brain changes associated w chemo induced cognitive dysfunction identified

Lani · 11-14-2011, 11:27 PM

there may be some changes from the breast cancer itself as well

Neurological and executive function impairment associated with breast cancer

CHICAGO – Women who survive breast cancer show significant neurological impairment, and outcomes appear to be significantly poorer for those treated with chemotherapy, according to a report in the November issue of the Archives of Neurology, one of the JAMA/Archives journals.

Breast cancer (BC) is one of the most common public health problems, with a worldwide estimated incidence of 39 per 100,000 individuals annually. Although primary BC has not been associated historically with neurological problems, a growing body of evidence suggests that patients are at increased risk for altered brain structure and function, according to background information in the article.

Shelli R. Kesler, Ph.D., and colleagues at Stanford University School of Medicine, Stanford, Calif., conducted an observational study to determine whether profiles of brain activation differ among BC survivors treated with or without chemotherapy, compared with healthy control women. The study included 25 women with BC who received chemotherapy, 19 women with BC who did not receive chemotherapy, and 18 healthy female controls, all matched for age and other demographic variables. The women were asked to perform various tasks, and the researchers used functional MRI to measure activation in several areas of the brain.

"Women with BC demonstrated significantly reduced activation in the left middle dorsolateral prefrontal cortex and premotor cortex compared with healthy controls," the authors report.

"The chemotherapy group also demonstrated significantly reduced left caudal lateral prefrontal cortex activation and increased perseverative errors and reduced processing speed compared with the other two groups," they write.

The study also found that the negative effects of chemotherapy on brain function may be exacerbated by such factors as increased age and lower educational level.

"This study provides further evidence that primary BC may cause measurable brain injury," the authors conclude. "Women treated with chemotherapy may show additional prefrontal deficits and have difficulty compensating for neurobiological changes such that they also show impaired executive function."

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(Arch Neurol. 2011;68[11]:1447-1453. Available pre-embargo to the media at www.jamamedia.org.)

Editor's Note: Please see the article for additional information, including other authors, financial contributions and affiliations, financial disclosures, funding and support, etc.

To contact Shelli R. Kesler, Ph.D., call Michelle Brandt at 650-723-0272 or email mbrandt@stanford.edu.

StephN · 11-14-2011, 11:32 PM

Lani -
What other changes possible from the breast cancer itself? You mean besides what the chemo can do?

I certainly know that I could not think very well some times!

NEDenise · 11-15-2011, 06:12 AM

Yikes!
This is scary! I guess confused and disorganized is better than dead...but I was really hoping this 'decreased function' was temporary. Have to admit...this makes me sad.

I wonder if anyone is doing research about how to regain some of that function...or if it's even possible.

Thanks for the new info, Steph.
Denise

Jackie07 · 11-15-2011, 06:45 AM

Put 'Idelle' into the search box. She's published a book on the subject and we've had some discussions on the topic before. PBS has a program about 'Brain elasticity' - yes, there are a lot of things we can do to improve our cognitive function.

Most people don't use but 2% -5% of all the brain cells in their life time. The key is to get the neurons connected (synapse) Exercise (both mental and physical) does wonders.

Lani · 11-15-2011, 11:12 PM

No mention of antiestrogen treatment in these abstracts, news items. I will look at the original article and see if they are mentioned. It seems Estrogen signalling is very important in the brain (even in men!), so I can't see how they would fail to mention it.

Breast cancers secrete many substances. Perhaps some of them are acting on the brain. It would not just be fear, stress, lack of sleep or worry as those go with many things besides breast cancer without showing the same brain changes.

Lots to find out!

