Normandie Univ, UNICAEN, PSL University, EPHE, INSERM, U1077, CHU de Caen, Neuropsychologie et Imagerie de la Mémoire Humaine, 14000, Caen, France.
Breast Committee Department, Centre François Baclesse, Caen, France.
Brain Imaging Behav. 2020 Feb;14(1):226-241. doi: 10.1007/s11682-018-9991-0.
Cognitive deficits are a major complaint in breast cancer patients, even before chemotherapy. Comprehension of the cerebral mechanisms related to cognitive impairment in breast cancer patients remains difficult due to the scarcity of studies investigating both cognitive and anatomical imaging changes. Furthermore, only some of the patients experienced cognitive decline following chemotherapy, yet few studies have identified risk factors for cognitive deficits in these patients. It has been shown that education level could impact cognitive abilities during the recovery phase following chemotherapy. Our main aim was to longitudinally evaluate cognitive and anatomical changes associated with cancer and chemotherapy in breast cancer patients. Our secondary aim was to assess the impact of education level on cognitive performances and gray matter (GM) atrophy in these patients. Twenty patients were included before chemotherapy (T1), 1 month (T2) and 1 year (T3) after chemotherapy. Twenty-seven controls without a history of cancer were assessed at T1 and T3 only. Cluster groups based on education level were defined for both groups and were further compared. Comparison between patients and controls revealed deficits in patients on verbal episodic memory retrieval at T1 and T3 and on executive functions at T3. After chemotherapy, breast cancer patients had GM atrophy that persisted or recovered 1 year after chemotherapy depending on the cortical areas. Increase in GM volumes from T1 to T3 were also found in both groups. At T2, patients with a higher level of education compared to lower level exhibited higher episodic memory retrieval and state anxiety scores, both correlating with cerebellar volume. This higher level of education group exhibited hippocampal atrophy. Our results suggest that, before chemotherapy, cancer-related processes impact cognitive functioning and that this impact seems exacerbated by the effect of chemotherapy on certain brain regions. Increase in GM volumes after chemotherapy were unexpected and warrant further investigations. Higher education level was associated, 1 month after the end of chemotherapy, with greater anxiety and hippocampal atrophy despite a lack of cognitive deficits. These results suggest, for the first time, the occurrence of compensation mechanisms that may be linked to cognitive reserve in relationship to state anxiety. This identification of factors, which may compensate cognitive impairment following chemotherapy, is critical for patient care and quality of life.
认知缺陷是乳腺癌患者的主要抱怨之一，甚至在化疗之前就已经存在。由于研究认知和解剖影像学变化的研究很少，因此仍然难以理解与乳腺癌患者认知障碍相关的大脑机制。此外，只有一些患者在化疗后经历了认知能力下降，但很少有研究确定这些患者认知缺陷的风险因素。已经表明，教育水平可能会影响化疗后恢复阶段的认知能力。我们的主要目的是纵向评估乳腺癌患者癌症和化疗相关的认知和解剖变化。我们的次要目的是评估教育水平对这些患者认知表现和灰质（GM）萎缩的影响。20 名患者在化疗前（T1）、化疗后 1 个月（T2）和 1 年后（T3）进行了评估。27 名无癌症病史的对照者仅在 T1 和 T3 时进行了评估。根据教育水平为两组定义聚类组，并进一步进行比较。患者与对照组的比较显示，患者在 T1 和 T3 时在言语情景记忆检索方面存在缺陷，在 T3 时在执行功能方面存在缺陷。化疗后，乳腺癌患者在 GM 萎缩方面存在，根据皮质区域的不同，GM 萎缩在化疗后 1 年内持续或恢复。两组 GM 体积也从 T1 增加到 T3。在 T2，与较低水平的教育相比，较高水平的教育患者表现出较高的情景记忆检索和状态焦虑评分，这两个评分都与小脑体积相关。较高水平的教育组表现出海马萎缩。我们的研究结果表明，在化疗之前，癌症相关过程会影响认知功能，而化疗对某些大脑区域的影响似乎会加剧这种影响。化疗后 GM 体积的增加是出乎意料的，需要进一步研究。较高的教育水平与化疗结束后 1 个月的更高焦虑和海马萎缩相关，尽管没有认知缺陷。这些结果首次表明，可能与状态焦虑相关的认知储备存在补偿机制。确定可能补偿化疗后认知障碍的因素对患者护理和生活质量至关重要。
