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VanLandingham HB, Ellison RL, Turchmanovych-Hienkel N, Alfonso D, Oh A, Kaseda ET, Basurto K, Tse PKY, Khan H. Neuropsychological assessment, intervention, and best practices for women with non-Central nervous system cancer: A scoping review of current standards. Clin Neuropsychol 2024:1-32. [PMID: 38641949 DOI: 10.1080/13854046.2024.2343147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 04/10/2024] [Indexed: 04/21/2024]
Abstract
Objective: Existing literature has sought to characterize the broad cognitive impact of non-central nervous system cancer and its treatment, including chemotherapy, radiation, surgery, and hormonal regulation. However, despite the frequency of women that are diagnosed with breast and gynecological cancer, there is limited research on the specific cognitive experiences of women undergoing cancer treatment. Presently, the current literature lacks concise guidance for neuropsychologists to support the cognitive health of women facing cancer, despite the acknowledged impact of cancer interventions and chronic illness on cognitive outcomes. Method: Applying scoping review criteria outlined by Peters et al. (2015) and adhering to Preferred Reporting Items for Systemic Reviews and Meta-Analysis (PRISMA) guidelines, we conducted a comprehensive examination of literature spanning multiple databases (Google Scholar, PubMed, PsychINFO) with a focus on the cognitive impact of cancer treatment on women. Conclusions: Women are subject to unique treatment-related outcomes due to the impact of hormonal alterations, differences in metabolization of certain chemotherapies, and psychosocial risk factors. Despite the known impact of cancer intervention, chronic illness, and cancer-related sequelae on cognitive outcomes, the current literature does not parsimoniously outline best practices for neuropsychologists to promote the health of women experiencing cancer. The current paper (1) provides an overview of the cognitive implications of cancer treatment with an intentional focus on cancers that are more prevalent in women versus men, (2) addresses the characteristics of this impact for women undergoing cancer intervention(s), and (3) provides possible intervention and treatment strategies for mental health providers and neuropsychologists.
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Affiliation(s)
- Hannah B VanLandingham
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Rachael L Ellison
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | | | - Demy Alfonso
- Department of Psychology, Northern Illinois University, DeKalb, IL, USA
| | - Alison Oh
- Department of Psychology, Illinois Institute of Technology, Chicago, IL, USA
| | - Erin T Kaseda
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Karen Basurto
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Phoebe K Y Tse
- Department of Psychology, The Chicago School, Chicago, IL, USA
| | - Humza Khan
- Department of Psychology, Northern Illinois University, DeKalb, IL, USA
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2
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Been LE, Halliday AR, Blossom SM, Bien EM, Bernhard AG, Roth GE, Domenech Rosario KI, Pollock KB, Abramenko PE, Behbehani LM, Pascal GJ, Kelly ME. Long-Term Oral Tamoxifen Administration Decreases Brain-Derived Neurotrophic Factor in the Hippocampus of Female Long-Evans Rats. Cancers (Basel) 2024; 16:1373. [PMID: 38611051 PMCID: PMC11010888 DOI: 10.3390/cancers16071373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/24/2024] [Accepted: 03/29/2024] [Indexed: 04/14/2024] Open
Abstract
Tamoxifen, a selective estrogen receptor modulator (SERM), is commonly used as an adjuvant drug therapy for estrogen-receptor-positive breast cancers. Though effective at reducing the rate of cancer recurrence, patients often report unwanted cognitive and affective side effects. Despite this, the impacts of chronic tamoxifen exposure on the brain are poorly understood, and rodent models of tamoxifen exposure do not replicate the chronic oral administration seen in patients. We, therefore, used long-term ad lib consumption of medicated food pellets to model chronic tamoxifen exposure in a clinically relevant way. Adult female Long-Evans Hooded rats consumed tamoxifen-medicated food pellets for approximately 12 weeks, while control animals received standard chow. At the conclusion of the experiment, blood and brain samples were collected for analyses. Blood tamoxifen levels were measured using a novel ultra-performance liquid chromatography-tandem mass spectrometry assay, which found that this administration paradigm produced serum levels of tamoxifen similar to those in human patients. In the brain, brain-derived neurotrophic factor (BDNF) was visualized in the hippocampus using immunohistochemistry. Chronic oral tamoxifen treatment resulted in a decrease in BDNF expression across several regions of the hippocampus. These findings provide a novel method of modeling and measuring chronic oral tamoxifen exposure and suggest a putative mechanism by which tamoxifen may cause cognitive and behavioral changes reported by patients.
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Affiliation(s)
- Laura E. Been
- Department of Psychology and Neuroscience Program, Haverford College, Haverford, PA 19041, USA; (A.R.H.); (S.M.B.); (E.M.B.); (A.G.B.); (G.E.R.); (K.I.D.R.); (K.B.P.); (P.E.A.); (L.M.B.); (G.J.P.); (M.E.K.)
| | - Amanda R. Halliday
- Department of Psychology and Neuroscience Program, Haverford College, Haverford, PA 19041, USA; (A.R.H.); (S.M.B.); (E.M.B.); (A.G.B.); (G.E.R.); (K.I.D.R.); (K.B.P.); (P.E.A.); (L.M.B.); (G.J.P.); (M.E.K.)
| | - Sarah M. Blossom
- Department of Psychology and Neuroscience Program, Haverford College, Haverford, PA 19041, USA; (A.R.H.); (S.M.B.); (E.M.B.); (A.G.B.); (G.E.R.); (K.I.D.R.); (K.B.P.); (P.E.A.); (L.M.B.); (G.J.P.); (M.E.K.)
| | - Elena M. Bien
- Department of Psychology and Neuroscience Program, Haverford College, Haverford, PA 19041, USA; (A.R.H.); (S.M.B.); (E.M.B.); (A.G.B.); (G.E.R.); (K.I.D.R.); (K.B.P.); (P.E.A.); (L.M.B.); (G.J.P.); (M.E.K.)
| | - Anya G. Bernhard
- Department of Psychology and Neuroscience Program, Haverford College, Haverford, PA 19041, USA; (A.R.H.); (S.M.B.); (E.M.B.); (A.G.B.); (G.E.R.); (K.I.D.R.); (K.B.P.); (P.E.A.); (L.M.B.); (G.J.P.); (M.E.K.)
| | - Grayson E. Roth
- Department of Psychology and Neuroscience Program, Haverford College, Haverford, PA 19041, USA; (A.R.H.); (S.M.B.); (E.M.B.); (A.G.B.); (G.E.R.); (K.I.D.R.); (K.B.P.); (P.E.A.); (L.M.B.); (G.J.P.); (M.E.K.)
| | - Karina I. Domenech Rosario
- Department of Psychology and Neuroscience Program, Haverford College, Haverford, PA 19041, USA; (A.R.H.); (S.M.B.); (E.M.B.); (A.G.B.); (G.E.R.); (K.I.D.R.); (K.B.P.); (P.E.A.); (L.M.B.); (G.J.P.); (M.E.K.)
| | - Karlie B. Pollock
- Department of Psychology and Neuroscience Program, Haverford College, Haverford, PA 19041, USA; (A.R.H.); (S.M.B.); (E.M.B.); (A.G.B.); (G.E.R.); (K.I.D.R.); (K.B.P.); (P.E.A.); (L.M.B.); (G.J.P.); (M.E.K.)
| | - Petra E. Abramenko
- Department of Psychology and Neuroscience Program, Haverford College, Haverford, PA 19041, USA; (A.R.H.); (S.M.B.); (E.M.B.); (A.G.B.); (G.E.R.); (K.I.D.R.); (K.B.P.); (P.E.A.); (L.M.B.); (G.J.P.); (M.E.K.)
| | - Leily M. Behbehani
- Department of Psychology and Neuroscience Program, Haverford College, Haverford, PA 19041, USA; (A.R.H.); (S.M.B.); (E.M.B.); (A.G.B.); (G.E.R.); (K.I.D.R.); (K.B.P.); (P.E.A.); (L.M.B.); (G.J.P.); (M.E.K.)
| | - Gabriel J. Pascal
- Department of Psychology and Neuroscience Program, Haverford College, Haverford, PA 19041, USA; (A.R.H.); (S.M.B.); (E.M.B.); (A.G.B.); (G.E.R.); (K.I.D.R.); (K.B.P.); (P.E.A.); (L.M.B.); (G.J.P.); (M.E.K.)
| | - Mary Ellen Kelly
- Department of Psychology and Neuroscience Program, Haverford College, Haverford, PA 19041, USA; (A.R.H.); (S.M.B.); (E.M.B.); (A.G.B.); (G.E.R.); (K.I.D.R.); (K.B.P.); (P.E.A.); (L.M.B.); (G.J.P.); (M.E.K.)
