A Twin Study of Cognitive Outcomes in Older Adult Cancer

描述（由申请人提供）： 该项目通过使用基于人群的瑞典双胞胎登记处，解决了癌症及其治疗对老年人的长期认知影响。所有65岁以上的双胞胎谁生存任何恶性癌症[脑癌除外]三年或以上已确定通过全国范围内的瑞典癌症登记。从之前的一项由美国国家卫生研究院资助的研究中，我们收集了这些双胞胎的认知结果数据，包括认知障碍的电话筛查和基于完整临床评估的痴呆症诊断。在这个项目中，我们将把有关癌症的信息与有关认知功能的信息联系起来。资金将允许分析这些以前收集的数据，用于流行病学目的和规划未来更大的应用。 癌症登记处显示了癌症诊断和所有患者的治疗中心。登记研究未指明治疗类型。因此，我们建议去癌症治疗中心，并获得每个幸存者的记录。从记录中，我们将提取有关治疗日期、类型、持续时间和剂量的详细信息。这是没有资金就无法开展的主要活动。 这些信息将用于检验癌症幸存者的认知功能较差的假设，并且与未接受癌症治疗的老年人相比，更有可能被临床诊断为痴呆症，控制测量的协变量（教育，酒精使用和体育锻炼）和假设的调解人（心血管疾病，抑郁症状和疲劳），以及不可测量的家族效应（遗传影响和生命早期的共同环境影响）。其次，我们将研究如何具体的治疗，例如，化疗和放疗，与损害。 将对已诊断患有癌症的人与（1）共同双胞胎（即每对中未被诊断患有癌症的双胞胎兄弟姐妹）和（2）由未被诊断患有癌症且与患有癌症的个体无关的双胞胎组成的无关对照组进行比较，以检验假设。这项双胞胎研究包括500多对双胞胎，自诊断以来平均存活近12年。对于不相关的比较设计，我们将双胞胎登记处的三个人与700多名癌症幸存者中的每一个进行匹配。 关键结果和相关协变量的数据将来自住院患者出院登记处; 30多年前双胞胎登记处成立时收集的问卷; 1998-2001年对整个双胞胎登记处的电话采访;以及电话筛查后进行的痴呆症临床评价。 这项研究利用了一个独特的基于人群的老年癌症幸存者数据集。通过从癌症治疗记录中提取数据并将其与现有数据集联系起来，我们将能够检查可能的长期影响，沿着可能的协变量，以及最佳比较组。

DESCRIPTION (provided by applicant): This project addresses the longer term cognitive impact of cancer and its treatment on older adults through use of the population-based Swedish Twin Registry. All twins aged 65+ who have survived any malignant cancer [excluding brain cancer] for three or more years have been identified through the nationwide Swedish Cancer Registry. From a previous NIA-funded study, we have collected data about cognitive outcomes for these twins, including telephone screening for cognitive impairment and diagnoses for dementia based on complete clinical evaluations. For the proposed project, we will link information about cancer with information about cognitive function. Funding will permit analyzing these previously collected data for epidemiologic purposes and for planning a future larger application. The Cancer Registry indicates the cancer diagnosis and the center where treatment took place for all patients. The registry does not indicate type of treatment. Thus, we propose to go to the cancer treatment centers and obtain records for each survivor. From the records, we will abstract detailed information about date, type, length, and dose of treatment. This is the main activity that cannot take place without funding. This information will be used to test the hypothesis that cancer survivors will have poorer cognitive functioning and will be more likely to be clinically diagnosed as demented than older adults who have not been treated for cancer, controlling for measured covariates (education, alcohol use, and physical exercise) and hypothesized mediators (cardiovascular disease, depressive symptoms, and fatigue), as well as unmeasured familial effects (genetic influences and shared environmental influences early in life). Secondly, we will examine how specific treatments, for example, chemotherapy and radiotherapy, relate to impairment. Hypotheses will be tested comparing those who have been diagnosed with cancer to both (1) co-twins, that is, within each pair, the twin sibling who has not been diagnosed with cancer, and (2) an unrelated comparison group consisting of individual twins who were not diagnosed with cancer and are not related to the individuals with cancer. The co-twin study includes over 500 twin pairs discordant for cancer, with average survival of nearly 12 years since diagnosis. For the unrelated comparison design, we will match three individuals from the twin registry to each of over 700 cancer survivors. Data on key outcomes and relevant covariates will come from the Inpatient Discharge Registry; questionnaires collected when the twin registry was formed over 30 years ago; a telephone interview of the entire twin registry in 1998-2001; and clinical evaluations for dementia conducted after telephone screening. This study capitalizes on a uniquely available population-based dataset of older adult cancer survivors. Through abstracting data from cancer treatment records and linking them to existing datasets, we will be able to examine possible longer term effects, along with likely covariates, with optimal comparison groups.