Forskningsartikler

Background and objectives: Impaired spatial navigation is considered an early sign in many neurodegenerative diseases. We aimed to determine if spatial navigation was associated with future dementia in patients with subjective cognitive decline (SCD) or mild cognitive impairment (MCI), and to explore associations between spatial navigation and biomarkers of Alzheimer’s disease (AD) and neurodegeneration.

Methods: The study included memory clinic patients without dementia in the longitudinal BioFINDER cohort. The Floor Maze Test (FMT) was used to assess spatial navigation at baseline. Conversion to dementia were evaluated at 2- and 4-year follow-ups. At baseline, amyloid-β 42/40 ratio, phosphorylated-tau (p-tau) and neurofilament light (NfL) were analysed in CSF. Cortical thickness and volume of regions relevant for navigation, and white matter lesion volume were quantified from MRI. The predictive role of the FMT for conversion to all-cause dementia was analysed using logistic regression analyses in two models; 1) controlled for age, sex and education, and 2) adding baseline cognitive status and MMSE. Associations between FMT and biomarkers were adjusted for age, sex, and cognitive status (SCD or MCI).

Results: 156 patients with SCD and 176 patients with MCI were included. FMT total time was associated with progression to all-cause dementia in model 2 at 2-year (OR 1.10, 95% CI 1.04, 1.16) and at 4-year follow-up (OR 1.10, 95% CI 1.04, 1.16), i.e., a 10 % increase in odds of developing dementia per every 10 sec increase in FMT. In the adjusted analyses, P-tau and NfL was associated with FMT total time, as well as hippocampal volume, parahippocampal and inferior parietal cortical thickness. Amyloid-β 42/40 ratio was not associated with FMT total time.

Discussion: Impaired spatial navigation was associated with conversion to dementia within 2 and 4 years, and with key CSF and MRI biomarkers for AD and neurodegeneration in patients with SCD and MCI. This supports its use in early cognitive assessments, but the predictive accuracy should be validated in other cohorts.

Classification of evidence: This is a Class 1 prospective cohort study demonstrating association of baseline markers of spatial recognition with development of dementia in patients with SCD or MCI at baseline.

Gro Gujord Tangen, Maria H Nilsson, Erik Stomrud, Sebastian Palmqvist, Oskar Hansson

Introduction
Quality of life (QoL) and function are important outcomes for older adults with cancer. We aimed to assess differences in trends in patient-reported outcomes (PROs) during radiotherapy (RT) between (1) groups with curative or palliative treatment intent and (2) groups defined according to the number of geriatric impairments.
Materials and Methods
A prospective observational study including patients aged ≥65 years receiving curative or palliative RT was conducted. Geriatric assessment (GA) was performed before RT, and cut-offs for impairments within each domain were defined. Patients were grouped according to the number of geriatric impairments: 0, 1, 2, 3, and ≥ 4. Our primary outcomes, global QoL and physical function (PF), were assessed by The European Organisation for Research and Treatment of Cancer Quality-of-Life Core Questionnaire (EORTC) (QLQ-C30) at baseline, RT completion, and two, eight, and sixteen weeks later. Differences in trends in outcomes between the groups were assessed by linear mixed models.
Results
301 patients were enrolled, mean age was 73.6 years, 53.8% received curative RT. Patients receiving palliative RT reported significantly worse global QoL and PF compared to the curative group. The prevalence of 0, 1, 2, 3 and ≥ 4 geriatric impairments was 16.6%, 22.7%, 16.9%, 16.3% and 27.5%, respectively. Global QoL and PF gradually decreased with an increasing number of impairments. These group differences remained stable from baseline throughout follow-up without any clinically significant changes for any of the outcomes.
Discussion
Increasing number of geriatric impairments had a profound negative impact on global QoL and PF, but no further decline was observed for any group or outcome, indicating that RT was mainly well tolerated. Thus, geriatric impairments per se should not be reasons for withholding RT. GA is key to identifying vulnerable patients in need of supportive measures, which may have the potential to improve treatment tolerance.

Guro Falk Eriksen, Jūratė Šaltytė Benth, Bjørn Henning Grønberg, Siri Rostoft, Lene Kirkhus, Øyvind Kirkevold, Line Merethe Oldervoll, Asta Bye, Anne Hjelstuen, Marit Slaaen