- Neuroscience Program, University of Pennsylvania, Philadelphia, PA 19104, USA
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3
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Wang Y, Chen Q, Zhang X, Wang K, Cheng H, Chen X. Changes in decision-making function in patients with subacute mild traumatic brain injury. Eur J Neurosci 2024; 59:69-81. [PMID: 38044718 DOI: 10.1111/ejn.16195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 10/09/2023] [Accepted: 11/03/2023] [Indexed: 12/05/2023]
Abstract
Although awareness regarding patients with mild traumatic brain injury has increased, they have not received sufficient attention in clinics; hence, many patients still experience only partial recovery. Deficits in decision-making function are frequently experienced by these patients. Accurate identification of impairment in the early stages after brain injury is particularly crucial for timely intervention and the prevention of long-term cognitive consequences. Therefore, we investigated the changes in decision-making ability under tasks of ambiguity and risk in patients with mild traumatic brain injury with a rule-based neuropsychological paradigm. In this study, patients (n = 39) and matched healthy controls (n = 38) completed general neuropsychological background tests and decision-making tasks (Iowa Gambling Task and Game of Dice Task). We found that patients had extensive cognitive impairment in general attention, memory and information processing speed in the subacute phase, and confirmed that patients had different degrees of impairment in decision-making abilities under ambiguity and risk. Furthermore, the decline of memory and executive function may be related to decision-making dysfunction.
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Affiliation(s)
- Yuyang Wang
- Department of Neurosurgery, the First Affiliated Hospital of Anhui Medical University, Hefei, China
- Department of Neurosurgery, the Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Qing Chen
- Department of Neurology, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xinyu Zhang
- Department of Neurosurgery, Funan County People's Hospital, Fuyang, China
| | - Kai Wang
- Department of Neurology, the First Affiliated Hospital of Anhui Medical University, Hefei, China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China
| | - Hongwei Cheng
- Department of Neurosurgery, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xingui Chen
- Department of Neurology, the First Affiliated Hospital of Anhui Medical University, Hefei, China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China
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4
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Klann IP, Fulco BCW, Nogueira CW. Subchronic exposure to Tamoxifen modulates the hippocampal BDNF/ERK/Akt/CREB pathway and impairs memory in intact female rats. Chem Biol Interact 2023; 382:110615. [PMID: 37392961 DOI: 10.1016/j.cbi.2023.110615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 06/13/2023] [Accepted: 06/27/2023] [Indexed: 07/03/2023]
Abstract
Tamoxifen (TAM), a Selective Estrogen Receptor Modulator (SERM), is commonly used to treat and prevent breast cancer. Memory impairment has been noticed in patients who experience hormone therapy in the case of TAM and other SERMs. Animal studies that mimic the TAM longer exposure effects are needed to better elucidate the adverse effects of continuous treatment in humans. This study evaluated the effects of TAM subchronic administration on the memory performance and hippocampal neural plasticity of intact female Wistar rats. Animals were treated intragastrically with TAM (0.25 and 2.5 mg/kg) for 59 days. The rats were subjected to the Object Location Test (OLT) and Object Recognition Test (ORT) to evaluate memory performance. After euthanasia, the hippocampus samples were excised and the protein levels of the BDNF/ERK/Akt/CREB pathway were evaluated. The rat's locomotor activity and hippocampal TrkB levels were similar among the experimental groups. TAM at both doses reduced the memory performance of female rats in the OLT and short-term memory of ORT, and impaired hippocampal levels of mBDNF, proBDNF, and pCREB/CREB. TAM only at the dose of 2.5 mg/kg reduced the memory performance of rats in the long-term memory of ORT and hippocampal pERK/ERK and pAkt/Akt ratios. TAM subchronic administration induced amnesic effects and modulated the hippocampal BDNF/ERK/Akt/CREB pathway in intact young adult female Wistar rats.
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Affiliation(s)
- Isabella P Klann
- Laboratório de Síntese, Reatividade e Avaliação Farmacológica e Toxicológica de Organocalcogênios, CCNE, Universidade Federal de Santa Maria, Santa Maria, Rio Grande do Sul, Brazil
| | - Bruna C W Fulco
- Laboratório de Síntese, Reatividade e Avaliação Farmacológica e Toxicológica de Organocalcogênios, CCNE, Universidade Federal de Santa Maria, Santa Maria, Rio Grande do Sul, Brazil
| | - Cristina W Nogueira
- Laboratório de Síntese, Reatividade e Avaliação Farmacológica e Toxicológica de Organocalcogênios, CCNE, Universidade Federal de Santa Maria, Santa Maria, Rio Grande do Sul, Brazil.
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5
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Sharma S, Wright HH. Tamoxifen Effects on Cognition and Language in Women with Breast Cancer. Semin Speech Lang 2023; 44:189-202. [PMID: 37220780 DOI: 10.1055/s-0043-1768135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Cognitive changes following adjuvant treatment for breast cancer (BC) are well documented following chemotherapy. However, limited studies have examined cognitive and/or language functions in chemotherapy-naive women with BC taking tamoxifen (TAM). Using ambulatory cognitive assessment, we investigated the trajectory of cognitive and language changes during early period of adjuvant endocrine treatment (TAM) in women with BC at two time periods (pretreatment and 2 months after treatment began). Four women with BC and 18 cognitively healthy age-matched controls completed three cognitive tasks using smartphones, during a short time period (5 days) and repeated them at two time periods. To determine language ability, language samples were collected at two time periods, where the participants described two stories from two wordless picture books and samples were assessed using core lexicon analyses. Wilcoxon-signed rank tests were computed to identify differences in linguistic and cognitive performances of both the groups at two time periods. No significant within-group or between-group differences were seen on the cognitive and language tasks at the two time periods; however, women with BC performed more poorly compared to the control group. We did see decline in some women with BC and not in others, in cognition and language during initial course of TAM treatment. However, the approach we used to assess these changes is valuable and innovative. This approach will help refine current research paradigms for determining cognitive and linguistic changes and will help determine if women with BC might require language intervention in the future.
