Background Up to 60% of breast cancer patients treated with chemotherapy is confronted with cognitive problems, which can have a significant impact on daily activities and quality of life (QoL). We investigated whether exercise training improves cognition in chemotherapy-exposed breast cancer patients 2–4 years after diagnosis. Methods Chemotherapy-exposed breast cancer patients, with both self-reported cognitive problems and lower than expected performance on neuropsychological tests, were randomized to an exercise or control group. The 6-month exercise intervention consisted of supervised aerobic and strength training (2 h/week), and Nordic/power walking (2 h/week). Our primary outcome was memory functioning (Hopkins Verbal Learning Test-Revised; HVLT-R). Secondary outcomes included online neuropsychological tests (Amsterdam Cognition Scan; ACS), self-reported cognition (MD Anderson Symptom Inventory for multiple myeloma; MDASI-MM), physical fitness (relative maximum oxygen uptake; VO2peak), fatigue (Multidimensional Fatigue Inventory), QoL (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire; EORTC QLQ C-30), depression (Patient Health Questionnaire-9, Hospital Anxiety and Depression Scale; HADS), and anxiety (HADS). HVLT-R total recall was analyzed with a Fisher exact test for clinically relevant improvement (≥ 5 words). Other outcomes were analyzed using multiple regression analyses adjusted for baseline and stratification factors. Results We randomized 181 patients to the exercise (n = 91) or control group (n = 90). Two-third of the patients attended ≥ 80% of the exercise sessions, and physical fitness significantly improved compared to control patients (B VO2peak 1.4 ml/min/kg, 95%CI:0.6;2.2). No difference in favor of the intervention group was seen on the primary outcome. Significant beneficial intervention effects were found for self-reported cognitive functioning [MDASI-MM severity (B-0.7, 95% CI − 1.2; − 0.1)], fatigue, QoL, and depression. A hypothesis-driven analysis in highly fatigued patients showed positive exercise effects on tested cognitive functioning [ACS Reaction Time (B-26.8, 95% CI − 52.9; − 0.6) and ACS Wordlist Learning (B4.4, 95% CI 0.5; 8.3)]. Conclusions A 6-month exercise intervention improved self-reported cognitive functioning, physical fitness, fatigue, QoL, and depression in chemotherapy-exposed breast cancer patients with cognitive problems. Tested cognitive functioning was not affected. However, subgroup analysis indicated a positive effect of exercise on tested cognitive functioning in highly fatigued patients. Trial Registration Netherlands Trial Registry: Trial NL5924 (NTR6104). Registered 24 October 2016, https://www.trialregister.nl/trial/5924.

Background Patients with Parkinson's disease (PD) who have mild cognitive impairment (PD‐MCI) are at increased risk of developing PD dementia (PDD). Therefore, it is important to identify PD‐MCI in a reliable way. Objectives We evaluated the accuracy of the Parkinson's Disease‐Cognitive Rating Scale (PD‐CRS) and the Mattis Dementia Rating Scale‐2 (MDRS‐2) for detecting PD‐MCI. Data from healthy subjects were used to correct for demographic influences. Methods We compared the accuracy of the two instruments using ROC analysis. The gold standard was level II diagnosis of PD‐MCI according to consensus criteria of the International Parkinson and Movement Disorder Society. Results Seventy‐five healthy subjects and 125 PD patients were included. Education level, age and sex correlated with the PD‐CRS, but only age correlated with the MDRS‐2. Twenty‐seven percent of the patients had PD‐MCI. Areas under the curve (AUCs) for raw scores of PD‐CRS and MDRS‐2 were 0.83 and 0.81, respectively. At the optimal cut‐off for the PD‐CRS (101/102), sensitivity was 88% and specificity was 64%. For the MDRS‐2 (139/140) sensitivity and specificity were 68% and 79%, respectively. AUCs for demographically corrected scores of PD‐CRS and for age‐corrected scores of MDRS‐2 were 0.80 and 0.78, respectively. At the optimal cut‐off for the PD‐CRS, sensitivity was 79% and specificity was 72%, while for the MDRS‐2 these were 77% and 67%, respectively. Conclusions Both cognitive screening tools are suitable for distinguishing PD‐MCI patients from cognitively intact PD patients. Demographical correction of scores did not improve sensitivity and specificity.

IntroductionAfter treatment with chemotherapy, many patients with breast cancer experience cognitive problems. While limited interventions are available to improve cognitive functioning, physical exercise showed positive effects in healthy older adults and people with mild cognitive impairment. The Physical Activity and Memory study aims to investigate the effect of physical exercise on cognitive functioning and brain measures in chemotherapy-exposed patients with breast cancer with cognitive problems.Methods and analyticsOne hundred and eighty patients with breast cancer with cognitive problems 2–4 years after diagnosis are randomised (1:1) into an exercise intervention or a control group. The 6-month exercise intervention consists of twice a week 1-hour aerobic and strength exercises supervised by a physiotherapist and twice a week 1-hour Nordic or power walking. The control group is asked to maintain their habitual activity pattern during 6 months. The primary outcome (verbal learning) is measured at baseline and 6 months. Further measurements include online neuropsychological tests, self-reported cognitive complaints, a 3-tesla brain MRI, patient-reported outcomes (quality of life, fatigue, depression, anxiety, work performance), blood sampling and physical fitness. The MRI scans and blood sampling will be used to gain insight into underlying mechanisms. At 18 months online neuropsychological tests, self-reported cognitive complaints and patient-reported outcomes will be repeated.Ethics and disseminationStudy results may impact usual care if physical exercise improves cognitive functioning for breast cancer survivors.Trial registration numberNTR6104