A Scoping Review on Cognition in Myelodysplastic Syndromes: Advances and Challenges

Myelodysplastic syndromes (MDS) are clonal hematopoietic disorders characterized by ineffective hematopoiesis and a risk of progression to acute myeloid leukemia (AML). Cognitive impairments, including deficits in memory, attention, and executive function, are frequently reported in MDS patients. These impairments are linked to systemic inflammation, neurotoxic treatment effects, and the psychological burden of chronic disease. This review synthesizes existing evidence on cognitive dysfunction in MDS, highlighting knowledge gaps and opportunities for future research.

A scoping review was conducted following PRISMA-ScR guidelines. MEDLINE and Scopus databases were searched for studies examining cognition in MDS patients, using terms like "myelodysplastic syndromes" and "cognition." Inclusion criteria were original, English-language studies reporting cognitive outcomes in MDS. Reviews, animal studies, and abstracts were excluded. Data on study design, patient characteristics, cognitive tests, and outcomes were extracted and descriptively analyzed.

The review included 25 studies involving 2390 patients with hematologic malignancies, 493 of whom had MDS. Key findings identified cognitive deficits primarily in attention, executive function, and memory. Systemic inflammation and treatment-related neurotoxicity were significant contributors, with older age compounding these effects. Longitudinal studies demonstrated persistent cognitive challenges post-treatment, though the severity varied by patient demographics and therapeutic regimens.

Cognitive impairments in MDS are multifactorial and significantly impact patients' quality of life. Current research highlights the need for routine cognitive assessments and targeted interventions. Future studies should focus on longitudinal designs to explore specific cognitive domains and develop therapeutic strategies to mitigate cognitive decline.