Improving Cognitive Function in Older Adults Undergoing Stem Cell Transplant

Summary

Cancer and treatment-related cognitive changes, such as thinking or remembering, hinder resumption of normal routine and roles and worsen quality of life. Older adults undergoing hematopoietic cell transplantation (HCT) are at high-risk for cognitive impairment. Age is a risk factor for Alzheimer's Dementia (AD) and the hematological malignancies leading to HCT. There are shared mechanisms and interactions between AD and cancer-related cognitive decline (CRCD). Physical activity improves cognitive function in older adults and survivors of other cancers. This study hypothesizes that increasing physical activity can also improve cognitive function in this vulnerable population. The study has two goals. The first is to adapt and test an evidence-based physical activity intervention, The Community Health Activities Model Program for Seniors II (CHAMPS II), in the HCT setting for adults 55 years and older. This will be done using semi-structured interview of up to 10 patients who have experienced the HCT process within the last 3 to 6 months with HCT care-team partners. The second goal will explore the prevalence and impact of AD-neuropathology and inflammation on cancer-related cognitive decline (CRCD) in older adults undergoing HCT.

Eligibility

Arm 1:

Inclusion Criteria for Participants:

* age 60 years and older
* have a diagnosis of hematological malignancy
* have received autologous or allogeneic HCT within the prior 3-6 months
* able to speak and read English
* have provided written informed consent

Exclusion Criteria for Participants:

* there are no exclusion criteria

Inclusion Criteria for Participants' Care-Partner:

* age 19 years and older
* able to speak and read English

Exclusion Criteria for Participants' Care-Partner:

* there are no exclusion criteria

Inclusion Criteria for Transplant Team Member:

* age 19 years and older
* able to speak and read English

Exclusion Criteria for Transplant Team Member:

* there are no exclusion criteria

Arms 2 and 3:

Inclusion Criteria for Participants:

* age 55 years and older
* have a diagnosis of hematological malignancy
* planned to receive an autologous or allogeneic HCT
* able to walk 4 meters as part of the Short Physical Performance Battery (with or without assistance)
* (In Arm 3 only): willingness to be randomized to either initiate the physical activity intervention pre-HCT or following Day 180 post-HCT, and to follow the protocol for the group to which they have been assigned
* able to speak and read English
* have provided written informed consent

Exclusion Criteria for Participants:

* development of chest pain, severe shortness of breath, or occurrence of other safety concerns during the physical performance measures (i.e. Short Physical Performance Battery)
* is not cleared to participate in exercise by a physician

Individuals with the following current conditions/diagnoses documented in medical history will be required to provide clearance for exercise from their cardiologist:

* Myocardial infarctions in the past 3 months
* Resting or unstable angina
* Uncontrolled and/or serious arrhythmias
* 3rd degree heart block
* Acute congestive heart failure or ejection fraction \<30%
* Clinically significant aortic stenosis

Individuals with the following conditions/diagnoses will be required to provide clearance for exercise from their surgeon:

* Hip fracture, hip or knee replacement, or spinal surgery in the past 3 months

  * other medical, psychiatric, or behavioral factors that in the judgement of the principal investigator may interfere with study participation or the ability to follow either the intervention or the active control condition
  * (In Arm 3 for those who agree to the voluntary measures of blood, saliva and MRI, there are additional exclusions to avoid conditions that may confound study outcomes):
* history of residual brain abnormalities from prior severe traumatic brain injury (e.g. encephalomalacia) or other significant abnormalities documented on a recent brain MRI (e.g. brain cancer, large vessel strokes, residual subdural hematoma)
* history of major stroke with obvious residual deficits
* history of relapsing and remitting Multiple Sclerosis
* active moderate to severe psychiatric symptoms due to primary psychiatric disorder

Inclusion Criteria for Participants' Care-Partner:

* age 19 years and older
* able to speak and read English
* able to walk 4 meters as part of the Short Physical Performance Battery (with or without assistance)
* have no medical contraindications for participating in light to moderate-intensity physical activity per PI review of medical history as reported on the care-partner medical history form

Exclusion Criteria for Participants' Care-Partner:

* development of chest pain, severe shortness of breath, or occurrence of other safety concerns during the physical performance measures (i.e. Short Physical Performance Battery)
* is not cleared to participate in exercise by a physician

Individuals with the following current conditions/diagnoses documented in medical history will be required to provide clearance for exercise from their cardiologist:

* Myocardial infarctions in the past 3 months
* Resting or unstable angina
* Uncontrolled and/or serious arrhythmias
* 3rd degree heart block
* Acute congestive heart failure or ejection fraction \<30%
* Clinically significant aortic stenosis

Individuals with the following conditions/diagnoses will be required to provide clearance for exercise from their surgeon:

o Hip fracture, hip or knee replacement, or spinal surgery in the past 3 months

* other medical, psychiatric, or behavioral factors that in the judgement of the principal investigator may interfere with study participation or the ability to follow either the intervention or the active control condition

Inclusion Criteria for Transplant Team Member:

* age 19 years and older
* able to speak and read English

Exclusion Criteria for Transplant Team Member:

* there are no exclusion criteria

Conditions6

Locations1 site

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