Lani · 11-15-2011, 11:49 PM

on my way looking for the original article I came across this other article, also pretty hot off the press:

Front Hum Neurosci. 2011;5:122. Epub 2011 Nov 1.
Pre-chemotherapy differences in visuospatial working memory in breast cancer patients compared to controls: an FMRI study.
Scherling C, Collins B, Mackenzie J, Bielajew C, Smith A.
Source
School of Psychology, University of Ottawa Ottawa, ON, Canada.
Abstract
Introduction: Cognitive deficits are a side-effect of chemotherapy, however pre-treatment research is limited. This study examines neurofunctional differences during working memory between breast cancer (BC) patients and controls, prior to chemotherapy. Methods: Early stage BC females (23), scanned after surgery but before chemotherapy, were individually matched to non-cancer controls. Participants underwent functional magnetic resonance imaging (fMRI) while performing a Visuospatial N-back task and data was analyzed by multiple group comparisons. fMRI task performance, neuropsychological tests, hospital records, and salivary biomarkers were also collected. Results: There were no significant group differences on neuropsychological tests, estrogen, or cortisol. Patients made significantly fewer commission errors but had less overall correct responses and were slower than controls during the task. Significant group differences were observed for the fMRI data, yet results depended on the type of analysis. BC patients presented with increased activations during working memory compared to controls in areas such as the inferior frontal gyrus, insula, thalamus, and midbrain. Individual group regressions revealed a reverse relationship between brain activity and commission errors. Conclusion: This is the first fMRI investigation to reveal neurophysiological differences during visuospatial working memory between BC patients pre-chemotherapy and controls. These results also increase the knowledge about the effects of BC and related factors on the working memory network. Significance: This highlights the need to better understand the pre-chemotherapy BC patient and the effects of associated confounding variables.

PMID: 22053153 [PubMed] PMCID: PMC3205481 Free PMC Article

SoCalGal · 11-16-2011, 11:45 PM

It seems like a very small sampling of women.

StephN · 11-17-2011, 12:33 AM

Hopefully this is just the start of such studies. With such a small sample, it would be hard to cover all treatment modalities.

Lani · 11-17-2011, 10:13 AM

I looked at the article.

It did NOT test them before surgery and then after surgery but before chemo or hormonal and then after chemo/hormonal and then periodically thereafter as you would need to to draw more meaningful conclusions

It just matched the numbers of those who got chemo and those who did not for hormonal therapy NOT EVEN CONSIDERING IT could be the antihormonal therapy that was responsible (not even in the discussion of possible confounders at the end of the article) and didn't reflect on the fact that one of the mechanisms of action/results of chemotherapy is to put patients in premature menopause ie, it might be the time course of estrogen deprivation which is important. It just matched the patients with and without chemo and without bc for age and menopausal status.

Lot of work left to be done!

Laurel · 11-17-2011, 06:06 PM

Lani,

I am glad you are raising the question of anti-hormonal therapy and cognitive function. I had long considered my "fluffiness between my ears" to be exacerbated by the A.I. I am taking. I suspect when someone subdivides the anti-hormonal patients from the other post-chemo patients they will find the cumulative effects of chemo and anti-hormonals to be considerably more affecting.

MJo · 11-18-2011, 03:19 PM

When I met my onc in 2006 and told him I was a business writer, he told me that chemo might affect my work. I am different now. I can't write or think as fast. I'm not as "imaginative." When I tell myself it could be age related, I remind myself that Hillary Clinton is secretary of state! Yeah, it's better than being dead. These side effects aren't terrible, but they are noticeable. So oncologists suspected long-term side effects back in 2006.

fauxgypsy · 11-19-2011, 03:17 PM

I had some issues during and after chemo. I still have trouble finding words occasionally. However, I have had no problems with creativity (in fact I painted more and designed more items after chemo than I did before) and I teach biology courses at a community college (started teaching full time in 2009). Years ago I took Reglan and I think it affected my (creative) writing more than chemo did. I do believe that teaching has helped with cognition. If anything really affected me, though, it was the Arimidex. I felt so much better when I refused to take it any longer, both physically and mentally. I don't feel exceptional. Maybe I've been lucky. I don't have the energy levels that I used to. I was the energizer bunny. But I'm still in the running.

chicagoetc · 11-19-2011, 06:40 PM

I'm glad there is ongoing research on this. My oncologist sent me as a test (I think) to a neurologist who believed something real was going on. Even now I notice a difference (and have a previous experience of a different nature to compare it with). I suspect it's highly related to chemo...but I don't understand how the cancer itself would cause problems....

Melanie