Effects of Tamoxifen and Exemestane on Cognitive Functioning of Postmenopausal Patients With Breast Cancer: Results From the Neuropsychological Side Study of the Tamoxifen and Exemestane Adjuvant Multinational Trial

2010 ◽  
Vol 28 (8) ◽  
pp. 1294-1300 ◽  
Author(s):  
Christina M. Schilder ◽  
Caroline Seynaeve ◽  
Louk V. Beex ◽  
Willem Boogerd ◽  
Sabine C. Linn ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Adjuvant Therapy ◽  
Executive Functioning ◽  
Cognitive Functioning ◽  
Verbal Memory ◽  
Endocrine Treatment ◽  
Healthy Controls ◽  
Cohen’S D ◽  
Multinational Trial ◽  
Cohen's D

PurposeTo evaluate the influence of adjuvant tamoxifen and exemestane on cognitive functioning in postmenopausal patients with breast cancer (BC).Patients and MethodsNeuropsychological assessments were performed before the start (T1) and after 1 year of adjuvant endocrine treatment (T2) in Dutch postmenopausal patients with BC, who did not receive chemotherapy. Patients participated in the international Tamoxifen and Exemestane Adjuvant Multinational trial, a prospective randomized study investigating tamoxifen versus exemestane as adjuvant therapy for hormone-sensitive BC.ResultsParticipants included 80 tamoxifen users (mean age, 68.7 years; range 51 to 84), 99 exemestane users (mean age, 68.3 years; range, 50 to 82), and 120 healthy controls (mean age, 66.2 years; range, 49 to 86). At T2, after adjustment for T1 performance, exemestane users did not perform statistically significantly worse than healthy controls on any cognitive domain. In contrast, tamoxifen users performed statistically significantly worse than healthy controls on verbal memory (P < .01; Cohen's d = .43) and executive functioning (P = .01; Cohen's d = .40), and statistically significantly worse than exemestane users on information processing speed (P = .02; Cohen's d = .36). With respect to visual memory, working memory, verbal fluency, reaction speed, and motor speed, no significant differences between the three groups were found.ConclusionAfter 1 year of adjuvant therapy, tamoxifen use is associated with statistically significant lower functioning in verbal memory and executive functioning, whereas exemestane use is not associated with statistically significant lower cognitive functioning in postmenopausal patients with BC. Our results accentuate the need to include assessments of cognitive effects of adjuvant endocrine treatment in long-term safety studies.

Neuropsychological sequelae of tamoxifen and exemestane after AC-chemotherapy in postmenopausal women with early breast cancer

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 566-566 ◽  
Author(s):  
C. M. Schilder ◽  
P. C. Eggens ◽  
W. Boogerd ◽  
F. S. van Dam ◽  
S. B. Schagen
Keyword(s):  
Breast Cancer ◽  
Cognitive Functioning ◽  
Cancer Patients ◽  
Endocrine Therapy ◽  
Cognitive Functions ◽  
Daily Life ◽  
Endocrine Treatment ◽  
Healthy Controls ◽  
Breast Cancer Patients ◽  
Cognitive Complaints

566 Background: Cognitive deficits and cognitive complaints in daily life have been associated with adjuvant chemotherapy in breast cancer survivors. The role of endocrine treatments with respect to these cognitive problems is unclear. Because estrogen deficiency may have adverse effects on certain cognitive functions, it is plausible that endocrine treatments affect cognitive functioning in addition to chemotherapy. The current aim was to investigate whether cognitive functioning of breast cancer patients treated with AC-chemotherapy and endocrine therapy differs from healthy controls and to examine possible distinctive effects between tamoxifen and exemestane. Methods: Postmenopausal breast cancer patients from the TEAM-trial, randomized to receive tamoxifen (n=30) or exemestane (n=51), underwent neuropsychological testing and were interviewed regarding cognitive complaints in daily life 1.5–4 years post AC- chemotherapy. At the time of testing, all patients still received their assigned endocrine treatment. Depression was measured with the Hopkins Symptom Checklist (HSCL), fatigue with the Multidimensional Fatigue Inventory (MFI). Healthy controls (n=48) underwent the same assessment. Results: After controlling for age and IQ, both tamoxifen and exemestane users scored significantly lower on ‘information processing speed’ than healthy controls (Reaction times; p = .023 and p = .008). Tamoxifen users scored significantly lower on ‘mental flexibility’ (Stroop Card 3; p = .007) and ‘category fluency’ (p = .<0001) than healthy controls. A significant higher proportion of both tamoxifen and exemestane users reported memory problems in daily life compared to healthy controls (27.6 and 25.5% versus 6.3%, p = .02). Reported cognitive complaints did not correlate with test scores but with fatigue and depression. Conclusions: These results suggest that endocrine treatments combined with AC-chemotherapy have an effect on certain cognitive functions and provide indications for distinctive cognitive effects of different types of endocrine therapy. No significant financial relationships to disclose.

