SABCS: Cognitive Dysfunction Precedes Breast Cancer Chemotherapy and 'Chemo Brain'

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(ChemotherapyAdvisor)–Low pre-chemotherapy activation of a region of the brain involved in short-term memory predicts post-chemotherapy fatigue levels, according to a prospective neurocognitive performance and functional MRI (fMRI) neuroimaing study reported during the 2012 CTRC-AACR San Antonio Breast Cancer Symposium (SABCS).

“Neurocognitive alterations during a working memory task and greater fatigue were evidence before any adjuvant chemotherapy for breast cancer,” reported senior author Bernadine Cimprich, PhD, RN, associate professor emeriti at the University of Michigan, School of Nursing in Ann Arbor, MI, and her coauthors.

Women who underwent anthracycline-based combination chemotherapy (n=29) reported significantly greater severity of fatigue (P<0.05) and had poorer performance on a verbal working memory task (VWMT) during fMRI neuroimaging than did radiotherapy-arm patients (n=37) or age-matched healthy controls (n=32), the coauthors reported.

Importantly, this was found to be the case both a month before and a month after chemotherapy, suggesting that the women selected for chemotherapy experience symptoms commonly referred to as “chemo brain” even before they begin treatment, the coauthors noted.

Patients underwent high and low-demand cognitive tasks during fMRI imaging. Poorer performance during high-demand tasks appeared to be associated with lower activation of the left inferior frontal gyrus (LiFS), a region of prefrontal cortex involved in working memory function, the researchers noted.

“Of interest, lower pre-treatment activation in the LiFG in the high-low demand contrast predicted severity of fatigue across all participants at the post-treatment assessment (r=-0.27, P<0.01), linking early compromise in neurocognitive performance with greater fatigue over time,” Dr. Cimprich said.

“Taken together, these findings indicate that pre-treatment neurocognitive compromise and fatigue are key contributors to the cognitive impact often attributed solely to chemotherapy,” they concluded. “Early therapeutic interventions targeting fatigue may improve cognitive function and reduce the distress of ‘chemo brain' throughout the course of adjuvant treatment.”


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