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Affiliation(s)
- Saryu Sharma
- Department of Communication Sciences and Disorders, Idaho State University, Pocatello, Idaho
| | - Heather Harris Wright
- Department of Communication Sciences and Disorders, East Carolina University, Greenville, North Carolina
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6
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Downs TL, Whiteside EJ, Foot G, Mills DE, Bliss ES. Differences in total cognition and cerebrovascular function in female breast cancer survivors and cancer-free women. Breast 2023; 69:358-365. [PMID: 37018967 PMCID: PMC10122006 DOI: 10.1016/j.breast.2023.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/24/2023] [Accepted: 03/30/2023] [Indexed: 04/03/2023] Open
Abstract
Reduced cognition is often reported by breast cancer patients and survivors, but the mechanisms for this decline are yet to be determined. We compared the differences in cerebrovascular function and cognition in breast cancer survivors (n = 15) and cancer-free women (n = 15) matched by age and body mass index. Participants undertook anthropometric, mood, cardiovascular, exercise performance, strength, cerebrovascular, and cognitive measurements. Transcranial Doppler ultrasound was used to measure the cerebrovascular responsiveness (CVR) to physiological (hypercapnia; 5% carbon dioxide) and psychological stimuli. Breast cancer survivors had a lower CVR to hypercapnia (21.5 ± 12.8 vs 66.0 ± 20.9%, P < 0.001), CVR to cognitive stimuli (15.1 ± 1.5 vs 23.7 ± 9.0%, P < 0.001) and total composite cognitive score (100 ± 12 vs. 113 ± 7, P = 0.003) than cancer-free women. These parameters remained statistically different between the groups following adjustments for covariates using an analysis of co-variance. We observed significant correlations between multiple measures and exercise capacity the only variable positively correlated to all primary measures (CVR to hypercapnia, r = 0.492, P = 0.007; CVR to cognitive stimuli r = 0.555, P = 0.003; and total composite cognitive score, r = 0.625, P < 0.001). In this study, breast cancer survivors had lower cerebrovascular and cognitive function than age-matched cancer-free women, which may be attributable to the effects of cancer and cancer treatment on brain health.
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7
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Hosseinzadeh Sahafi O, Rezayof A, Ghasemzadeh Z, Alijanpour S, Rahimian S. Ameliorating effect offluoxetine on tamoxifen-induced memory loss: The role of corticolimbic NMDA receptors and CREB/BDNF/cFos signaling pathways in rats. Brain Res 2022; 1794:148058. [PMID: 36007581 DOI: 10.1016/j.brainres.2022.148058] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 08/16/2022] [Accepted: 08/17/2022] [Indexed: 11/02/2022]
Abstract
Tamoxifen-induced cognitive dysfunction may lead to fluoxetine consumption in patients with breast cancer. Since the brain mechanisms are unclear in tamoxifen/fluoxetine therapy, the blockade effect of hippocampal/amygdala/prefrontal cortical NMDA receptors was examined in fluoxetine/tamoxifen-induced memory retrieval. We also assessed the corticolimbic signaling pathways in memory retrieval under the drug treatment in adult male Wistar rats. Using the Western blot technique, the expression levels of the cAMP response element-binding protein (CREB), brain-derived neurotrophic factor (BDNF), and cFos were evaluated in the corticolimbic regions. The results showed that pre-test administration of fluoxetine (3 and 5 mg/kg, i.p.) improved tamoxifen-induced memory impairment in the passive avoidance learning task. Pre-test bilateral microinjection of D-AP5, a selective NMDA receptor antagonist, into the dorsal hippocampal CA1 regions and the central amygdala (CeA), but not the medial prefrontal cortex (mPFC), inhibited the improving effect of fluoxetine on tamoxifen response. It is important to note that the microinjection of D-AP5 into the different sites by itself did not affect memory retrieval. Memory retrieval increased the signaling pathway of pCREB/CREB/BDNF/cFos in the corticolimbic regions. Tamoxifen-induced memory impairment decreased the hippocampal/PFC BDNF level and the amygdala level of pCREB/CREB/cFos. The improving effect of fluoxetine on tamoxifen significantly increased the hippocampal/PFC expression levels of BDNF, the PFC/amygdala expression levels of cFos, and the ratio of pCREB/CREB in all targeted areas. Thus, NMDA receptors' activity in the different corticolimbic regions mediates fluoxetine/tamoxifen memory retrieval. The corticolimbic synaptic plasticity changes likely accompany the improving effect of fluoxetine on tamoxifen response.
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Affiliation(s)
- Oveis Hosseinzadeh Sahafi
- Department of Animal Biology, School of Biology, College of Science, University of Tehran, Tehran, Iran; Department of Neurophysiology, Graduate School of Medicine, The University of Tokyo, Tokyo, 113-0033, Japan
| | - Ameneh Rezayof
- Department of Animal Biology, School of Biology, College of Science, University of Tehran, Tehran, Iran.
| | - Zahra Ghasemzadeh
- Department of Animal Biology, School of Biology, College of Science, University of Tehran, Tehran, Iran
| | - Sakineh Alijanpour
- Department of Biology, Faculty of Science, Gonbad Kavous University, Gonbad Kavous, Iran
| | - Sepehrdad Rahimian
- Department of Animal Biology, School of Biology, College of Science, University of Tehran, Tehran, Iran
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8
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Haggstrom LR, Vardy JL, Carson EK, Segara D, Lim E, Kiely BE. Effects of Endocrine Therapy on Cognitive Function in Patients with Breast Cancer: A Comprehensive Review. Cancers (Basel) 2022; 14:cancers14040920. [PMID: 35205665 PMCID: PMC8870664 DOI: 10.3390/cancers14040920] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 02/05/2022] [Accepted: 02/08/2022] [Indexed: 12/10/2022] Open
Abstract
Simple Summary Many persons diagnosed with breast cancer are treated with endocrine therapy and will experience the side effects of endocrine therapy. Cognitive adverse effects of endocrine therapy are increasingly being recognised, and can significantly affect quality of life, adherence and treatment outcome. This review aims to discuss the nature of cognitive dysfunction associated with endocrine therapy, the mechanisms underpinning its development, and evidence-based management strategies. Abstract Endocrine therapy forms the backbone of systemic therapy for the majority of persons with early and late-stage breast cancer. However, the side effects can negatively affect quality of life, and impact treatment adherence and overall oncological outcomes. Adverse effects on cognition are common, underreported and challenging to manage. We aim to describe the nature, incidence, risk factors and underlying mechanisms of endocrine therapy-induced cognitive dysfunction. We conducted a comprehensive literature review of the studies reporting on cognitive dysfunction associated with endocrine therapies for breast cancer. We also summarise prevention and treatment strategies, and ongoing research. Given that patients are taking endocrine therapies for longer durations than ever before, it is essential that these side effects are managed pro-actively within a multi-disciplinary team in order to promote adherence to endocrine therapy and improve patients’ quality of life.
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Affiliation(s)
- Lucy R. Haggstrom
- Campbelltown Hospital, Therry Road, Campbelltown, NSW 2560, Australia; (L.R.H.); (E.-K.C.)
| | - Janette L. Vardy
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2006, Australia;
- Concord Cancer Centre, Concord Repatriation and General Hospital, Concord, NSW 2139, Australia
| | - Emma-Kate Carson
- Campbelltown Hospital, Therry Road, Campbelltown, NSW 2560, Australia; (L.R.H.); (E.-K.C.)
- Concord Clinical School, University of Sydney, Concord, NSW 2139, Australia
| | - Davendra Segara
- St Vincent’s Clinical School, University of New South Wales, Darlinghurst, NSW 2010, Australia;
| | - Elgene Lim
- St Vincent’s Clinical School, University of New South Wales, Darlinghurst, NSW 2010, Australia;
- Garvan Institute of Medical Research, Darlinghurst, NSW 2010, Australia
- Correspondence: (E.L.); (B.E.K.)
| | - Belinda E. Kiely
- Campbelltown Hospital, Therry Road, Campbelltown, NSW 2560, Australia; (L.R.H.); (E.-K.C.)
- Concord Clinical School, University of Sydney, Concord, NSW 2139, Australia
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW 2050, Australia
- Correspondence: (E.L.); (B.E.K.)