scholarly journals Highly Predictive Transdiagnostic Features Shared across Schizophrenia, Bipolar Disorder, and ADHD Identified Using a Machine Learning Based Approach

2018 ◽  
Author(s):  
Yuelu Liu ◽  
Monika S. Mellem ◽  
Humberto Gonzalez ◽  
Matthew Kollada ◽  
Atul R. Mahableshwarkar ◽  
...  
Keyword(s):  
Machine Learning ◽  
Bipolar Disorder ◽  
Psychiatric Disorders ◽  
Patient Group ◽  
Attention Deficit ◽  
The United States ◽  
Self Report ◽  
Healthy Controls ◽  
Cohen’S D ◽  
Cohen's D

AbstractThe Diagnostic and Statistical Manual of Mental Disorders (DSM) is the standard for diagnosing psychiatric disorders in the United States. However, evidence has suggested that symptoms in psychiatric disorders are not restricted to the boundaries between DSM categories, implying an underlying latent transdiagnostic structure of psychopathology. Here, we applied an importance-guided machine learning technique for model selection to item-level data from self-reported instruments contained within the Consortium for Neuropsychiatric Phenomics dataset. From 578 questionnaire items, we identified a set of features which consisted of 85 items that were shared across diagnoses of schizophrenia (SCZ), bipolar disorder (BD), and attention deficit/hyperactivity disorder (ADHD). A classifier trained on the transdiagnostic features reliably distinguished the patient group as a whole from healthy controls (classification AUC = 0.95) and only 10 items were needed to attain the performance level of AUC being 0.90. A sum score created from the items produced high separability between patients and healthy controls (Cohen’s d = 2.85), and it outperformed predefined sum scores and sub-scores within the instruments (Cohen’s d ranging between 0.13 and 1.21). The transdiagnostic features comprised both symptom domains (e.g. dysregulated mood, attention deficit, and anhedonia) and personality traits (e.g. neuroticism, impulsivity, and extraversion). Moreover, by comparing the features that were common across the three patient groups with those that were most predictive of a single patient category, we can describe the unique features for each patient group superimposed on the transdiagnostic feature structure. Overall, our results reveal a latent transdiagnostic symptom/behavioral phenotypic structure shared across SCZ, BD, and ADHD and present a new perspective to understand insights offered by self-report psychiatric instruments.

scholarly journals COGNITIVE FUNCTIONING AMONG BREAST CANCER SURVIVORS AND NON-CANCER PARTICIPANTS: EVIDENCE FOR SIMILARITIES

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S649-S650
Author(s):  
Giancarlo Pasquini ◽  
Brent J Small ◽  
Jacqueline Mogle ◽  
Martin Sliwinski ◽  
Stacey B Scott
Keyword(s):  
Breast Cancer ◽  
Working Memory ◽  
Executive Functioning ◽  
Cancer Survivors ◽  
Cognitive Functioning ◽  
Processing Speed ◽  
Breast Cancer Survivors ◽  
Cancer History ◽  
History Of ◽  
History Of Cancer

Abstract Breast cancer survivors may experience accelerated decline in cognitive functioning compared to same-aged peers with no cancer history (Small et al., 2015). Survivors may show important differences in mean-level performance or variability in cognitive functioning compared to those without a history of cancer (Yao et al., 2016). This study compared ambulatory cognitive functioning in a sample of breast cancer survivors and an age-matched community sample without a history of cancer (n_cancer=47, n_non-cancer=105, age range: 40-64 years, M=52.13 years). Participants completed three cognitive tasks measuring working memory, executive functioning, and processing speed up to five times per day for 14 days. Results indicated no mean-level differences in cognitive performance on the three tasks between cancer survivors and those without cancer history (p’s&gt;.05). Unexpectedly, women without cancer history showed more variability than survivors on working memory but not on the other two tasks. Across both groups, those without a college education performed worse on executive functioning (B=-0.05, SE=0.03, p&lt;.05) and working memory (B=0.94, SE=0.36, p&lt;.05) compared to those that completed college. Additionally, older age was associated with slower processing speed (B=31.67, SE=7.44, p&lt;.001). In sum, this study did not find mean-level group differences in cognitive functioning between cancer survivors and age-matched women without a history of cancer. Contrary to hypotheses, those without a history of cancer were more variable on working memory. Results suggested similarities in cognitive functioning in the two samples and that education and age are important predictors of cognitive functioning independent of cancer history.

