Cognitive and Functional Changes With Chemotherapy in Adult Cancer
Chemotherapy is increasingly used in the management of various cancers. There are reports in
the literature of chemotherapy-induced cognitive impairments ranging from deficits in memory
and attention to slowed information-processing and deficiencies in executive function,
including planning and problem-solving. These deficits have been shown to affect work-place
productivity and social role-functioning which present significant public health risks in an
era of increased chemotherapy usage. However, previous studies investigating cognitive
deficits after chemotherapy have mainly used neurocognitive assessments, which are limited
in their utility for clinical diagnosis due to their likelihood for practice effects and low
sensitivity for detecting subtle cognitive changes that may be functionally relevant to the
patient.
Resting-state functional connectivity magnetic resonance imaging (fcMRI) is a sensitive test
that measures resting-state neural network connectivity, reflecting the integrity between
functionally-related brain regions. fcMRI has been used to delineate cortical neural
networks involved in a variety of cognitive domains, including memory, and attention. The
investigators believe that fcMRI will be more sensitive than neurocognitive tests alone for
investigating chemotherapy-induced cognitive changes. The goal of this novel study is to use
fcMRI to investigate cognitive changes after chemotherapy in an attempt to understand the
currently unknown neurobiological mechanisms associated with this phenomenon.
This prospective study will investigate the presence of cognitive deficits after
chemotherapy in cancer patients by assessing changes in three fcMRI-defined neural networks
involved in cognition. The three networks include (1) Dorsal Frontal Attention network (2)
"Default" network and (3) Cognition "Core" control network. Sixteen cancer patients
scheduled for chemotherapy will undergo fcMRI of the brain and neurocognitive testing within
two weeks before and after chemotherapy. Comparisons between time-points will establish the
effect of chemotherapy on cognition.
Results obtained from this study in cancer patients will provide insight into the mechanisms
underlying the development of chemotherapy-induced cognitive deficits. Knowledge of the
development of chemotherapy-induced cognitive deficits will enhance positive outcomes by
allowing practitioners and patients to be better informed of the potential cognitive
consequences to anticipate. With patients equipped with such information before starting
cancer treatment, they will be better able to manage their affairs and daily activities in
such a way that allows them to maintain productive living through their course of cancer and
its treatment.
Observational
Observational Model: Cohort, Time Perspective: Prospective
Change in fcMRI
Baseline and post-chemotherapy fcMRI maps will be compared for changes in degree of activation within the cognition-associated cortical networks. To compute statistical significance, correlation co-efficients from the fcMRI will be converted to a normal distribution using Fischer's r-to-z transformation.
before and after chemotherapy
No
Jay F Piccirillo, MD
Principal Investigator
Washington University School of Medicine
United States: Institutional Review Board
201105082
NCT01569932
February 2011
January 2013
Name | Location |
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Washington University School of Medicine | Saint Louis, Missouri 63110 |