Cognitive Dysfunction and Its Predictors in Adult Patients With Cancer Receiving Chemotherapy: A Cross-Sectional Correlational Study

Abstract

À Deus por me amparar nos momentos difíceis, me dar força interior para superar as dificuldades, mostrar os caminho nas horas incertas e me suprir em todas as minhas necessidades. Muito especialmente, desejo agradecer ao meu orientador Prof. Doutor Nuno Lunet, pela disponibilidade, atenção dispensada, paciência, dedicação e profissionalismo. À minha co-orientadora, Filipa Fontes, por tanto cuidado, atenção, incentivo e pela disponibilidade em tempo integral. Aos colegas do Mestrado em Saúde Pública do ISPUP pelo companheirismo e pelos momentos de entusiasmo partilhados em conjunto. À minha irmã, pelos momentos de suporte e carinho. Ao meu marido, Tarcisio, pelo incentivo, compreensão e encorajamento, durante todo este período. Ao meu pai, por ter me dado o dom precioso da vida, o carinho e pelo apoio em minhas escolhas. À minha mãe, pelo exemplo de força e superação, pelo exemplo de vida e por ter me ensinado que o maior bem adquirido em nossas vidas é a educação e o conhecimento pois estes nada nos pode tirar. 12 Background: Cognitive decline associated with breast cancer diagnosis and treatment has been increasingly described. We aimed to quantify the association between cancer treatments and cognitive decline in early stage breast cancer patients during the first year of follow-up, taking into account the potential effect modification of anxiety before treatment. Patients and Methods: We conducted a prospective cohort study that included 506 women with newly diagnosed breast cancer, followed for one year. Patients were evaluated with the Hospital Anxiety and Depression Scale (HADS) and the Montreal Cognitive Assessment (MoCA) before starting treatment and at the 1-year follow-up. We described standardized scores of the mean variation in each MoCA subdomain between the two evaluations, and used Poisson regression to compute adjusted relative risks (RR) and corresponding 95%CI for the relation between different patients' and treatments' characteristics and cognitive decline, according to the patients' anxiety status at baseline. Results: During the first year after diagnosis, 34 patients presented cognitive decline and 38.0% were classified as having anxiety prior to treatment. Within each subdomain of the MoCA, the participants with cognitive decline had a significantly higher variation in the attention and memory subdomains, among those without anxiety, and for attention, visuospatial/executive function and orientation, for those anxious. The presence of anxiety at baseline was not significantly associated with cognitive decline (RR=1.43 95%CI: 0.73, 2.81), but modified the effect of chemotherapy (P for interaction=0.030), with the RR for chemotherapy being higher among patients with no anxiety prior to treatment (adjusted RR=4.35, 95%CI: 1.26, 15.02, for schemes including doxorubicin + cyclophosphamide). Conclusions: Anxiety modified the association between chemotherapy and cognitive decline; among women with no anxiety at baseline the risk of cognitive decline was four-fold higher among patients undergoing c...

Feasibility of DNA Methylation Age as a Biomarker of Symptoms and Resilience among Cancer Survivors with Multiple Chronic Conditions

“…For the objective measurement of cognitive function, we employed the Montreal Cognitive Assessment (MoCA) to screen for early-stage cognitive decline or mild cognitive impairment. In our study, the Cronbach's α coefficient for the MoCA instrument among cancer survivors was 0.79 [49].…”

Gambaran Fungsi Kognitif pada Pasien Keganasan Payudara yang Menjalani Kemoterapi di RSUP Dr. M. Djamil Padang

“…Orang yang berpendidikan lebih tinggi memiliki berat otak yang lebih dan lebih mampu untuk memperbaiki dan meregenerasi neuron di otak dibandingkan dengan orang yang berpendidikan rendah sehingga fungsi kognitifnya cenderung lebih baik. 19 Pada penelitian didapatkan subjek penelitian mengalami gangguan kognitif sejak kemoterapi kedua dilakukan. Pada kemoterapi kedua hingga keempat ditemukan adanya fungsi kognitif yang normal.…”

Research Trends on Cancer-Related Cognitive Impairment in Patients with Non-Central Nervous System Cancer: Text Network Analysis and Topic Modeling

“…Cancer-related cognitive impairment (CRCI) mainly affects memory and concentration and is one of the most common health problems in patients with non-CNS cancer [4,5]. Although the exact mechanism of CRCI is unknown, reportedly, it is related to various and complex causes such as decrease in nervous tissue development, hormonal abnormalities, changes in blood flow, and cerebral atrophy [4,5].…”

“…Cancer-related cognitive impairment (CRCI) mainly affects memory and concentration and is one of the most common health problems in patients with non-CNS cancer [4,5]. Although the exact mechanism of CRCI is unknown, reportedly, it is related to various and complex causes such as decrease in nervous tissue development, hormonal abnormalities, changes in blood flow, and cerebral atrophy [4,5]. CRCI was reported to occur in 12~82% of patients with non-CNS cancer receiving systemic chemotherapy [4]; among them, about 17~35% experienced severe or worse cognitive impairment that persisted for several years after the end of treatment [5].…”

“…Although the exact mechanism of CRCI is unknown, reportedly, it is related to various and complex causes such as decrease in nervous tissue development, hormonal abnormalities, changes in blood flow, and cerebral atrophy [4,5]. CRCI was reported to occur in 12~82% of patients with non-CNS cancer receiving systemic chemotherapy [4]; among them, about 17~35% experienced severe or worse cognitive impairment that persisted for several years after the end of treatment [5]. Furthermore, 45.7% of patients with cancer experienced cognitive impairment for an average of 4.6 years after cancer diagnosis [6].Cancer patients with CRCI are not only directly affected by hospital visits, follow-up appointments, and taking prescribed medications during treatment, but also face reduced ability to perform roles in the family, community, and at work.…”