Adjuvant Endocrine Therapy Compared With No Systemic Therapy for Elderly Women With Early Breast Cancer: 21-Year Results of International Breast Cancer Study Group Trial IV

2003 ◽  
Vol 21 (24) ◽  
pp. 4517-4523 ◽  
Author(s):  
Diana Crivellari ◽  
Karen Price ◽  
Richard D. Gelber ◽  
Monica Castiglione-Gertsch ◽  
Carl-Magnus Rudenstam ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Adjuvant Therapy ◽  
Older Women ◽  
Early Breast Cancer ◽  
Systemic Therapy ◽  
Cancer Recurrence ◽  
Breast Cancer Recurrence ◽  
Endocrine Treatment ◽  
Competing Causes ◽  
Causes Of Failure

Purpose: Increasing numbers of older women are affected by early breast cancer, because of prolonged life expectancy and the increasing incidence of breast cancer with age. The role of adjuvant therapy for this population is still a matter of debate. We reviewed the long-term outcome of a mature trial comparing endocrine treatment versus no adjuvant therapy in older women with node-positive breast cancer. Patients and Methods: From 1978 to 1981, 349 women 66 to 80 years of age with pathologically involved lymph nodes after total mastectomy and axillary clearance were randomly assigned to receive 12 months of adjuvant tamoxifen plus low-dose prednisone (p+T) or no adjuvant therapy. Three hundred twenty patients were eligible. Results: At 21 years’ median follow-up, 1 year of p+T significantly prolonged disease-free survival (DFS; P = .003) and overall survival (P = .05; 15-year DFS, 10% ± 3% v 19% ± 3%; hazard ratio, 0.71; 95% CI, 0.58 to 0.86). When comparing competing causes of failure (breast cancer recurrence and deaths before breast cancer recurrence), p+T was far superior in controlling breast cancer recurrence (P = .0003), but the improvement was seen mainly in soft tissue sites. Conversely, patients in the p+T group were more likely to die before a breast cancer recurrence (P = .03). Conclusion: This trial demonstrates that significant treatment benefits continue to be observed in older patients treated for 1 year with p+T. Despite issues relating to competing causes of failure, older breast cancer patients can benefit from treatment and should be considered for trials of adjuvant systemic therapy.

The effect of psychiatric co-morbidity on cognitive functioning in a population-based sample of depressed young adults

2009 ◽  
Vol 40 (1) ◽  
pp. 29-39 ◽  
Author(s):  
A. E. Castaneda ◽  
M. Marttunen ◽  
J. Suvisaari ◽  
J. Perälä ◽  
S. I. Saarni ◽  
...  
Keyword(s):  
Young Adults ◽  
Executive Functioning ◽  
Cognitive Functioning ◽  
Cognitive Deficits ◽  
Verbal Memory ◽  
Verbal Learning ◽  
Population Based ◽  
Term Memory ◽  
Co Morbidity ◽  
History Of

BackgroundPsychiatric co-morbidity is often inadequately controlled for in studies on cognitive functioning in depression. Our recent study established no major deficits in cognition among young adults with a history of pure unipolar depression. The present study extends our previous work by examining the effects of psychiatric co-morbidity and other disorder characteristics on depression-related cognitive functioning.MethodPerformance in verbal and visual short-term memory, verbal long-term memory and learning, attention, processing speed, and executive functioning was compared between a population-based sample aged 21–35 years with a lifetime history of unipolar depressive disorders (n=126) and a random sample of healthy controls derived from the same population (n=71). Cognitive functioning was also compared between the subgroups of pure (n=69) and co-morbid (n=57) depression.ResultsThe subgroups of pure and co-morbid depression did not differ in any of the cognitive measures assessed. Only mildly compromised verbal learning was found among depressed young adults in total, but no other cognitive deficits occurred. Received treatment was associated with more impaired verbal memory and executive functioning, and younger age at first disorder onset with more impaired executive functioning.ConclusionsPsychiatric co-morbidity may not aggravate cognitive functioning among depressed young adults. Regardless of co-morbidity, treatment seeking is associated with cognitive deficits, suggesting that these deficits relate to more distress.