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9
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Jebahi F, Sharma S, Bloss JE, Wright HH. Effects of tamoxifen on cognition and language in women with breast cancer: A systematic search and a scoping review. Psychooncology 2021; 30:1262-1277. [PMID: 33866625 DOI: 10.1002/pon.5696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 04/01/2021] [Accepted: 04/02/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Breast cancer treatments bring adverse consequences that interfere with everyday functioning. Importantly, some of these treatments are associated with cognitive and language changes. Tamoxifen is a selective estrogen receptor modulator and is a common endocrine therapy treatment for breast cancer. The current review examines the specific domains of cognition and language affected by the use of tamoxifen in women with breast cancer. METHODS We conducted a systematic search that examined cognitive and/or language functions in chemotherapy-naïve women with breast cancer taking tamoxifen. PubMed, Cochrane CENTRAL, CINAHL Complete, PsycINFO, Scopus, EMBASE, and the Grey Literature Report (greylit.org) were searched. Covidence Systematic Review software (covidence.org) was used to manage the screening process of study titles and abstracts as well as full texts. A total of 17 studies were included in the review. RESULTS A range of cognitive and language domains were reported. These were grouped into seven broad domains: attention, memory, speed, executive functioning, verbal abilities, visual abilities, and language abilities. Results showed that there is compelling evidence that specific domains of memory and speed are negatively affected by the use of tamoxifen. In addition, there was a pattern of change in domains of executive functions and verbal abilities. CONCLUSIONS Tamoxifen affects specific cognitive and language domains. Language domains beyond semantics have not been studied and thus conclusions related to these domains, and language in general, could not be made. Studies exploring the effects of tamoxifen on the different domains of language are recommended.
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Affiliation(s)
- Fatima Jebahi
- Department of Communication Sciences and Disorders, East Carolina University, Greenville, North Carolina, USA.,Fulbright Association, Washington, District of Columbia, USA
| | - Saryu Sharma
- Department of Communication Sciences and Disorders, East Carolina University, Greenville, North Carolina, USA
| | - Jamie E Bloss
- Laupus Library Liaison, East Carolina University, Greenville, North Carolina, USA
| | - Heather H Wright
- Department of Communication Sciences and Disorders, East Carolina University, Greenville, North Carolina, USA
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10
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Zhang Z, Park JW, Ahn IS, Diamante G, Sivakumar N, Arneson D, Yang X, van Veen JE, Correa SM. Estrogen receptor alpha in the brain mediates tamoxifen-induced changes in physiology in mice. eLife 2021; 10:63333. [PMID: 33647234 PMCID: PMC7924955 DOI: 10.7554/elife.63333] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 01/25/2021] [Indexed: 12/24/2022] Open
Abstract
Adjuvant tamoxifen therapy improves survival in breast cancer patients. Unfortunately, long-term treatment comes with side effects that impact health and quality of life, including hot flashes, changes in bone density, and fatigue. Partly due to a lack of proven animal models, the tissues and cells that mediate these negative side effects are unclear. Here, we show that mice undergoing tamoxifen treatment experience changes in temperature, bone, and movement. Single-cell RNA sequencing reveals that tamoxifen treatment induces widespread gene expression changes in the hypothalamus and preoptic area (hypothalamus-POA). These expression changes are dependent on estrogen receptor alpha (ERα), as conditional knockout of ERα in the hypothalamus-POA ablates or reverses tamoxifen-induced gene expression. Accordingly, ERα-deficient mice do not exhibit tamoxifen-induced changes in temperature, bone, or movement. These findings provide mechanistic insight into the effects of tamoxifen on the hypothalamus-POA and indicate that ERα mediates several physiological effects of tamoxifen treatment in mice.
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Affiliation(s)
- Zhi Zhang
- Department of Integrative Biology and Physiology, University of California Los Angeles, Los Angeles, United States.,Laboratory of Neuroendocrinology of the Brain Research Institute, University of California Los Angeles, Los Angeles, United States
| | - Jae Whan Park
- Department of Integrative Biology and Physiology, University of California Los Angeles, Los Angeles, United States.,Laboratory of Neuroendocrinology of the Brain Research Institute, University of California Los Angeles, Los Angeles, United States
| | - In Sook Ahn
- Department of Integrative Biology and Physiology, University of California Los Angeles, Los Angeles, United States
| | - Graciel Diamante
- Department of Integrative Biology and Physiology, University of California Los Angeles, Los Angeles, United States
| | - Nilla Sivakumar
- Department of Integrative Biology and Physiology, University of California Los Angeles, Los Angeles, United States.,Laboratory of Neuroendocrinology of the Brain Research Institute, University of California Los Angeles, Los Angeles, United States
| | - Douglas Arneson
- Department of Integrative Biology and Physiology, University of California Los Angeles, Los Angeles, United States
| | - Xia Yang
- Department of Integrative Biology and Physiology, University of California Los Angeles, Los Angeles, United States
| | - J Edward van Veen
- Department of Integrative Biology and Physiology, University of California Los Angeles, Los Angeles, United States.,Laboratory of Neuroendocrinology of the Brain Research Institute, University of California Los Angeles, Los Angeles, United States
| | - Stephanie M Correa
- Department of Integrative Biology and Physiology, University of California Los Angeles, Los Angeles, United States.,Laboratory of Neuroendocrinology of the Brain Research Institute, University of California Los Angeles, Los Angeles, United States
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11
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Dijkshoorn ABC, van Stralen HE, Sloots M, Schagen SB, Visser-Meily JMA, Schepers VPM. Prevalence of cognitive impairment and change in patients with breast cancer: A systematic review of longitudinal studies. Psychooncology 2021; 30:635-648. [PMID: 33533166 PMCID: PMC8248098 DOI: 10.1002/pon.5623] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 12/23/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Patients with breast cancer face cognitive impairment that affects their quality of life; partially attributable to treatment. Our aim was to detail the prevalence and change of cognitive impairment during the course of treatment. We also investigated the effect of therapy (chemotherapy [CT]) vs. radiotherapy and/or endocrine therapy vs. healthy controls). METHODS This article reviews longitudinal cohort studies published to date in Medline and Embase that (i) assess cognition before and after therapy, (ii) report prevalence cognitive impairment or change, and (iii) use standardized and valid neuropsychological tests. We used the original authors' criteria for cognitive impairment. RESULTS The title and abstract of 891 articles were screened, resulting in the identification of 90 potentially relevant articles while applying the eligibility criteria. After full-text examination, 17 studies were included. Prevalence of cognitive impairment range from 25% before therapy, through 24% after therapy to 21% at maximal 1-year follow-up (FU). Compared to their pretreatment cognitive functioning, 24% of patients decline after treatment and 24% at 1-year FU. Some studies also reported cognitive improvement showing that 15% and 31% of patients improve, respectively. In general, patients undergoing CT have a higher chance of cognitive impairment and decline than no-CT patients and healthy controls. CONCLUSIONS This study shows that one out of four breast cancer patients shows cognitive impairment prior to treatment administration CT and a significant number of patients decline during the course of disease, suggesting that cognitive impairment is not exclusively related to CT and/or no-CT therapies. This study shows that assessment of cognitive functioning, ideally over time, is crucial and may help the implementation of personalized rehabilitation pathways.
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Affiliation(s)
- Aicha B C Dijkshoorn
- Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Haike E van Stralen
- Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Maurits Sloots
- Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Sanne B Schagen
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Johanna M A Visser-Meily
- Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands.,Center of Excellence for Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Vera P M Schepers
- Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands.,Center of Excellence for Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
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12
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Novick AM, Scott AT, Neill Epperson C, Schneck CD. Neuropsychiatric effects of tamoxifen: Challenges and opportunities. Front Neuroendocrinol 2020; 59:100869. [PMID: 32822707 PMCID: PMC7669724 DOI: 10.1016/j.yfrne.2020.100869] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 08/12/2020] [Accepted: 08/16/2020] [Indexed: 02/08/2023]
Abstract
Epidemiological, clinical, and basic research over the past thirty years have described the benefits of estrogen on cognition, mood, and brain health. Less is known about tamoxifen, a selective estrogen receptor modifier (SERM) commonly used in breast cancer which is able to cross the blood-brain barrier. In this article, we review the basic pharmacology of tamoxifenas well as its effects on cognition and mood. The literature reveals an overall impairing effect of tamoxifen on cognition in breast cancer patients, hinting at central antiestrogen activity. On the other hand, tamoxifen demonstrates promising effects in psychiatric disorders, like bipolar disorder, where its therapeutic action may be independent of interaction with estrogen receptors. Understanding the neuropsychiatric properties of SERMs like tamoxifen can guide future research to ameliorate unwanted side-effects and provide novel options for difficult to treat disorders.
