Cognitive Impairment in Cancer Patients Treated with Immune Checkpoint Inhibitors: A Cross-Sectional Study

<b>Background and Objectives:</b> Immune checkpoint inhibitors (ICIs) have transformed cancer care, but their impact on cognition is unclear. This study examined the prevalence and clinical correlates of cognitive impairment in patients receiving ICIs. <b>Materials and Methods:</b> In this two-center, cross-sectional cohort of 189 adults with solid tumors treated with ICIs, cognitive function was assessed using the Montreal Cognitive Assessment (MoCA). Cognitive impairment was defined as MoCA ≤ 21. Age, sex, education, Eastern Cooperative Oncology Group (ECOG) performance status, treatment line, number of metastatic sites, and ICI exposure were compared between cognitive groups using chi-square tests. Univariate and multivariate logistic regression models were used to identify independent predictors of cognitive impairment. <b>Results:</b> The median age was 65 years and 73% of patients were male. Overall, 102 of 189 participants (54%) met criteria for cognitive impairment. Patients with impaired cognition were more often aged ≥65 years, female, and educated at or below high school level, and more frequently had ECOG ≥ 1, second- or later-line ICI therapy, and ≥2 metastatic sites (all <i>p</i> < 0.05). In multivariate analysis, independent predictors of cognitive impairment were age ≥ 65 years (OR: 2.98, 95% CI 1.45-6.12, <i>p</i> = 0.003), female sex (OR: 2.48, 1.09-5.67, <i>p</i> = 0.030), lower education (OR: 3.10, 1.35-7.07, <i>p</i> = 0.007), later-line therapy (OR: 3.51, 1.56-7.88, <i>p</i> = 0.002), ECOG ≥ 1 (OR: 3.38, 1.46-7.83, <i>p</i> = 0.004), and ≥2 metastatic sites (OR: 2.85, 1.37-5.90, <i>p</i> = 0.005). <b>Conclusions:</b> More than half of patients receiving ICIs exhibit objective cognitive deficits. Systematic cognitive screening in high-risk subgroups may allow for earlier recognition of impairment and more timely supportive care.