Ferguson Robert J, McDonald Brenna C, Saykin Andrew J, Ahles Tim A
Department of Rehabilitation Medicine, Eastern Maine Medical Center, Bangor, ME 04401, USA.
J Clin Oncol. 2007 Sep 1;25(25):3866-70. doi: 10.1200/JCO.2007.10.8639.
Adjuvant chemotherapy has been associated with mild cognitive decline among a subset of breast cancer survivors. Late cognitive effects after chemotherapy can have a deleterious impact on survivor quality of life and functional health; however, the etiology of chemotherapy-related cognitive dysfunction remains unknown.
We present a case of monozygotic twins who are discordant for breast cancer and chemotherapy exposure (ie, one twin contracted breast cancer and underwent chemotherapy, and the other had no breast cancer). As part of a larger study, each was evaluated with standardized, self-report measures of cognitive function, standard neuropsychological tests, and structural and functional magnetic resonance imaging (MRI).
Results indicated small differences in neuropsychological test performance but striking contrasts in self-reported cognitive complaints and structural and functional MRI images. Specifically, the twin who underwent chemotherapy had substantially more subjective cognitive complaints, more white matter hyperintensities on MRI, and an expanded spatial extent of brain activation during working memory processing than her nonaffected twin.
This case illustrates possible physiologic mechanisms that could produce long-term cognitive complaints among chemotherapy recipients and help formulate hypotheses for further empirical study in the area of chemotherapy-associated cognitive dysfunction.
辅助化疗与一部分乳腺癌幸存者的轻度认知衰退有关。化疗后的晚期认知影响会对幸存者的生活质量和功能健康产生有害影响；然而，化疗相关认知功能障碍的病因仍不明确。
我们报告了一对同卵双胞胎的病例，她们在乳腺癌及化疗暴露情况上存在差异（即其中一个双胞胎患乳腺癌并接受了化疗，另一个没有患乳腺癌）。作为一项更大规模研究的一部分，她们各自接受了认知功能的标准化自我报告测量、标准神经心理学测试以及结构和功能磁共振成像（MRI）检查。
结果表明神经心理学测试表现存在细微差异，但在自我报告的认知主诉以及结构和功能MRI图像方面存在显著差异。具体而言，接受化疗的双胞胎主观认知主诉明显更多，MRI上的白质高信号更多，并且在工作记忆处理过程中大脑激活的空间范围比未受影响的双胞胎更大。
该病例说明了可能导致化疗接受者长期认知主诉的生理机制，并有助于为化疗相关认知功能障碍领域的进一步实证研究提出假设。