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Affiliation(s)
- Andrew M Novick
- Department of Psychiatry, University of Colorado School of Medicine, 13001 E 17th Place, Campus Box F546, Aurora, CO 80045, United States.
| | - Anthony T Scott
- Department of Psychiatry, University of Colorado School of Medicine, 13001 E 17th Place, Campus Box F546, Aurora, CO 80045, United States
| | - C Neill Epperson
- Department of Psychiatry, University of Colorado School of Medicine, 13001 E 17th Place, Campus Box F546, Aurora, CO 80045, United States
| | - Christopher D Schneck
- Department of Psychiatry, University of Colorado School of Medicine, 13001 E 17th Place, Campus Box F546, Aurora, CO 80045, United States
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13
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Zhang S, Wu L, Zhang B, Zhu Y, Fan Y, Wang Q, Hu X, Tian Y. Impaired decision-making under risk in patients with functional dyspepsia. J Clin Exp Neuropsychol 2020; 42:771-780. [PMID: 32741250 DOI: 10.1080/13803395.2020.1802406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION The cognitive processing in patients with functional dyspepsia (FD) has not been well established. Decision-making is an important component of cognitive function. Most brain regions involved in decision-making are abnormal in FD patients. This study aimed to investigate the decision-making under ambiguity and risk in FD patients. METHODS We recruited 40 FD patients meeting Rome III criteria and 40 healthy controls (HCs) matched for age, sex, marital status, and education level. The Hamilton Anxiety Scale (HAMA) and the 17-item Hamilton Depression Scale (HAMD-17) were used to evaluate their anxiety and depression emotions. The Iowa Gambling Task (IGT) and Game of Dice Task (GDT) were used to evaluate decision-making under ambiguity and risk, respectively. Helicobacter pylori status, disease duration, dyspeptic symptom score, and the Nepean Dyspepsia Life Quality Index (NDLQI) were obtained from all patients. RESULTS In IGT, FD patients had a lower total net score, chose more adverse choices, and showed a slower response to change their behavior than HCs. However, there was no significant difference in the net score of the first 2 blocks between the two groups. In GDT, FD patients had a lower total net score, higher risk score, and lower use of negative feedback than HCs. In addition, FD patients showed better GDT performance than those without early satiation. CONCLUSIONS FD patients showed impaired decision-making under risk. The deficiency might be related to dyspeptic symptoms of FD patients.
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Affiliation(s)
- Shenshen Zhang
- Digestive Department, The Second Affiliated Hospital of Anhui Medical University , Hefei, China
| | - Lihong Wu
- Digestive Department, The Second Affiliated Hospital of Anhui Medical University , Hefei, China
| | - Boyu Zhang
- Digestive Department, The Second Affiliated Hospital of Anhui Medical University , Hefei, China
| | - Yuanrong Zhu
- Digestive Department, The Second Affiliated Hospital of Anhui Medical University , Hefei, China
| | - Yinguang Fan
- Department of Epidemiology and Biostatistics, School of Public Health of Anhui Medical University , Hefei, China
| | - Qiao Wang
- Digestive Department, The Second Affiliated Hospital of Anhui Medical University , Hefei, China
| | - Xiangpeng Hu
- Digestive Department, The Second Affiliated Hospital of Anhui Medical University , Hefei, China
| | - Yanghua Tian
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University , Hefei, China
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14
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Pathogenesis, Assessments, and Management of Chemotherapy-Related Cognitive Impairment (CRCI): An Updated Literature Review. JOURNAL OF ONCOLOGY 2020; 2020:3942439. [PMID: 32684930 PMCID: PMC7333028 DOI: 10.1155/2020/3942439] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/10/2020] [Accepted: 06/08/2020] [Indexed: 02/06/2023]
Abstract
There are various cancer treatments at present, and chemotherapy is one of the main methods. Chemotherapy-related cognitive impairment (CRCI), as one of the side effects of chemotherapy, has gradually attracted the attention of more and more researchers. CRCI has been verified by subjective reports and objective neuropsychological tests so far. But oncologists' understanding of it and its treatments are still incomplete. In this review, we mainly give a comprehensive overview of the mechanism of CRCI, then describe a variety of evaluation methods, and finally summarize the treatment approaches under current medical conditions and compare it with an excellent article published in 2015 with the aim of providing directions for future research and better understanding of CRCI for clinicians.
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15
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Biro E, Kahan Z, Kalman J, Rusz O, Pakaski M, Irinyi T, Kelemen G, Dudás R, Drotos G, Hamvai C. Cognitive Functioning and Psychological Well-being in Breast Cancer Patients on Endocrine Therapy. In Vivo 2019; 33:1381-1392. [PMID: 31280234 DOI: 10.21873/invivo.11615] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 06/14/2019] [Accepted: 06/18/2019] [Indexed: 01/19/2023]
Abstract
BACKGROUND/AIM Anti-cancer therapies may deteriorate cognitive functioning, affective functioning and psychological well-being. MATERIALS AND METHODS In this prospective longitudinal pilot study, premenopausal and postmenopausal patients received adjuvant endocrine therapy (ET) (tamoxifen with or without LHRH analog or aromatase inhibitor) or were observed only (control group). At baseline testing and 6, 12 and 24 months thereafter, cognitive, depression and anxiety tests and quality of life (QOL) measurements were performed. RESULTS Overall, 46 cases were evaluated. None of the studied cognitive parameters differed between the subgroups or changed by time. No differences were found regarding anxiety, depression or QOL measures either. Baseline cognitive test and QOL results were in association with later anxiety and depression. CONCLUSION No cognitive impairment was found during the two years of ET. Baseline cognitive scores and QOL dimensions proved good predictors of later anxiety and depression.
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Affiliation(s)
- Edit Biro
- Department of Psychiatry, University of Szeged, Szeged, Hungary
| | - Zsuzsanna Kahan
- Department of Oncotherapy, University of Szeged, Szeged, Hungary
| | - Janos Kalman
- Department of Psychiatry, University of Szeged, Szeged, Hungary
| | - Orsolya Rusz
- Department of Oncotherapy, University of Szeged, Szeged, Hungary
| | | | - Tamas Irinyi
- Department of Psychiatry, University of Szeged, Szeged, Hungary
| | - Gyöngyi Kelemen
- Department of Oncotherapy, University of Szeged, Szeged, Hungary
| | - Rita Dudás
- Department of Oncotherapy, University of Szeged, Szeged, Hungary
| | - Gergely Drotos
- Department of Psychiatry, University of Szeged, Szeged, Hungary
| | - Csaba Hamvai
- Department of Oncotherapy, University of Szeged, Szeged, Hungary
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16
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Van Dyk K, Crespi CM, Bower JE, Castellon SA, Petersen L, Ganz PA. The cognitive effects of endocrine therapy in survivors of breast cancer: A prospective longitudinal study up to 6 years after treatment. Cancer 2018; 125:681-689. [PMID: 30485399 DOI: 10.1002/cncr.31858] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 09/10/2018] [Accepted: 10/22/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND After treatment of primary breast cancer, endocrine therapy (ET) is prescribed for patients with hormone receptor-positive cancers. Despite ET recommendations of 5 to 10 years of treatment, to the authors' knowledge there is little prospective study of its impact on cognitive function over an extended period of time. ET has known pharmacologic effects on the brain. Cognitive side effects are a concern for many women, with mixed findings reported in various studies. The current prospective longitudinal study examined the neuropsychological effects of ET over time, up to 6 years after treatment. METHODS A total of 189 survivors of early-stage breast cancer enrolled in the study prior to initiating ET if prescribed, and were followed at 6 months (175 patients), 12 months (173 patients), and for 3 to 6 years (102 patients) with self-report and neuropsychological assessments. Using linear mixed models, the authors examined whether neuropsychological performance or impairment rates differed over time based on whether or not ET was received. RESULTS The authors did not find any effect of ET on neuropsychological performance or impairment at any time point among survivors who received it compared with women who did not. However, those who participated in the 3-year to 6-year year visit demonstrated better executive function at baseline. CONCLUSIONS In the current observational cohort study, no detrimental effect of ET on cognitive function was identified in survivors of early-stage breast cancer receiving treatment with ET compared with those who were not.
