Longitudinal Assessment of Cognitive Changes Associated With Adjuvant Treatment for Breast Cancer: Impact of Age and Cognitive Reserve

DOI Web Site 4 Citations
  • Tim A. Ahles
    From the Memorial Sloan-Kettering Cancer Center, New York, NY; Norris Cotton Cancer Center, Dartmouth Medical School, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Center for Neuroimaging, Melvin and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN.
  • Andrew J. Saykin
    From the Memorial Sloan-Kettering Cancer Center, New York, NY; Norris Cotton Cancer Center, Dartmouth Medical School, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Center for Neuroimaging, Melvin and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN.
  • Brenna C. McDonald
    From the Memorial Sloan-Kettering Cancer Center, New York, NY; Norris Cotton Cancer Center, Dartmouth Medical School, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Center for Neuroimaging, Melvin and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN.
  • Yuelin Li
    From the Memorial Sloan-Kettering Cancer Center, New York, NY; Norris Cotton Cancer Center, Dartmouth Medical School, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Center for Neuroimaging, Melvin and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN.
  • Charlotte T. Furstenberg
    From the Memorial Sloan-Kettering Cancer Center, New York, NY; Norris Cotton Cancer Center, Dartmouth Medical School, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Center for Neuroimaging, Melvin and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN.
  • Brett S. Hanscom
    From the Memorial Sloan-Kettering Cancer Center, New York, NY; Norris Cotton Cancer Center, Dartmouth Medical School, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Center for Neuroimaging, Melvin and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN.
  • Tamsin J. Mulrooney
    From the Memorial Sloan-Kettering Cancer Center, New York, NY; Norris Cotton Cancer Center, Dartmouth Medical School, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Center for Neuroimaging, Melvin and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN.
  • Gary N. Schwartz
    From the Memorial Sloan-Kettering Cancer Center, New York, NY; Norris Cotton Cancer Center, Dartmouth Medical School, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Center for Neuroimaging, Melvin and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN.
  • Peter A. Kaufman
    From the Memorial Sloan-Kettering Cancer Center, New York, NY; Norris Cotton Cancer Center, Dartmouth Medical School, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Center for Neuroimaging, Melvin and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN.

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<jats:sec><jats:title>Purpose</jats:title><jats:p> To examine the impact of age and cognitive reserve on cognitive functioning in patients with breast cancer who are receiving adjuvant treatments. </jats:p></jats:sec><jats:sec><jats:title>Patients and Methods</jats:title><jats:p> Patients with breast cancer exposed to chemotherapy (n = 60; mean age, 51.7 years) were evaluated with a battery of neuropsychological and psychological tests before treatment and at 1, 6, and 18 months after treatment. Patients not exposed to chemotherapy (n = 72; mean age, 56.6 years) and healthy controls (n = 45; mean age, 52.9 years) were assessed at matched intervals. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> Mixed-effects modeling revealed significant effects for the Processing Speed and Verbal Ability domains. For Processing Speed, a three-way interaction among treatment group, age, and baseline cognitive reserve (P < .001) revealed that older patients with lower baseline cognitive reserve who were exposed to chemotherapy had lower performance on Processing Speed compared with patients not exposed to chemotherapy (P = .003) and controls (P < .001). A significant group by time interaction for Verbal Ability (P = .01) suggested that the healthy controls and no chemotherapy groups improved over time. The chemotherapy group failed to improve at 1 month after treatment but improved during the last two follow-up assessments. Exploratory analyses suggested a negative effect of tamoxifen on Processing Speed (P = .036) and Verbal Memory (P = .05) in the no-chemotherapy group. </jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p> These data demonstrated that age and pretreatment cognitive reserve were related to post-treatment decline in Processing Speed in women exposed to chemotherapy and that chemotherapy had a short-term impact on Verbal Ability. Exploratory analysis of the impact of tamoxifen suggests that this pattern of results may be due to a combination of chemotherapy and tamoxifen. </jats:p></jats:sec>

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