essential” for long-term survivors to maintain contact with their physicians and go through recommended screening to identify early chronic conditions that may affect a survivor’s frailty and neurocognitive abilities.

Children who currently have cancer can also follow these approaches, Williams said. She mentioned that patients should talk to their doctor about what kind of exercises they could be doing during treatment; she noted that moderate exercises such as yoga, light stretching, or walking are beneficial. Children who are receiving treatment for cancer may also consider reading or playing cards when a visitor comes to prevent cognitive decline, Williams suggested.

“I think it’s important in all groups, but I think it’s especially important in survivors of childhood and adolescent cancer, because this is a unique group of survivors who (may) have many decades ahead of them. … So, (they) may be cured of (their) cancer at age 14, and we want to ensure that (the survivor) makes it all the way to 100 feeling great, living the life the way (they) would have if (they) didn’t have cancer,” Williams concluded.

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