scholarly journals Dancing With Health: Quality of Life and Physical Improvements From an EU Collaborative Dance Programme With Women Following Breast Cancer Treatment

2021 ◽  
Vol 12 ◽  
Author(s):  
Vicky Karkou ◽  
Irene Dudley-Swarbrick ◽  
Jennifer Starkey ◽  
Ailsa Parsons ◽  
Supritha Aithal ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Quality Of Life ◽  
Latin American ◽  
Radiation Treatment ◽  
Well Being ◽  
Post Intervention ◽  
Dance Movement ◽  
Cohen’S D ◽  
Cohen's D

Background: Women's health has received renewed attention in the last few years including health rehabilitation options for women affected by breast cancer. Dancing has often been regarded as one attractive option for supporting women's well-being and health, but research with women recovering from breast cancer is still in its infancy. Dancing with Health is multi-site pilot study that aimed to evaluate a dance programme for women in recovery from breast cancer across five European countries.Methods: A standardized 32 h dance protocol introduced a range of Latin American dances presented within a sports and exercise framework with influences from dance movement therapy. Fifty-four women (M age 53.51; SD 7.99) participated in the study who had a breast cancer diagnosis &lt;3 years, chemotherapy &gt;6 weeks, no indication of metastasis, or scheduled surgery/chemotherapy/radiation treatment for the duration of the intervention. Primary outcome data was collected for anthropometric and fitness measures next to cancer-related quality of life. T-tests and Wilcoxon signed ranked tests were used to establish differences pre and post intervention. Cohen's d was also calculated to determine the effect size of the intervention.Results: Statistically significant changes were found for: (i) weight, right and left forearm circumference and hip; (ii) 6 min walking, right and left handgrip, sit-to-stand and sit-and-reach; (iii) the EORTC-QLQ C30 summary score as well as the subscales of emotional and social functioning and symptoms. In all cases the direction of change was positive, while Cohen's d calculated showed that the effect of the intervention for these parameters ranged from intermediate to large.Conclusion: Changes on the above anthropometric, fitness and quality of life measures suggest that the intervention was of value to the participating women recovering from breast cancer. Results also advocate collaborative efforts across countries to further research.

scholarly journals Trends in Healthy Eating Index Scores Among Women of Varying Ethnic Backgrounds with Gynecological and Breast Cancers

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 346-346
Author(s):  
Meghan Owens ◽  
Derek Miketinas
Keyword(s):  
Breast Cancer ◽  
Ovarian Cancer ◽  
Healthy Eating ◽  
Diet Quality ◽  
White Women ◽  
Healthy Eating Index ◽  
Cohen’S D ◽  
Cancer Types ◽  
Cohen's D ◽  
Hispanic White

Abstract Objectives The purpose of this study is to determine if Healthy Eating Index (HEI) scores significantly differ between women in varying ethnicity groups with self-reported gynecological cancer or breast cancer. Methods NHANES 2015–2016 data were examined to determine subjects and categorize them based on ethnicity group and self-reported cancer diagnoses. A total of 2602 women were identified and grouped by self-reported cancer diagnosis. Usual HEI scores were estimated over two days using the NCI method and adjusted for the following covariates: family income to poverty ratio, Body Mass Index, age, and smoking exposure. Ethnicity groups included were Mexican-American, Other Hispanic, Non-Hispanic White, Non-Hispanic Black, and Multiracial. Cancer diagnoses of breast, cervical, ovarian, and uterine were compared across ethnicity groups.  Independent samples t-tests and Cohen's D were calculated. Analysis was conducted using SAS version 9.4. Results Overall, diet quality was poor among the sample. Those with cervical cancer had the highest average HEI scores (48.6 + 3.0; 95% CI: 42.1 – 55.0) while those with breast cancer had the lowest average HEI scores (41.7 + 3.6; 95% CI: 34.0 – 49.3). Within those with breast cancer, non-Hispanic white women had the highest HEI scores (43.5 + 4.0; 95%CI: 34.8, 52.1) compared to other ethnicities (Cohen's D ranged between 0.28–0.42). Hispanic women with ovarian cancer had an HEI score of 26.98 points lower than white women with ovarian cancer. Overall, ethic minority groups had lower average HEI scores when compared to Non-Hispanic White women with the same type of cancer. Conclusions In some instances Non-Hipsanic white women had higher average HEI scores; however, this was not true across all cancer types. These results suggest that there are differences in diet quality scores among various cancer types, but overall diet quality is generally poor across ethnicity groups. Funding Sources None.

