Cancer-related cognitive impairment in breast cancer survivors: An examination of conceptual and statistical cognitive domains using principal component analysis

Exercise as a Therapeutic Strategy to Improve Cerebrovascular Function and Cognition in Breast Cancer Survivors: A Scoping Review

Breast cancer is the most diagnosed cancer globally. While the breast cancer prevalence continues to rise, so too do patient survival rates, thus resulting in a large survivor population. Up to 75% of this population report experiencing cancer-related cognitive impairment during their cancer journey, thus reducing their quality of survivorship. This review systematically evaluates the effect of physical activity and exercise training on cerebrovascular function and cognition in breast cancer survivors. Cross-sectional, intervention or observational studies that examined the effect of acute or chronic exercise training or physical activity levels on cerebrovascular function and cognition in female breast cancer survivors were searched for systematically. The 11 included studies were tabulated and described narratively. The included studies primarily focused on aerobic exercise training, while only four studies investigated the effect of resistance exercise training or concurrent training on cerebrovascular function and/or cognition in breast cancer survivors. Collectively, these studies provide preliminary evidence supporting the positive effect of exercise training on cerebrovascular function and cognition in breast cancer survivors, irrespective of their age, stage of breast cancer and treatment regimen. However, more research is required to comprehensively evaluate the effect of exercise training on cerebrovascular function and cognition in breast cancer survivors and the mechanisms leading to these potential improvements.

Cognitive function and its associated factors among patients with cancer pain: a multicentre cross-sectional study in China

OBJECTIVE

This research aimed to assess the levels of cognitive function and its contributing factors among individuals experiencing cancer pain (CP) in mainland China.

DESIGN

A descriptive, cross-sectional study.

SETTING

The investigation was undertaken within three tertiary oncology hospitals.

PARTICIPANTS

We included 220 hospitalised individuals who reported experiencing cancer-related pain and consented to complete the research questionnaires.

OUTCOME MEASURES

The collected data encompassed sociodemographic and clinical variables, augmented by results from validated questionnaires. Cognitive impairment (CI) was evaluated using the Functional Assessment of Cancer Therapy-Cognitive (FACT-Cog) scale, with scores ranging from 0 to 148. Sleep quality, depression and anxiety were assessed through the Pittsburgh Sleep Quality Index, the Patient Health Questionnaire-9 and the Generalised Anxiety Disorder-7, respectively. A binary logistic regression model was used to identify factors associated with CI in individuals with CP.

RESULTS

Of the 225 individuals approached, 220 (97.8%) participated in the study. The mean FACT-Cog score for those with CP was 101.29 (SD=25.24; range=25-148). The prevalence of CI among these individuals was 35.90%. Sleep quality was rated below medium in 45% of participants with CP. More than moderate pain was reported by 28.2%, with 64.6% experiencing depression and 38.6% experiencing anxiety. Increased odds of developing CI were observed in those with CP (OR 1.422, 95% CI 1.129 to 1.841), depression (OR 1.119, 95% CI 1.029 to 1.2117), anxiety (OR 1.107, 95% CI 1.005 to 1.220), advancing age (OR 1.042, 95% CI 1.013 to 1.073), poor sleep quality (OR 1.126, 95% CI 1.013 to 1.252) and a history of smoking (OR 3.811, 95% CI 1.668 to 8.707).

CONCLUSIONS

CI associated with CP is notably prevalent in China. Those older, with a smoking history, inadequate sleep, more severe pain, depression and anxiety, have a heightened risk of CI. Consequently, interventions need to be personalised, addressing these key determinants.

Cognitive Component Structure of a Neuropsychological Battery Administered to Cognitively-Normal Adults in the SIU Longitudinal Cognitive Aging Study

We used principal component analysis (PCA) to examine the component structure of a neuropsychological test battery administered to 943 cognitively-normal adults enrolled in the Southern Illinois University (SIU) Longitudinal Cognitive Aging Study (LCAS). Four components explaining the most variance (63.9%) in the dataset were identified: speed/cognitive flexibility, visuospatial skills, word-list learning/memory, and story memory. Regression analyses confirmed that increased age was associated with decreased component scores after controlling for gender and education. Our identified components differ slightly from previous studies using PCA on similar test batteries. Factors such as the demographic characteristics of the study sample, the inclusion of mixed patient and control samples, the inclusion of different test measures in previous studies, and the fact that many neuropsychological test measures assess multiple cognitive processes simultaneously, may help to explain these inconsistencies.

Doxorubicin induces dysregulation of AMPA receptor and impairs hippocampal synaptic plasticity leading to learning and memory deficits

Doxorubicin (Dox) is a chemotherapeutic agent used widely to treat a variety of malignant cancers. However, Dox chemotherapy is associated with several adverse effects, including "chemobrain," the observation that cancer patients exhibit through learning and memory difficulties extending even beyond treatment. This study investigated the effect of Dox treatment on learning and memory as well as hippocampal synaptic plasticity. Dox-treated mice (5 mg/kg weekly x 5) demonstrated impaired performance in the Y-maze spatial memory task and a significant reduction in hippocampal long-term potentiation. The deficit in synaptic plasticity was mirrored by deficits in the functionality of synaptic `α-amino-3- hydroxy-5-methyl-4-isoxazolepropionic acid receptor (AMPAR) channels, including reduced probability of opening, decreased dwell open time, and increased closed times. Furthermore, a reduction in the AMPAR subunit GluA1 level, its downstream signaling molecule Ca2+/calmodulin-dependent protein kinase (CaMKII), and brain-derived neurotrophic factor (BDNF) were observed. This was also accompanied by an increase in extracellular signal regulated kinase (ERK) and protein kinase B (AKT) activation. Together these data suggest that Dox-induced cognitive impairments are at least partially due to alterations in the expression and functionality of the glutamatergic AMPAR system.

Neuropsychological functioning among patients with different types of cancer : Postchemotherapy cognitive impairment and implications for rehabilitation

BACKGROUND

Chemotherapeutic drugs often contribute to the cognitive impairment observed in some individuals following chemotherapy treatment. Postchemotherapy cognitive impairment (PCCI) is referred to as a decline in a variety of neuropsychological measures after chemotherapy and has an acute onset.

METHODS

The goals of the present study are to compare the manifestation of longitudinal PCCI among 182 patients with four different types of cancer (breast, colorectal, prostate and thyroid cancer) before chemotherapy (T1), immediately after chemotherapy (T2) and 6 months later (T3).

RESULTS

Although no statistically significant differences were observed between the study groups in any of the cognitive domains before chemotherapy, patients with breast cancer showed significantly lower performance on all cognitive domains compared to other patients at the postchemotherapy timepoints.

CONCLUSIONS

Although cognitive difficulties are reported during and after chemotherapy for cancer, it seems that there are differences between different types of cancer. We conclude that it is particularly important to assess and manage these cognitive disorders. Management includes rehabilitation programs that can improve cognitive functions and contribute to changes in brain functions to facilitate this improvement.