A prospective study of grey matter and cognitive function alterations in chemotherapy-treated breast cancer patients

Chris Lepage, Andra M Smith, Jeremy Moreau, Emily Barlow-Krelina, Nancy Wallis, Barbara Collins, Joyce MacKenzie, Carole Scherling, Chris Lepage, Andra M Smith, Jeremy Moreau, Emily Barlow-Krelina, Nancy Wallis, Barbara Collins, Joyce MacKenzie, Carole Scherling

Abstract

Purpose: Subsequent to chemotherapy treatment, breast cancer patients often report a decline in cognitive functioning that can adversely impact many aspects of their lives. Evidence has mounted in recent years indicating that a portion of breast cancer survivors who have undergone chemotherapy display reduced performance on objective measures of cognitive functioning relative to comparison groups. Neurophysiological support for chemotherapy-related cognitive impairment has been accumulating due to an increase in neuroimaging studies in this field; however, longitudinal studies are limited and have not examined the relationship between structural grey matter alterations and neuropsychological performance. The aim of this study was to extend the cancer-cognition literature by investigating the association between grey matter attenuation and objectively measured cognitive functioning in chemotherapy-treated breast cancer patients.

Methods: Female breast cancer patients (n = 19) underwent magnetic resonance imaging after surgery but before commencing chemotherapy, one month following treatment, and one year after treatment completion. Individually matched controls (n = 19) underwent imaging at similar intervals. All participants underwent a comprehensive neuropsychological battery comprising four cognitive domains at these same time points. Longitudinal grey matter changes were investigated using voxel-based morphometry.

Results: One month following chemotherapy, patients had distributed grey matter volume reductions. One year after treatment, a partial recovery was observed with alterations persisting predominantly in frontal and temporal regions. This course was not observed in the healthy comparison group. Processing speed followed a similar trajectory within the patient group, with poorest scores obtained one month following treatment and some improvement evident one year post-treatment.

Conclusion: This study provides further credence to patient claims of altered cognitive functioning subsequent to chemotherapy treatment.

Keywords: Breast cancer; Chemotherapy; Cognition; MRI; Neuroimaging; Voxel-based morphometry.

Figures

Figure 1
Figure 1
Images are presented in radiological view where right is the patient’s left side and left is the patient’s right side. Coordinates presented in MNI space. a) middle frontal gyrus (36 28 22); b) precuneus (20 -58 25); c) gyrus rectus (6 48 -20); d) hippocampus (34 -14 -20) e) middle temporal gyrus (-58 -4 -20); f) anterior cingulate (4 38 5); g) paracentral lobule (10 -36 75); h) medial orbitofrontal gyrus (-32 44 -5); i) inferior orbitofrontal gyrus (-32 28 -5); j) superior temporal gyrus (-65 2 -5); k) insular cortex (-36 6 0); l) inferior frontal operculum (-54 10 0); m) anterior cingulate (-10 38 10); n) calcarine cortex (-12 -86 5).

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