Neurocognitive and Physical Functioning Screening in Hematopoietic Cell Transplant (HCT) Survivorship Clinic

2020 
Neurocognitive impairment and musculoskeletal complications are among the most common complications of long-term allogeneic hematopoietic cell transplant (HCT) survivors, for which recommendations regarding routine screening and therapeutic interventions remain limited. Changes in cognitive functioning have been described in 40% of long-term allogeneic hematopoietic cell transplant survivors, and although the incidence of musculoskeletal complications has not been clearly defined, is very common- ranging from steroid-induced myopathy, myositis related to chronic graft-versus-host disease (GVHD), and fasciitis/scleroderma manifestations. Patient-reported data collected from the Cleveland Clinic Blood and Marrow Transplant (BMT) Survivorship Clinic over a 2 year period revealed that 57-69% of patients report “difficulty remembering things,” and 83% of patients report significant changes in their functional status. To better address this symptomology, we established systematic screening of all allogeneic HCT recipients in our BMT Survivorship Clinic evaluate neurocognitive and physical functioning impairment. The tpMontreal Cognitive Assessment (MoCA) is a sensitive screening test for a variety of neurocognitive diseases, and has been used in the general population to assess global cognition. The MoCA has a maximum score of 30, and a score Neurocognitive and musculoskeletal/functional concerns are highly prevalent in allogeneic HCT Survivors. Systematic screening of patients may help us better recognize concerns earlier and further identify interventions which may help mitigate deficits.
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