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Affiliation(s)
- Kathleen Van Dyk
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California at Los Angeles, Los Angeles, California.,Jonsson Comprehensive Cancer Center, University of California at Los Angeles, Los Angeles, California
| | - Catherine M Crespi
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California at Los Angeles, Los Angeles, California.,Jonsson Comprehensive Cancer Center, University of California at Los Angeles, Los Angeles, California.,Department of Biostatistics, Fielding School of Public Health, University of California at Los Angeles, Los Angeles, California
| | - Julienne E Bower
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California at Los Angeles, Los Angeles, California.,Jonsson Comprehensive Cancer Center, University of California at Los Angeles, Los Angeles, California.,Department of Psychology, University of California at Los Angeles, Los Angeles, California
| | - Steven A Castellon
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California at Los Angeles, Los Angeles, California.,VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Laura Petersen
- Jonsson Comprehensive Cancer Center, University of California at Los Angeles, Los Angeles, California
| | - Patricia A Ganz
- Jonsson Comprehensive Cancer Center, University of California at Los Angeles, Los Angeles, California.,David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California.,Department of Health Policy and Management, Fielding School of Public Health, University of California at Los Angeles, Los Angeles, California
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17
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Rhodes CT, Zunino G, Huang SWA, Cardona SM, Cardona AE, Berger MS, Lemmon VP, Lin CHA. Region specific knock-out reveals distinct roles of chromatin modifiers in adult neurogenic niches. Cell Cycle 2018; 17:377-389. [PMID: 29433384 PMCID: PMC5914887 DOI: 10.1080/15384101.2018.1426417] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Histone methyltransferases (HMTs) are present in heterogeneous cell populations within the adult brain including neurogenic niches. Yet the question remains whether loss of HMTs and the resulting changes in histone methylation alter cell fate in a region-specific manner. We utilized stereotaxic injection of Cre recombinant protein into the adult neurogenic niches, the subventricular zone (SVZ) adjacent to the lateral ventricle and the subgranular zone (SGZ) of the dentate gyrus. We confirmed that Cre protein was enzymatically active in vivo and recombination events were restricted to the vicinity of injection areas. In this study, we focus on using Cre mediated recombination in mice harboring floxed HMT: enhancer of zeste homolog 2 (EZH2) or suppressor of variegation homolog (Suv4-20h). Injectable Cre protein successfully knocked out either EZH2 or Suv4-20h, allowing assessment of long-term effects in a region-specific fashion. We performed meso-scale imaging and flow cytometry for phenotype analysis and unbiased quantification. We demonstrated that regional loss of EZH2 affects the differentiation paradigm of neural stem progenitor cells as well as the maintenance of stem cell population. We further demonstrated that regional loss of Suv4-20h influences the cell cycle but does not affect stem cell differentiation patterns. Therefore, Cre protein mediated knock-out a given HMT unravel their distinguishable and important roles in adult neurogenic niches. This Cre protein-based approach offers tightly-controlled knockouts in multiple cell types simultaneously for studying diverse regulatory mechanisms and is optimal for region-specific manipulation within complex, heterogeneous brain architectures.
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Affiliation(s)
- Christopher T Rhodes
- a Department of Biology , University of Texas at San Antonio , San Antonio , TX 78249 , USA
| | - Giulia Zunino
- b The Miami Project to Cure Paralysis , University of Miami , Miami , FL 33136 , USA
| | - Shu-Wei Angela Huang
- a Department of Biology , University of Texas at San Antonio , San Antonio , TX 78249 , USA
| | - Sandra M Cardona
- a Department of Biology , University of Texas at San Antonio , San Antonio , TX 78249 , USA
| | - Astrid E Cardona
- a Department of Biology , University of Texas at San Antonio , San Antonio , TX 78249 , USA.,c South Texas Center for Emerging Infectious Diseases , University of Texas at San Antonio , TX 78249 , USA
| | - Mitchel S Berger
- d Department of Neurological Surgery , University of California , San Francisco , CA , 94143 , USA
| | - Vance P Lemmon
- b The Miami Project to Cure Paralysis , University of Miami , Miami , FL 33136 , USA
| | - Chin-Hsing Annie Lin
- a Department of Biology , University of Texas at San Antonio , San Antonio , TX 78249 , USA.,e Neuroscience Institute, University of Texas at San Antonio , San Antonio , TX 78249 , USA
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18
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Underwood EA, Rochon PA, Moineddin R, Lee PE, Wu W, Pritchard KI, Tierney MC. Cognitive sequelae of endocrine therapy in women treated for breast cancer: a meta-analysis. Breast Cancer Res Treat 2017; 168:299-310. [PMID: 29264751 DOI: 10.1007/s10549-017-4627-4] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 12/11/2017] [Indexed: 12/29/2022]
Abstract
PURPOSE Evidence suggests anti-estrogen endocrine therapy (ET) is associated with adverse cognitive effects; however, findings are based on small samples and vary in the cognitive abilities affected. We conducted a meta-analysis to quantitatively synthesize the evidence. METHODS Electronic databases were searched in November 2016. Fourteen studies totaling 911 BC patients on aromatase inhibitors (AIs) or tamoxifen (TAM) and 911 controls (i.e., non-cancer controls and BC controls not using ET) were included. Neuropsychological tests were categorized into six domains. Effect sizes were computed to compare (1) ET patients versus controls and (2) TAM patients versus AI patients. RESULTS In cross-sectional comparisons, ET patients performed worse than control groups on verbal learning/memory, visual learning/memory, frontal executive function, and processing speed, but did not differ on psychomotor efficiency or visuospatial function. Subgroup analyses revealed that verbal learning/memory was the only domain where ET patients performed worse than both non-cancer and BC controls. In other domains, ET patients and BC controls performed equivalently. Regarding change from pre-treatment performance, ET patients did not differ from controls on any domain. TAM and AI patients did not from one another differ overall; however, subgroup analyses indicated that TAM patients performed better than non-steroidal AI patients on several domains, but showed few performance differences relative to steroidal AI patients. CONCLUSIONS Verbal learning/memory was the only domain where ET patients performed worse than both non-cancer and BC controls, suggesting specific adverse effects on this domain. Additional studies assessing change from pre-treatment performance and differences between steroidal and non-steroidal AIs are warranted.