Oxidative stress, inflammation and cognitive impairment in first psychotic patients

2011 ◽  
Vol 26 (S2) ◽  
pp. 427-427
Author(s):  
M. Martínez-Cengotitabengoa ◽  
J.C. Leza ◽  
S. Alberich ◽  
S. Barbeito ◽  
R. González-Oliveros ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Nitric Oxide ◽  
Cognitive Impairment ◽  
Cognitive Functioning ◽  
Verbal Memory ◽  
First Episode Psychosis ◽  
First Episode ◽  
Healthy Controls ◽  
Episode Psychosis ◽  
Activity Of Enzymes

IntroductionBoth oxidative stress and the inflammatory chemokine MCP-1 have been linked to the pathophysiology of certain mental illnesses such as psychosis. There are previous studies in rats and dogs suggesting that oxidative stress can cause cognitive impairment.ObjectivesTo correlate oxidative stress and the chemokine MCP-1 levels with cognitive impairment in first episode psychosis.Methods28 patients with first episode psychosis and 28 healthy controls matched by sex and age were included in the study, who were given a battery of neurocognitive tests and we determined their blood levels of lipid peroxidation (TBARS), nitric oxide, total antioxidant status (TAS), glutathione, activity of enzymes catalase (CAT), glutathione peroxidase (cGPx) and superoxide dismutase (SOD) and the inflammatory chemokine MCP-1.ResultsHealthy controls had better TAS than patients and increased activity of enzymes cGPx and CAT.We found a statistically significant negative relationship between levels of MCP-1 and working memory, attention and verbal memory. At higher levels of chemokines, worse cognitive functioning in these areas.Verbal memory was also negatively related, in a meaningful way, with nitric oxide levels in blood.Likewise, we found that higher levels of glutathione correlated with better scores on the 3 tests performed of verbal fluency.ConclusionsIn patients with a PEP, levels of certain markers of oxidative stress and inflammation are associated with poorer cognitive functioning.

scholarly journals Neurocognitive Function in Persons with HIV and Healthy Controls from Tijuana, a Border Region in Mexico

2019 ◽  
Vol 34 (7) ◽  
pp. 1253-1253
Author(s):  
M L Garcia Gomar ◽  
A J Negrete Cortes ◽  
R Chavez Mendez ◽  
N Castillo Martinez ◽  
A Morlett Paredes ◽  
...  
Keyword(s):  
Executive Function ◽  
Processing Speed ◽  
Verbal Fluency ◽  
Neurocognitive Function ◽  
Mexican Population ◽  
Medium Effect ◽  
Healthy Controls ◽  
Cohen’S D ◽  
Global Cognition ◽  
Cohen's D

Abstract Objective To examine neurocognitive impairment (NCI) in vulnerable HIV infected (HIV+) adults in Mexico. Participants and Method Twenty-eight adults (15 HIV+ and 13 HIV-) living in Tijuana (Mexico) participated in the study (Age: M = 40.5, SD = 11.1; 54% female; Education: M = 8.6, SD = 4.7). Participants with HIV were recruited from the board-and-care home “Las Memorias” (100% AIDS; 93% on ART; Years since HIV diagnosis: Median = 11, IQR = 5,16). Healthy controls, matched in age and education to HIV+ participants, were recruited from the same city. Participants completed a neuropsychological test battery which was comprised of the Modified Wisconsin Card Sorting Test, letter and animal fluency, Trail Making Test Parts A and B, Stroop Color-Word Test, and Symbol-Digit Test. Raw scores garnered from these tests were transformed to percentiles using norms for a Mexican population, and averaged to calculate scores on global cognition and on three cognitive domains (verbal fluency, processing speed and executive function). Wilcoxon rank sum tests were conducted to investigate group differences. NCI was defined as global percentile scores &lt; 16. Results HIV+ participants showed significantly lower scores in global cognition (p = .04, Cohen’s d = 0.86), as well as the domains of processing speed (p = .03, Cohen’s d = 0.87) and executive function (p = .04, Cohen’s d = 0.84), with no significant differences (but medium effect sizes) on verbal fluency (p = .10, Cohen’s d = 0.60). NCI was evident in 53% of HIV+ persons and 15% of healthy controls. Conclusions Approximately half of the persons living with HIV showed notable NCI, which is consistent with findings of prior studies of Latinos in the US with HIV. This pattern of neurocognitive function was also similar to those of prior studies in HIV. Future studies might examine key predictors of HIV-associated NCI in this vulnerable Mexican population, including biological and culturally relevant factors: such as deportation, and discrimination for sexual preference or HIV status.

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