Department of Medical Imaging, Medical Imaging Center, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Huai'an, Jiangsu, China.
Brain Behav. 2023 Jun;13(6):e3039. doi: 10.1002/brb3.3039. Epub 2023 May 8.
Amenorrhea induced decrease of hormones is associated with cognitive impairment. This study aimed to evaluate hippocampal functional connectivity patterns in chemotherapy-induced amenorrhea (CIA) breast cancer (BC) patients, to evaluate the relationship between the functional connectivity features and hormone levels.
Neuropsychological test, functional magnetic resonance imaging, and assessment of hormone levels were conducted in 21 premenopausal BC patients before chemotherapy (t ) and 1 week after completing chemotherapy (t ). Twenty matched healthy controls (HC) were also included and underwent the same assessments at similar time intervals. Mixed effect analysis and paired t-test were used to compare differences in brain functional connectivity.
Voxel-based paired t-tests revealed increased functional connectivity of the right and left hippocampus with the left fusiform gyrus, inferior and middle temporal gyrus, inferior occipital gyrus, left lingual gyrus, and parahippocampal gyrus after chemotherapy (p < .001) in CIA patients. Repeated measures analysis revealed significant group-by-time interactions in the left hippocampus with the bilateral fusiform gyrus, right parahippocampal gyrus, left inferior temporal gyrus, and left inferior occipital gyrus (p < .001). Premenopausal BC patients had no significant differences in cognitive function compared with HC at baseline. However, the CIA patients had high levels of self-rating depression scale, self-rating anxiety scale, total cholesterol, and triglycerides. Further, the CIA patients showed significant differences in hormone and fasting plasma glucose levels and cognitive performances between t and t (p < .05). Functional connectivity changes between the left hippocampus and the left inferior occipital gyrus was negatively correlated with E2 and luteinizing hormone changes (p < .05).
The CIA patients had cognitive dysfunction mainly in memory and visual mobility. Chemotherapy may affect hippocampal-posterior cortical circuit which mediates visual processing in CIA patients. Moreover, E2 may be involved in this process.
激素诱导的闭经会导致认知障碍。本研究旨在评估化疗诱导的闭经（CIA）乳腺癌（BC）患者的海马功能连接模式，并评估功能连接特征与激素水平之间的关系。
对 21 例化疗前（t 期）和化疗后 1 周（t 期）的绝经前 BC 患者进行神经心理学测试、功能磁共振成像和激素水平评估。还纳入了 20 名匹配的健康对照者（HC），并在相似的时间间隔进行相同的评估。采用混合效应分析和配对 t 检验比较脑功能连接的差异。
基于体素的配对 t 检验显示，CIA 患者化疗后右侧和左侧海马与左侧梭状回、下颞叶和中颞叶、下枕叶、左侧舌回和海马旁回的功能连接增加（p<0.001）。重复测量分析显示，左侧海马与双侧梭状回、右侧海马旁回、左侧颞下回和左侧枕下回的组间时间交互作用有统计学意义（p<0.001）。与 HC 相比，绝经前 BC 患者在基线时的认知功能无显著差异。然而，CIA 患者的自评抑郁量表、自评焦虑量表、总胆固醇和甘油三酯水平较高。此外，CIA 患者在 t 和 t 时的激素和空腹血糖水平以及认知表现均有显著差异（p<0.05）。左侧海马与左侧枕下回之间的功能连接变化与 E2 和黄体生成素的变化呈负相关（p<0.05）。
CIA 患者的认知功能障碍主要表现为记忆力和视觉运动能力受损。化疗可能会影响 CIA 患者的海马-后皮质回路，从而影响视觉处理。此外，E2 可能参与了这一过程。