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Affiliation(s)
- E A Underwood
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Primary Care Research Unit, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Suite E349, Toronto, ON, M4N 3M5, Canada.,Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - P A Rochon
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
| | - R Moineddin
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - P E Lee
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - W Wu
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - K I Pritchard
- Department of Medicine, University of Toronto, Toronto, ON, Canada.,Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - M C Tierney
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada. .,Institute of Medical Science, University of Toronto, Toronto, ON, Canada. .,Primary Care Research Unit, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Suite E349, Toronto, ON, M4N 3M5, Canada. .,Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
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19
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Valvassori SS, Borges CP, Varela RB, Bavaresco DV, Bianchini G, Mariot E, Arent CO, Resende WR, Budni J, Quevedo J. The different effects of lithium and tamoxifen on memory formation and the levels of neurotrophic factors in the brain of male and female rats. Brain Res Bull 2017; 134:228-235. [DOI: 10.1016/j.brainresbull.2017.08.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 08/03/2017] [Accepted: 08/07/2017] [Indexed: 01/22/2023]
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20
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Meattini I, Desideri I, Francolini G, Vannini A, Perna M, Garlatti P, Grassi R, Livi L. Systemic therapies and cognitive impairment for breast cancer: an overview of the current literature. Med Oncol 2017; 34:74. [PMID: 28364269 DOI: 10.1007/s12032-017-0935-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 03/28/2017] [Indexed: 12/26/2022]
Abstract
Both endocrine and chemotherapy can be utilized for breast cancer patients' management, in multiple setting (i.e., primary systemic therapy, adjuvant, metastatic treatment). Health-related quality of life in breast cancer survivors can be significantly influenced by cognitive impairment, which has been related in several previously reported experiences to systemic therapies administration. However, although the growing body of literature, the impact of both chemo- and endocrine therapy on cognitive function is currently unclear, due to many confounding factors (i.e., multiple therapies, duration of therapy, comorbidity, age). The aim of the present review is to present an overview of the current literature concerning the possible influence of endocrine and systemic therapy on breast cancer patients' cognitive impairment.
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Affiliation(s)
- Icro Meattini
- Azienda Ospedaliero Universitaria Careggi - University of Florence, Largo G.A. Brambilla 3, 50134, Florence, Italy.
| | - Isacco Desideri
- Azienda Ospedaliero Universitaria Careggi - University of Florence, Largo G.A. Brambilla 3, 50134, Florence, Italy
| | - Giulio Francolini
- Azienda Ospedaliero Universitaria Careggi - University of Florence, Largo G.A. Brambilla 3, 50134, Florence, Italy
| | - Agnese Vannini
- Azienda Ospedaliero Universitaria Careggi - University of Florence, Largo G.A. Brambilla 3, 50134, Florence, Italy
| | - Marco Perna
- Azienda Ospedaliero Universitaria Careggi - University of Florence, Largo G.A. Brambilla 3, 50134, Florence, Italy
| | - Pietro Garlatti
- Azienda Ospedaliero Universitaria Careggi - University of Florence, Largo G.A. Brambilla 3, 50134, Florence, Italy
| | - Roberta Grassi
- Azienda Ospedaliero Universitaria Careggi - University of Florence, Largo G.A. Brambilla 3, 50134, Florence, Italy
| | - Lorenzo Livi
- Azienda Ospedaliero Universitaria Careggi - University of Florence, Largo G.A. Brambilla 3, 50134, Florence, Italy
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21
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The attention network changes in breast cancer patients receiving neoadjuvant chemotherapy: Evidence from an arterial spin labeling perfusion study. Sci Rep 2017; 7:42684. [PMID: 28209975 PMCID: PMC5314322 DOI: 10.1038/srep42684] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 01/13/2017] [Indexed: 01/13/2023] Open
Abstract
To investigate the neural mechanisms underlying attention deficits that are related to neoadjuvant chemotherapy in combination with cerebral perfusion. Thirty one patients with breast cancer who were scheduled to receive neoadjuvant chemotherapy and 34 healthy control subjects were included. The patients completed two assessments of the attention network tasks (ANT), neuropsychological background tests, and the arterial spin labeling scan, which were performed before neoadjuvant chemotherapy and after completing chemotherapy. After neoadjuvant chemotherapy, the patients exhibited reduced performance in the alerting and executive control attention networks but not the orienting network (p < 0.05) and showed significant increases in cerebral blood flow (CBF) in the left posterior cingulate gyrus, left middle occipital gyrus, bilateral precentral gyrus, inferior parietal gyrus, supramarginal gyrus, angular gyrus, precuneus, cuneus, superior occipital gyrus, calcarine cortex, and temporal gyrus (p < 0.01 corrected) when compared with patients before chemotherapy and healthy controls. A significant correlation was found between the decrease performance of ANT and the increase in CBF changes in some brain regions of the patients with breast cancer. The results demonstrated that neoadjuvant chemotherapy influences hemodynamic activity in different brain areas through increasing cerebral perfusion, which reduces the attention abilities in breast cancer patients.
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22
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Chen X, Li J, Zhang J, He X, Zhu C, Zhang L, Hu X, Wang K. Impairment of the executive attention network in premenopausal women with hormone receptor-positive breast cancer treated with tamoxifen. Psychoneuroendocrinology 2017; 75:116-123. [PMID: 27815995 DOI: 10.1016/j.psyneuen.2016.10.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 10/09/2016] [Accepted: 10/21/2016] [Indexed: 01/02/2023]
Abstract
Tamoxifen (TAM) is most commonly prescribed for patients with hormone-sensitive breast cancer and exerts agonistic/antagonistic effects on estrogen receptors throughout the body. Accumulating evidence has revealed that breast cancer patients receiving TAM manifest cognitive dysfunction. However, whether these patients have a global attention deficit or a more selective impairment of specific attention networks remains unknown. In the present study, we sought to explore the attention function of premenopausal women with hormone receptor-positive breast cancer treated with TAM using the attention network test (ANT). The subjects included breast cancer patients receiving TAM (TAM, N=43), breast cancer patients not receiving TAM (non-TAM, N=41), and matched healthy controls (HC, N=46). The subjects completed the ANT and neuropsychological tests, which measure three independent attention networks and executive function performance, respectively. Our results indicated that patients in the TAM group had significant deficits in their executive control component but not in the alerting or orienting components. Moreover, the patients showed poor executive function performance in the neuropsychological tests. Additionally, in the TAM group, significant correlations were found between the decreased efficiency of the executive control component and their reduced performance in executive function tests. This study demonstrates that premenopausal women with hormone receptor-positive breast cancer treated with TAM have impairment of the executive attention network and that this impairment was associated with differences in executive function performance.
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Affiliation(s)
- Xingui Chen
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Medical Psychology, Anhui Medical University, Hefei, China
| | - Jingjing Li
- Department of Oncology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Jingjie Zhang
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xiaoxuan He
- Center for Biomedical Engineering, University of Science and Technology of China, Hefei, China
| | - Chunyan Zhu
- Department of Medical Psychology, Anhui Medical University, Hefei, China
| | - Lei Zhang
- Department of Medical Psychology, Anhui Medical University, Hefei, China
| | | | - Kai Wang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Medical Psychology, Anhui Medical University, Hefei, China.
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Mikelman S, Mardirossian N, Gnegy ME. Tamoxifen and amphetamine abuse: Are there therapeutic possibilities? J Chem Neuroanat 2016; 83-84:50-58. [PMID: 27585851 DOI: 10.1016/j.jchemneu.2016.08.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 08/05/2016] [Accepted: 08/14/2016] [Indexed: 12/11/2022]
Abstract
Although best known as a selective estrogen receptor modulator (SERM), tamoxifen is a drug with a wide range of activities. Tamoxifen has demonstrated some efficacy has a therapeutic for bipolar mania and is believed to exert these effects through inhibition of protein kinase C (PKC). As the symptoms of amphetamine treatment in rodents are believed to mimic the symptoms of a manic episode, many of the preclinical studies for this indication have demonstrated that tamoxifen inhibits amphetamine action. The amphetamine-induced increase in extracellular dopamine which gives rise to the 'manic' effects is due to interaction of amphetamine with the dopamine transporter. We and others have demonstrated that PKC reduces amphetamine-induced reverse transport through the dopamine transporter. In this review, we will outline the actions of tamoxifen as a SERM and further detail another known action of tamoxifen-inhibition of PKC. We will summarize the literature showing how tamoxifen affects amphetamine action. Finally, we will present our hypothesis that tamoxifen, or an analog, could be used therapeutically to reduce amphetamine abuse in addition to treating mania.
