Abstract
To investigate the neural mechanisms underlying attention deficits that are related to neoadjuvant chemotherapy in combination with cerebral perfusion. Thirty one patients with breast cancer who were scheduled to receive neoadjuvant chemotherapy and 34 healthy control subjects were included. The patients completed two assessments of the attention network tasks (ANT), neuropsychological background tests, and the arterial spin labeling scan, which were performed before neoadjuvant chemotherapy and after completing chemotherapy. After neoadjuvant chemotherapy, the patients exhibited reduced performance in the alerting and executive control attention networks but not the orienting network (p < 0.05) and showed significant increases in cerebral blood flow (CBF) in the left posterior cingulate gyrus, left middle occipital gyrus, bilateral precentral gyrus, inferior parietal gyrus, supramarginal gyrus, angular gyrus, precuneus, cuneus, superior occipital gyrus, calcarine cortex, and temporal gyrus (p < 0.01 corrected) when compared with patients before chemotherapy and healthy controls. A significant correlation was found between the decrease performance of ANT and the increase in CBF changes in some brain regions of the patients with breast cancer. The results demonstrated that neoadjuvant chemotherapy influences hemodynamic activity in different brain areas through increasing cerebral perfusion, which reduces the attention abilities in breast cancer patients.
Highlights
As a major component of the cognitive system, the attention work is involved in the centralization of brain or mental activities and the allocation of psychological resources[4]
At the beginning of the chemotherapy treatment, the patients did not differ from the healthy controls with regard to age, education, depression, and fatigue score, with the exception of the anxiety score of the Hamilton Anxiety Rating Scale (HAMA)
Our results demonstrate impairment of the alerting and executive control attention networks and an increase in perfusion in brain regions after chemotherapy in patients with breast cancer
Summary
As a major component of the cognitive system, the attention work is involved in the centralization of brain or mental activities and the allocation of psychological resources[4]. Arterial spin labeling (ASL) has become an important noninvasive functional magnetic resonance imaging technique that uses magnetically labeled arterial blood water as an endogenous contrast agent to measure resting CBF images. This method has been widely applied to assess the cerebral perfusion in various clinical conditions, including neurodegenerative diseases[12], age-related cognitive impairments[13] and psychiatric disorders[14]. In this study, some patients with breast cancer had received surgery and anti-estrogen therapy and were treated with different chemotherapeutic agents for systemic chemotherapy. We examined the relationships between the cerebral perfusion alterations and attention function changes that were observed in these patients
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