Breast cancer patients who have undergone chemotherapy were more likely to self-report cognitive impairment, and demonstrated neurological shifts on functional MRI (fMRI) tests, but these changes did not always translate to formal cognitive test results.
At the 2006 American Society of Clinical Oncology (ASCO) meeting in Atlanta, Dr. Christopher Booth reported results of a case-control study that used blood tests and fMRI to track cognitive impairment reported by women undergoing chemotherapy for breast cancer. Booth is the director of the Clinical Research Centre at Northwick Park Hospital in London.
The investigators recruited 60 women who had been diagnosed with breast cancer within five years. Twenty women reported cognitive impairment associated with chemotherapy, 20 had chemotherapy without cognitive impairment, and 20 had not received chemotherapy.
All participants underwent comprehensive tests of cognitive function using the Functional Assessment of Chemotherapy-Cog (FACT-Cog) questionnaire. Blood samples were collected and screened for hormone levels, coagulation factors, cytokine levels and the apolipoprotein-E, the so-called Alzheimer's gene. The women were evaluated with fMRI while performing a series of simple mental tasks.
Neuropsychiatric tests showed no statistically significant difference in the rates of cognitive deficits among the groups: 15% of the group reporting cognitive problems had discernible deficits on the tests, as did 20% of the chemotherapy patients who reported no such impairments and 15% of the breast cancer patients who did not undergo chemotherapy.
However, fMRI revealed decreased activation in the frontal areas and right parahippocampus in the women who self-reported greater cognitive impairment (p < 0.01). Separate frontal areas showed increased activity in women with greater objective cognitive impairment (p < 0.0005).
Of interest, women who had received chemotherapy were more likely to report fatigue than those who had not undergone chemotherapy (p = 0.027), and as might be expected fatigue was positively associated with self-reported cognitive impairment, but fatigue was not positively correlated with scores on neuropsychiatric tests.
By Peggy Peck
AuntMinnie.com contributing writer
July 14, 2006
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