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Affiliation(s)
- Sarah Mikelman
- Department of Pharmacology, 2220E MSRB III, 1150 West Medical Center Drive, University of Michigan Medical School, Ann Arbor, MI 28109-5632, United States
| | - Natalie Mardirossian
- Department of Pharmacology, 2220E MSRB III, 1150 West Medical Center Drive, University of Michigan Medical School, Ann Arbor, MI 28109-5632, United States
| | - Margaret E Gnegy
- Department of Pharmacology, 2220E MSRB III, 1150 West Medical Center Drive, University of Michigan Medical School, Ann Arbor, MI 28109-5632, United States.
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Tao L, Lin H, Yan Y, Xu X, Wang L, Zhang J, Yu Y. Impairment of the executive function in breast cancer patients receiving chemotherapy treatment: a functional MRI study. Eur J Cancer Care (Engl) 2016; 26. [PMID: 27436790 DOI: 10.1111/ecc.12553] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2016] [Indexed: 01/27/2023]
Affiliation(s)
- L. Tao
- Department of Radiology; The First Affiliated Hospital of Anhui Medical University; Hefei China
| | - H. Lin
- Department of Radiology; The First Affiliated Hospital of Anhui Medical University; Hefei China
| | - Y. Yan
- Department of Breast Surgery; The First Affiliated Hospital of Anhui Medical University; Hefei China
| | - X. Xu
- Department of Breast Surgery; The First Affiliated Hospital of Anhui Medical University; Hefei China
| | - L. Wang
- Center for Biomedical Engineering; University of Science and Technology of China; Hefei China
| | - J. Zhang
- Department of Breast Surgery; The First Affiliated Hospital of Anhui Medical University; Hefei China
| | - Y. Yu
- Department of Radiology; The First Affiliated Hospital of Anhui Medical University; Hefei China
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25
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Endocrine treatment-associated cognitive impairment in breast cancer survivors: evidence from published studies. Breast Cancer Res Treat 2016; 158:407-20. [DOI: 10.1007/s10549-016-3906-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 07/06/2016] [Indexed: 12/22/2022]
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26
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Tajik A, Rezayof A, Ghasemzadeh Z, Sardari M. Activation of the dorsal hippocampal nicotinic acetylcholine receptors improves tamoxifen-induced memory retrieval impairment in adult female rats. Neuroscience 2016; 327:1-9. [DOI: 10.1016/j.neuroscience.2016.04.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Revised: 04/04/2016] [Accepted: 04/05/2016] [Indexed: 12/20/2022]
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27
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Richard-Devantoy S, Olié E, Guillaume S, Courtet P. Decision-making in unipolar or bipolar suicide attempters. J Affect Disord 2016; 190:128-136. [PMID: 26496018 DOI: 10.1016/j.jad.2015.10.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 09/30/2015] [Accepted: 10/02/2015] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Disadvantageous decision-making (mainly measured by the Iowa Gambling Task) has been demonstrated in patients with suicidal behavior compared to controls. We, therefore, aimed at clarifying the qualitative and quantitative relationship between decision-making and the risk of suicidal behavior in unipolar and bipolar disorders respectively, as well as establishing the strength of this relationship. METHODS (1) We conducted a cross-sectional study comparing IGT performances between 141 unipolar suicide attempters and 57 bipolar suicide attempters. (2) We conducted a systematic review and a meta-analysis of studies comparing IGT performances in patients with vs. without a history of suicidal acts in bipolar and unipolar disorder, together and separately. RESULTS (1) Among suicide attempters, bipolar and unipolar groups performed similarly (t(195)=-0.7; p=0.48). Unipolar non-attempters performed better IGT than unipolar suicide attempters (t(221)=3.1; p=0.002), only in female gender, whereas performances were similar in bipolar patients whatever the history of suicide attempt (t(77)=-0.3; p=0.7). (2) A meta-analysis of 10 studies confirmed significantly impaired decision-making with a moderate effect-size (-0.38 (95% CI[-0.61--0.16]; z=-3.3; p=0.001) in unipolar disorder and (g=-0.4 (95% CI[-0.75 to -0.05]; z=-2.2; p<0.026) in bipolar disorder suicide attempters compared to unipolar and bipolar non-attempters, respectively. LIMITATIONS It was not possible to analyse according to the level of lethality attempt. CONCLUSION Overall, a strong significant association was found between decision-making and the risk of suicidal behavior in unipolar disorder and bipolar disorder. However, further neuropsychological studies need to analyse separately unipolar and bipolar disorder and to study gender differences.
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Affiliation(s)
- Stéphane Richard-Devantoy
- McGill University, Department of Psychiatry & Douglas Mental Health University, Institute McGill Group for Suicide Studies, FBC Building, 3rd floor, 6875 Boulevard Lasalle, Montréal (Québec), & Hôpital Régional de Saint-Jérôme, Saint-Jérôme, Québec, Canada; Laboratoire de Psychologie des Pays de la Loire EA 4638, Université de Nantes et Angers, France.
| | - Emilie Olié
- Université Montpellier & CHU Montpellier & Inserm, U1061 Montpellier, France
| | - Sébastien Guillaume
- Université Montpellier & CHU Montpellier & Inserm, U1061 Montpellier, France
| | - Philippe Courtet
- Université Montpellier & CHU Montpellier & Inserm, U1061 Montpellier, France
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28
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Denk F, Ramer LM, Erskine ELKS, Nassar MA, Bogdanov Y, Signore M, Wood JN, McMahon SB, Ramer MS. Tamoxifen induces cellular stress in the nervous system by inhibiting cholesterol synthesis. Acta Neuropathol Commun 2015; 3:74. [PMID: 26610346 PMCID: PMC4660723 DOI: 10.1186/s40478-015-0255-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 11/09/2015] [Indexed: 12/16/2022] Open
Abstract
Background Tamoxifen (TAM) is an important cancer therapeutic and an experimental tool for effecting genetic recombination using the inducible Cre-Lox technique. Despite its widespread use in the clinic and laboratory, we know little about its effects on the nervous system. This is of significant concern because TAM, via unknown mechanisms, induces cognitive impairment in humans. A hallmark of cellular stress is induction of Activating Transcription Factor 3 (Atf3), and so to determine whether TAM induces cellular stress in the adult nervous system, we generated a knock-in mouse in which Atf3 promoter activity drives transcription of TAM-dependent Cre recombinase (Cre-ERT2); when crossed with tdtomato reporter mice, Atf3 induction results in robust and permanent genetic labeling of cells in which it is up-regulated even transiently. Results We found that granular neurons of the olfactory bulb and dentate gyrus, vascular cells and ependymal cells throughout the brain, and peripheral sensory neurons expressed tdtomato in response to TAM treatment. We also show that TAM induced Atf3 up-regulation through inhibition of cholesterol epoxide hydrolase (ChEH): reporter expression was mitigated by delivery in vitamin E-rich wheat germ oil (vitamin E depletes ChEH substrates), and was partially mimicked by a ChEH-specific inhibitor. Conclusions This work demonstrates that TAM stresses cells of the adult central and peripheral nervous systems and highlights concerns about clinical and experimental use of TAM. We propose TAM administration in vitamin E-rich vehicles such as wheat germ oil as a simple remedy.
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Self-reported strategies in decisions under risk: role of feedback, reasoning abilities, executive functions, short-term-memory, and working memory. Cogn Process 2015; 16:401-16. [DOI: 10.1007/s10339-015-0665-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 07/09/2015] [Indexed: 11/25/2022]
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